As low- and middle-income countries transition from paper to digital systems, family planning programs can benefit from unprecedented opportunities to improve services. Investments in digital health tools have expanded exponentially, but information on what works—and what does not— remains limited and scattered. As investments have increased, digital applications and data fragmentation have proliferated, but stakeholders are moving towards more coordinated efforts to scale digital health solutions, support countries’ digital health infrastructure, and share evidence-based learnings.
This Digital Health Compendium enables users to explore case studies across a range of digital health technologies used to enhance family planning programs mainly in sub-Saharan Africa, but also in other regions of the world. Digital health applications in family planning programs can be broadly classified as those affecting demand generation, service delivery, supply chain management, and the policy and enabling environment. In many low- and middle-income countries, digital health innovations were adopted earlier in other health sectors, including HIV/AIDS, maternal and child health, and noncommunicable disease prevention and response. As a result, much of the impact evidence is likewise restricted to those sectors. To advance greater adoption of digital technology in family planning programs, more data and information on the challenges, opportunities, scalability, and results are needed. This compendium aims to consolidate emerging information and data on applications of digital technology in family planning programs to inform adoption and scale-up of successful approaches.
All of the case studies were submitted by the implementing organizations and include a description of the digital health intervention, program context, and, if available, important findings and lessons learned through rigorous evaluations or program data. The compendium facilitates a quick search for case studies based on the target user for digital health intervention, building block for the digital health enabling environment, family planning program classification, and country location. The case studies give policy and program decisionmakers insights on real-world applications of digital health, promising practices, challenges, and other lessons that can be applied to current and future programs.
New ways of delivering eLearning content
Senior Program Officer II
Johns Hopkins Center for Communication Programs
Johns Hopkins Center for Communication Programs (lead)
Recruited participants from Students from Kenya Medical Training College in Kitui and health providers at the Kitui District Hospital
September 2015 – December 2016
Health Care Provider
In response to a growing demand for customized training content, Knowledge for Health (K4Health) began to explore new ways to deliver the technical global health content available online for free from the Global Health eLearning Center (GHeL). The goal was to reach a wider audience of healthcare program managers and providers working in low- and middle-income countries (LMICs). While the proportion of households with internet access has increased globally, accessibility and connectivity continue to be an issue for the vast majority of people living in LMICs. On the other hand, there are almost as many mobile cellular subscriptions as people on Earth, and more than three-quarters of these subscribers live in LMICs.
K4Health thus sought to test how easily and effectively existing GHeL quiz content could be adapted to an interactive voice response (IVR) platform. IVR is a technology that works with any type of mobile phone. It delivers information via audio recordings, while users can provide feedback by pressing a number key. IVR can deliver more robust information than short message service (SMS) can, but because IVR information is audio-recorded, it does not require a Smartphone, internet connectivity—or even full literacy.
The K4Health IVR training—also called the Family Planning Mobile Training Course—was designed to deliver 20 audio questions with accompanying explanations. The course used the spaced-education methodology, which is a question-and-answer learning approach that repeats content in a way that has been scientifically proven to help students retain information and change their behaviors. To pass the IVR training, participants were required to answer each question correctly twice. Participants first received an SMS text message prompting them to initiate the daily training call by responding “Yes.” Once a participant’s text was received, the IVR platform immediately called the participant’s mobile phone. Participants could answer up to four questions per call. The fastest a participant could complete the training was 10 days, if every question was answered correctly on the first try.
After conducting a review of IVR technology platforms, K4Health selected InSTEDD’s Verboice platform and built custom code to accommodate the training design. Content for the Family Planning Mobile Training Course was adapted from the GHeL Family Planning 101 and Family Planning Counseling courses.
All participants (n=233) were invited to complete the Family Planning Mobile Training Course at least six weeks after completing the baseline knowledge assessment, if not longer, to allow for some decline in memory retention over time. Before and after the course, participants were asked to complete baseline and endline knowledge assessment tests. A total of 48 participants did not start the Family Planning Mobile Training Course, while 86 started but did not complete it. Because these two groups (n=134) were exposed to an IVR training course, but did not initiate or complete it, they were dropped from the analysis. Additionally, participants that did not complete both the baseline and endline assessment were dropped from the analysis. Among the intervention group (i.e., those who completed the baseline and endline knowledge assessments as well as the IVR training course, n=75), the mean scores increased from 12.1 at baseline to 15.9 at endline. This difference is statistically significant. Results indicate that IVR positively affected family planning knowledge.
The IVR platform monitoring data revealed that:
In addition, a usability assessment was conducted at midline to inform K4Health as to participants’ motivations to take part in the IVR training course, their overall likes and dislikes of the course, and suggestions for improvement.
To provide quality healthcare, healthcare workers need access to up-to-date technical information. Attending face-to-face learning events, such as conferences and workshops, can pose logistical challenges for health care providers who work in remote areas, as arranging travel and work coverage during an absence can be difficult.
Paper resources, such as textbooks and manuals, eventually become outdated, and it can be costly both to update and publish new versions and to distribute them to healthcare providers. New technologies like IVR can be used by programs and activities that seek solutions to the challenges of providing ongoing training to health care workers.
While further study and evidence is needed to fully understand the ideal platforms and training formats for different audiences, K4Health’s Family Planning Mobile Training Course activity showed that overall, both pre-service and in-service healthcare providers enjoyed using IVR as a learning platform. IVR is especially practical
for audiences that have limited internet access, low digital literacy, and even low literacy, as IVR delivers content directly to personal mobile phones in an audio format.
This activity is no longer active now that the K4Health Project is closed. KMTC Kitui did not take over and scale it up due to funding constraints and lack of capacitated staff to support the technology.
Jayarajan, N. et al (2017). Use of interactive voice response for professional development in Kenya. Baltimore, MD: Johns Hopkins Center for Communication Programs.