LMIC TELE-EDUCATION PANDEMIC PREPARATION

The objective of Assist International’s pandemic preparedness response is to equip frontline healthcare professionals in the Global South with virtual education, mentoring and support to build capacity to respond to global pandemics, in the absence of in-person mentoring.  

Our focus is on preparedness and treatment strategies specific to low-resource settings. Our targets are frontline healthcare providers and biomedical equipment technicians.

As examples, our current course with Stanford Global Anesthesia includes an adapted Ethiopian Ministry of Health sanctioned oxygen therapy curriculum into a virtual course; and likewise adapted a health technology curriculum that emphasizes best practices for the maintenance and repair of essential equipment such as ventilators and concentrators.

Altogether, our model brings together clinical expertise of academic partners, our programmatic expertise of working in last-mile settings, and innovative models of virtual education delivery to enable rapid, relevant, and actionable knowledge transfer that can save lives in a low-cost, scalable way. 

In March 2020, the WHO published a global report on Preparedness and Response Status as it relates to the COVID-19 pandemic. Alarmingly, all but one country in Sub-Saharan Africa was ranked as having a suboptimal readiness index score of 3, or less than 60%. Workforce gaps have been a concern in this current global pandemic, finding hospitals and frontline healthcare providers without the training and tools necessary to prepare. Our tele-education initiative equips healthcare workers in the Global South with the knowledge and skills needed to be prepared for global pandemics and associated surges in health system demand.

Medical oxygen is a primary example of this. The WHO has called medical oxygen “critical” for 20% of COVID-19 patients; however, access to oxygen is low in many LMICs. A review on medical oxygen use in LMICs has reported that even in settings where it is available, effective use of oxygen therapy is constrained by broken equipment and  gaps in staff training.

Our program addresses these gaps in critical care by convening experts to deliver virtual education webinars. While our  focus is on providing pandemic-preparedness and response curricula, we expect our program to enhance general knowledge and skills of participating health workers.

Our solution provides virtual education that equips frontline healthcare professionals in the global south to prepare for and respond to global pandemics.

We provide tele-education lecture series that connects international experts to health workers in low-resource settings, covers a wide range of topics, and establishes a platform for discussion and the sharing of best practices.

Example topics include the management of COVID-19 related symptoms, strategies for safely managing patients in critical care and surgical settings, proper use of PPE, considerations for special populations (obstetrics, pediatrics, and people living with HIV), and proper oxygen therapy administration.

At the core of these curricula is an emphasis on proper procedures and best practices in contexts with critical resource constraints. For example, how can clinicians re-use essential equipment or preserve oxygen supply? When oximeters are absent, what clinical indicators can the health worker rely upon? 

Operationally, we deploy the ECHO educational platform, which uses Zoom video conferencing software appropriate for resource-constrained settings. We integrate the online course platform LearnWorlds to host video demonstrations, interactive quizzes, and exercises. We also use WhatsApp as a forum for participants to engage with our educators and to crowd-source creative solutions to their context-specific challenges and constraints.

Our target audience is frontline healthcare professionals (including doctors, nurses, technicians, and biomedical engineers) in the Global South preparing for pandemics. To date, our tele-education programming has already reached an audience of over 1436 healthcare workers and 259 biomedical technicians across 94 countries worldwide, with the majority from Sub-Saharan Africa and Southeast Asia.

To ensure our programming aligns with the needs and knowledge gaps of our audience, we have developed a robust monitoring and evaluation strategy, which involves regular surveying, and feedback polling that occurs and is reviewed on a weekly basis so that we can iterate upon both the delivery model and content complexity as needed.

Direct beneficiaries will be the innumerable volume of patients that will receive better care (IE. proper critical care, oxygen therapy) at hospitals and health facilities whose staff have participated in our program. For example, patients that will reap benefit include the 20% of patients infected with the novel coronavirus that will require medical oxygen therapy, but also all others requiring oxygen therapy after the lifetime of this pandemic. Moreover, healthcare workers are directly benefiting from trainings on proper PPE use, mental health and well-being, and ensuring their own safety during a crisis. 

The COVID-19 pandemic has revealed and exacerbated significant gaps in health systems readiness. In particular, COVID-19 has emphasized the necessity of training the health workforce to address surges in healthcare demand. 

Our solution offers a freely accessible and contextually relevant resource for frontline workers in the Global South. Our program directly responds to gaps that have arisen from COVID-19, while simultaneously functioning as a proactive means of bolstering preparedness for potential future pandemics. 

While we know that various groups are offering virtual webinars during COVID-19, we are unaware of other organizations that implement virtual training programs that focus exclusively on healthcare workers and bio technicians working in resource-constrained contexts to plan not only for COVID-19, but for future pandemics and health crises.

Our courses are led by specialists from around the world and enhanced by the experiences of local trainees from the Global South, creating a collaborative atmosphere for sharing best practices and practical considerations. Moreover, we deploy innovative and creative models of teaching and mentorship that distinguish our program from others.

Our solution intelligently integrates three technological platforms to increase impact and knowledge-transfer: 1) ECHO, a model of didactic lectures and case study presentation that uses Zoom videoconferencing, 2) LearnWorlds, a platform that hosts video demonstrations, interactive quizzes, and session recordings, and 3) WhatsApp, which provides a forum for participants to engage with our educators and to crowd-source creative solutions.

At the core of our innovation is the strategic integration of three existing technologies- Project ECHO / Zoom, LearnWorlds, and WhatsApp- working together to create a novel and effective model of education delivery.

Project ECHO is an educational platform that uses videoconferencing (Zoom) to connect international and in-country experts to healthcare workers at low-resource facilities in the Global South. An important aspect of our delivery is the utilization of live interpreters on Zoom to increase the impact of a single session.

We deploy LearnWorlds to incorporate more innovative program components, including interactive demonstration videos, exercises, and quizzes, further enhancing knowledge transfer in a virtual setting.

Finally, we use WhatsApp to support information flow in real-time and foster ongoing mentorship and support between educators and participants.

The technology and curricula of our program have been successfully implemented in the Global South for many years.

The Project ECHO model is used worldwide as a robust tele-education model. Today, the community includes over 90K learners and 80 educational programs in over 39 countries worldwide.

Through the ECHO Platform, Assist International has implemented a Safe Surgery and Anesthesia Virtual Education Series in Tanzania (January 2019-Present) and Cambodia (June 2019-Present).

Since the start of the COVID-19 pandemic, we pivoted our program to focus on pandemic preparedness and treatment across sub-Saharan Africa and Southeast Asia.

To date, our COVID-19 pandemic tele-education courses have reached an audience of over 1436 healthcare workers and 259 biomedical technicians across 94 countries. Most of our participants live in Sub-Saharan Africa and Southeast Asia. Over 300 participants have opted in for a higher touch engagement in our program by participating in our WhatsApp learning communities, and we expect engagement to continue expanding as our programming evolves and partnerships expand.

The ultimate objective of our Pandemic Preparedness tele-education series is to equip frontline healthcare professionals in the Global South with virtual education, mentorship, and support needed to respond to this and future pandemics and health crises, with a focus on preparedness and treatment strategies directly related to low-resource settings.

At a basic level, our program aims to increase the clinical knowledge and effectiveness of health providers and improve the ability of biomedical engineers and technicians to repair and maintain equipment. We expect that these knowledge gains will significantly increase clinical and technical capacity.

Our internal program records emphasize the value of our training curricula in achieving meaningful knowledge gains.

We expect that pre- and post-assessment of participants in our program will reveal meaningful increases in knowledge and clinical decision-making skills. The ecological validity of our assessments is optimized by a focus on questions that require the application of theoretical constructs presented. For example, our oxygen curriculum, currently being adapted into a virtual format, has seen providers improve in test scores from 60-84% pre-post training. Participants also reported drastic improvements in their ability to administer oxygen therapy best practices.

We have also received qualitative feedback that the use of WhatsApp has enhanced the learning outcomes of our program. One participating physician stated: “The group has the ability to learn as a team, instead of just learning as individuals. This makes it easier to create change.”

Ultimately, as our program and learning community grows, our education model will have lasting impact because of our open-access library. Healthcare workers can access all of our current and future course materials, and these materials can be widely disseminated across the world at no cost. 

As of now, Assist International has hosted 38 tele-education courses that have reached an audience of over 1436 healthcare workers and 259 biomedical engineer professionals across 94 countries worldwide. As our partnerships and networks grow, we expect this number to increase to 3000 within the year, and potentially 10,000-15,000 in the next five years. Note that as we grow, we will be balancing efforts to increase absolute increases in unique participant registrations, with efforts to build more high-touch learning communities that overlap with our other programming, such as hospital networks to which we have an on-ground presence in facilitating a simulation center or oxygen distribution model.  

Within the year, our goal is to expand our library of tele-education to cover all centrally critical aspects of preparation and treatment related to pandemics. This will involve seeking out new partnerships with academic and clinical partners with specialized content expertise. For instance, we have collaborated with Vanderbilt University Medical Center on a wide range of clinical topics, Stanford Global Anesthesia and Lifebox on oxygen, and we are in early conversations with other potential partners on other topics. We will continue to engage feedback from our participants to gauge where key gaps remain, and where there are critical opportunities to provide a learning experience on a particular topic.

Over the next five years, we expect to continue scaling our tele-education courses, alongside more targeted engagement of local health networks that overlap with our other programming for synergistic impact. One of our primary programs is our innovation in oxygen distribution and supply models, which we help to establish in last-mile communities across the Global South. Access to oxygen therapy is critical in any health pandemic, and therefore even when COVID-19 has been resolved, our team will focus on equipping frontline workers with the requisite knowledge to meet surges in oxygen demand during future health crises. In these communities, where we are developing a long-term partnerships, we have a  interest in creating more formalized partnerships to provide educational opportunities. We also plan to partner with other NGOs to offer customized course offerings and facilitation for their target populations in a likewise manner. 

Barrier 1: COVID-19 Pandemic Constraints: One of the primary determinants of our team’s capacity to scale is our ability to establish new relationships with networks of frontline healthcare workers in the Global South. These are best formulated by meeting and engaging with workers in person, but this is now constrained due to physical distancing measures, travel bans and lockdowns. Our current strategy to expanding our learning audience is engaging participants from the existing networks of our partner academic, clinical institutions and NGOs across the world.

Barrier 2: Financial: As we grow, the resources needed to manage and facilitate a growing curricula of course offerings will also increase. While our solution is fairly low-cost, we nonetheless recognize financial constraints as a limitation to achieving a body of staff necessary to continue pulling these sessions into the long term. Our current programming primarily draws upon pro bono work from partner groups interested in partnering on our COVID-19 response; however, it is difficult to gauge whether this will continue.  

We plan to overcome these barriers by expanding our partnerships. By building new relationships and leveraging existing networks, we can grow our tele-education audience.

Many participants in our COVID-19 pandemic tele-education courses to-date have found us through word of mouth, or through networks that our partners have tapped into to share our session invitations. For example, we have had many participants from Latin America recently join our Africa courses. As learners benefit from the program, they feel encouraged to share with their networks and partners.

As we expand our learning audience, evolve and adapt our curricula and educational delivery model, and continue performing robust monitoring and evaluation, we expect to generate impact evidence that will attract additional funding.

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7 FT staff working partial % LOE on the Pandemic Preparedness tele-education programming

Goal is to hire 1 new FTE to work 100% LOE on this program 

Assist International believes that the best way to bring about sustainable change is by working with in-country partners and increasing their capacity. We design and implement innovative solutions to the challenges faced by the world’s most vulnerable people. We have a proven track record of expertise in program design, management, and implementation, and have successfully managed several multimillion-dollar grant awards. We are uniquely positioned to deliver this solution for three reasons:

1. Existing learning communities & global health expertise. Assist International has been engaging with frontline healthcare workers from last-mile communities for over a decade, with established networks that know us, and trust our brand of content delivery.

2. Partnerships: Assist International has already partnered throughout this current pandemic course with internationally renowned clinicians and partners from institutions such as Vanderbilt University Medical Center, Vanderbilt Institute for Global Health, Stanford Global Anesthesia, ALIMA and Lifebox. We have been approached by others to create additional series. We are connected with various networks – such as the Every Breath Counts and Project ECHO networks – that make organizations see us as a credible and helpful partner.

3. Experience in virtual education models: as an official member of the Project ECHO community we deployed virtual learning experiences through our Safe Surgery program. We have extensive experience with designing and iterating upon virtual course formats to enhance learner outcomes, which we are leveraging to optimize for our current series. 

To date, we have partnered with clinicians and global health experts from Stanford Global Anesthesia, Vanderbilt University Medical Centre, Vanderbilt Institute of Global Health, ALIMA, and Lifebox. Our academic and clinical partners are mainly responsible for the development of didactics and the presentation of our tele-education courses. Our role involves the organization, facilitation, hosting, and logistics of these programs, alongside robust monitoring and evaluation to monitor program impact. We are currently exploring new partnerships, including with Dartmouth School of Medicine, Touch Foundation, Gradian, and others. 

The funding for our programming is generally grant- and donor- based.

All teaching materials and didactic presentations will be open-source, available for anyone to use at no cost. Additionally, every session is recorded and uploaded as an open-source file. All materials and recordings are also translated into multiple languages to increase accessibility for non-English speakers. Content will be uploaded onto LearnWorlds and also accessible through YouTube and ours and our partners’ websites.

Not only will this program save the lives of COVID-19 patients, it will also increase the clinical knowledge and expertise of healthcare providers and biomedical technicians to respond to other pandemics or future health crises. The tools and resources that are being curated for these tele-education courses are being created to help address surges in critical care knowledge demand as a result of COVID-19. However, most of our participants are from contexts where the clinical knowledge and skillsets of the health workforce are insufficient to meet baseline needs of their communities. Therefore, by drastically improving the general knowledge and skillsets of participating healthcare workers, these courses will have a long-term impact that extends beyond the lifetime of the COVID-19 pandemic.

As we grow, the resources needed to manage and facilitate a growing number of course offerings will also increase. While our solution is fairly low-cost, we nonetheless recognize financial constraints as a limitation to achieving a body of staff necessary to continue providing these sessions in the long run. Our current funding primarily draws upon grants from donors interested in supporting our COVID-19 pandemic response.

As we build relationships with new partners, expand our learning audience, evolve and adapt our curricula and educational delivery model, and continue performing robust monitoring and evaluation, we expect to generate impact evidence that will attract additional funding.

The ultimate objective of our Pandemic Preparedness tele-education series is to equip frontline healthcare professionals in the Global South with virtual education, mentorship, and support needed to respond to this and future pandemics and health crises, with a focus on preparedness and treatment strategies directly related to low-resource settings. Funding will enable us expand our library of tele-education curricula to cover all of the centrally critical aspects of preparation and treatment related to pandemics. 

Within the next year, our goal is to expand our library of tele-education curricula to cover all of the centrally critical aspects of preparation and treatment related to pandemics. This will require new partnerships with academic and clinical partners with specialized content expertise. For instance, we have collaborated with Vanderbilt University Medical Center on a wide range of clinical topics, Stanford Global Anesthesia and Lifebox on oxygen, and we are in early conversations with other potential partners on other topics. We are also looking to partner with other NGOs in the health and development space to collaborate on designing and disseminating course offerings for those that our program may benefit.

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The ultimate objective of our Pandemic Preparedness tele-education series is to equip frontline healthcare professionals in the Global South with virtual education, mentorship, and support needed to respond to this and future pandemics and health crises, with a focus on preparedness and treatment strategies directly related to low-resource settings. Funding will enable us expand our library of tele-education curricula to cover all of the centrally critical aspects of preparation and treatment related to pandemics. 

Funding would also help us achieve our longer term goals. Over the next five years, we expect to continue scaling our tele-education courses, but alongside more targeted engagement of local health networks that overlap with our other programming for synergistic impact. For instance, one of Assist International’s primary programs is our innovation in oxygen distribution and supply models, which we help to establish in last-mile communities across the Global South. Access to oxygen therapy is critical in any health pandemic, and therefore even when COVID-19 has been largely resolved, our team will focus on equipping frontline workers with the requisite knowledge to meet surges in oxygen demand during future health crises. In these communities, where we are developing a long-term partnership to improve access to tangible resources, we have a concerted interest in creating more high-touch and formalized partnerships to provide educational opportunities. We also plan to partner with other NGOs in the health and development space to offer customized course offerings and facilitation for their target populations in a likewise manner.