South Sudan: Health eVillages Technology in Healthcare Program

Program Narrative
The partnership program between Health eVillages and RMF was launched this month at Juba Teaching Hospital (JTH). After several weeks of laying the groundwork for this exciting program, the mobile devices generously donated by Health eVillages finally reached the hands of health workers at the nation’s only public referral and teaching hospital. Participants were pre-selected based on their literacy in English (since the current content is in English), known level of responsibility so as to assure safety of the devices, and their willingness to participate in the program and give ongoing feedback.
Before the training took place, protocols were established to maintain a security system to prevent loss and breakage of devices. This involved labeling and numbering each device and creating a registry where devices are checked out by health workers and checked in when returned. Further, to be eligible to use the devices, all health workers must have completed both the Respectful Healthcare and the eLibrary/Omnio training program. They also must have signed an agreement form to participate in the program (see Appendix A).

Master Trainers
Two South Sudanese Master Trainers were recruited for this project. They were selected based on knowledge and experience with the RMF Respectful Health Care Training Program, advanced command of both English and Juba Arabic, extensive clinical experience, and their knowledge of participants as past staff at JTH and current faculty at the Juba College of Nursing and Midwifery (JCONAM). A collaboration session was conducted with RMF staff and the Master Trainers to finalize best methods for facilitating tablet use among JTH staff, data collection, and the creation of a feedback loop between participants and RMF.

Participant Demographics
The first round of training consisted of 14 staff members that are doctors, midwives, or nurses from maternity, antenatal, and pediatric wards at Juba Teaching Hospital. The second training session will take place later this month when the remainder of tablets will be transported from Uganda to Juba by RMF staff.  All participants were asked to fill out a demographic survey at the beginning of the training.
Table 1: Demographic Variables

Respectful Healthcare Training
As the foundation of all programs RMF does, we facilitate Respectful Healthcare (RHC) Workshops in order to promote the values of compassion, dignity and respect. We feel that this not only improves the quality of care patients receive, but also establishes a positive work environment that ensures good outcomes not only in our programs, but also sets the standard for maintaining an infrastructure with accountability, sustainability, and independence for entire communities. This aspect of our programs has been met with excellent feedback and positive outcomes. The core components of the program are:

• RMF Concept of “Friends Helping Friends Helping Friends”: welcoming patients and their families, creating rapport and trust, concepts of body language and respectful communication
• RMC concept of “Building Trust”: Assessing the Patient, Informed Consent, Privacy, Confidentiality, Human Rights
• RMF Concept of “Compassionate Care”: Evidence-Based Care, Collaborative Practice
• RMF Concept of “Liberating Human Potential”: Work Relationships, Accountability, Stress and Burnout Reduction

As part of this training, we have all participants complete a pre- and post-test to assess knowledge and attitudes (See appendix B)

eLibrary/Omnio Training
Training for the use of the tablets was collaboratively done with RMF staff and the Master Trainers in order to streamline the process. All subsequent training will take place with the Master Trainers. There were 4 components of the training:

1. Familiarity with the devices: turning them on and off, navigation to use apps and programs, charging devices, and other general mobile device orientation
2. Omnio functionality and use: Drugs, diseases, calculators, and library by search, browse, and additional features, use of reading list and front page features
3. Video content: review of Health eVillages promotional videos, navigation and use of Medical Aid Films, and use of camera and video camera for recording of medical cases
4. Data Collection: digital birth log and potential WelVU applications

Content Feedback
Participants had a chance to give feedback both during the training and in the days following as they began to use devices on the hospital wards and RMF staff and Master Trainers observed. The feedback can be grouped into 3 areas: Content feedback, device specific feedback, and additional suggestions.

Lessons Learned
Qualitative feedback from participants:
“We want to thank RMF and Health eVillages for this gift. We are being given the gift of knowledge and this is more important than anything else we could be given. As those who work in the hospital, it is like a lifeline.”

“I like the videos a lot. When you are busy with so many patients, I am thinking that showing the videos in the waiting area somehow with a projector would give education without me having to do it one on one with each woman. The warning signs of pregnancy one is especially useful.”

“We could use the camera to take photos of anomalies on babies born so we can present cases. We don’t have a system of peer review at all and this is a big problem. Maybe we can make a digital form that you insert he photo and answer put information about the case so you can email it to others or present it at a meeting.”

Center of Excellence Needs Assessment Progress
The architectural assessment of JTH began with general assessments by the engineer and photographic documentation of the current status of the buildings.

Women often have to share beds in labor or labor on the floor. There is no privacy or room for labor support from partners/family due to space constraints.

Updates and Next Steps

• Training of the remaining health workers when the final 20 devices arrive from Uganda will occur in the 3^rd week of this month.
• Patient Satisfaction Interviews will be conducted by the Master Trainers and compiled for the monthly reports. These will reflect Respectful Healthcare values as well as whether a health worker used a mobile advice at the bedside as part of their care and/or health education.
• Monthly participant feedback surveys will be collected; qualitative feedback and suggestions will be ongoing using a formal data collection tool designed by RMF.
• Maternal Mortality Data Collection Analysis will be done: Meetings with the Ministry of Health, Administration of the Department of OB/Gyn at JTH, and the JTH department of statistics were done. New data has been compiled on maternal mortality within JTH and nationwide that will be used as the baseline for this program.
• Architectural Needs Assessment has been initiated and will be completed in collaboration with the Ministry of Health and JTH administration.
• Monthly reporting will be submitted to stakeholders.
• Photographic documentation of the program will be ongoing.
• Site visits by any donors/stakeholders are welcome at any time.

“We really need the data collection to be digital. An electronic health record would prevent so many mistakes. My cousin died of anaphylaxis when she came to have her baby. The doctor did not know she was allergic to cephalosporin because there was no chart to show the nurse had asked her this. It could have been avoided if we did things on these tablets instead of paper. I also look at the interaction feature on Omnio and feel this will save lives.”

“I can’t believe all those textbooks fit on this small device! It is like a miracle. I dream that one day everyone who works in healthcare in the world can have this. It really makes me see how many things we can do to improve the hospital. It is very very exciting and I will use this every day.”

“Birth in the Squatting Position! Yes! The video from the Respectful Maternity Care Training! I will show this to all the students and the staff in maternity because nobody believed me about this. Since you showed it to me last year I have been letting women deliver in any position they want and now with this tablet I can show my colleagues and the women that I am correct in advising such a thing.”

Please see the full PDF report for Appendix A and B and additional photos.

Training Photos