This document discusses using mobile technologies to break down boundaries to learning and healthcare access in Africa. It notes that Africa has a large and growing mobile market, and inexpensive smartphones are being developed. Mobile apps can help community health volunteers in Kenya track childhood developmental milestones and make referrals. A pilot program used an app to provide structured support and supervision to volunteers, improving healthcare quality. The document argues that technologies can address information inequality and empower people by providing learning opportunities, with the goal of avoiding increased structural inequality.

1. Mobile learning for healthcare
training: breaking boundaries?
Niall Winters
London Knowledge Lab
Institute of Education, University of London
http://www.lkl.ac.uk/niall | @nwin
ESRC Breaking Boundaries Seminar Series, University of Oxford, March 13th 2014

2. “… discuss the notion that
Information communication
technologies can be used to break
down boundaries to learning and
participation in society”
http://breakingboundariesoxford.org

3. Mobile in Africa
• After China, Africa is the world’s second largest
mobile market
• There are 150 mobile money services in Africa,
over 22 mobile innovation labs, and mobile e-
commerce is thriving
• In 2013, IBM chose Nairobi for its 12th global
research lab
• Many mobile phone makers have focused on
developing inexpensive (e.g. USD$25)
smartphones

4. What types of boundaries?

5. “Despite its falling poverty rates, Sub-Saharan Africa is
the only region in the world for which the number of
poor individuals has risen steadily and dramatically
between 1981 and 2010. There are more than twice as
many extremely poor people living in SSA today (414
million) than there were three decades ago (205 million).
As a result, while the extreme poor in SSA represented
only 11 percent of the world’s total in 1981, they now
account for more than a third of the world’s extreme
poor.” - World Bank, State of the Poor Report

6. The community in Kibera is characterised by high levels of
poverty, insecurity, and inadequate access to basic social
services. There is little or no access to water, electricity, basic
services and adequate sanitation. Most structures are let on a
room-by-room basis with many families (on average 6 people)
living in just one room. These factors have serious health
repercussions, demonstrated by the child mortality rate: for
every 1,000 children born in Nairobi’s informal settlements,
151 will die before the age of five (the average for Nairobi as a
whole is 62).

7. Community Health Volunteers are community members
who provide basic medical services. Research
consistently evidences their pivotal role in providing
equitable health access in support of poverty alleviation
by preventing and diagnosing diseases like malaria and
HIV, treating minor ailments, referring patients and
providing support and care for pregnant women and
babies.

8. http://www.mchw.org | @m_CHW
The role of mobile technology in breaking boundaries

9. • Focus: Maternal and Child
Health (Developmental
Milestones)
• Target: Under 5 children
• Developed based on MDAT
(Malawi Development
Assessment Tool)
• Leverages on Smart phone
technology
• Supports referral decision
making
• Duration of use: 5 months
"

10. Focus on structured support and supervision via
the mobile app
• There is consistent evidence that good quality supervision “is one of
the key approaches to improving the quality of health
care” (Marquez & Kean, 2002), in particular when backed up by
regular support and feedback (e.g. Bhattacharji et al., 1986; Ashwell
& Freeman, 1995; Bhattacharyya et al., 2001; Laughlin, 2004;
Lehmann & Sanders, 2007; Baqui et al., 2009)
• Consequently, UNICEF/WHO have recommended that CHW
programmes “enable CHWs to organize themselves for peer
support and supervision” (Gilroy and Winch, 2006 p.43)
• Systematic reviews have shown that consistent supervision, peer
learning and feedback, rather than single and isolated interventions,
can improve CHW performance and integration with the primary
healthcare system (e.g. WHO, 2001)

12. “The members were eager to know the purpose of the
phone and the application but I was able to tell them it is
good because the information will help us know the
development of the child. If the child is growing well, if
the child is able to do this, the phone is assisting us to
know the steps; when the child is of this age we are able
to know he/she should be doing this and that. So it is
easy to identify some, may be abnormalities or you are
able to know whether the child is growing well.” -CHV

13. How?

17. Underpinning conceptualisation

18. Reconceptualising the “Digital
Divide”
• Conceptualise as information inequality
(van Dijk, 1999)
• Four kinds of access barriers
– Lack of experience (lack of interest)
– No access to hardware (tradition view)
– Resources more generally – MOOCs (Fail?)
– Lack of digital skills
– Limited to development of basic skills
– Lack of significant usage opportunities

19. As Jerome Bruner (1996, p.
146) put it, learning ‘is not
simply a technical business of
well managed information
processing’. Instead, learning
can be seen to involve an
individual having to make
sense of who they are and
develop an understanding of
the world in which they live.
From this perspective
learning can be seen as a
continuing process of
‘participation’ rather than a
discrete instance of
‘acquisition’ (Sfard 1998).

20. From Sfard (1998)

22. Avoiding structural inequality
• Breaking boundaries
– Learning as participation
• Addressing inequality through
empowerment
• Immediate next steps
• Mobile web app generator (mWAG)
• Researcher position (Mar 28th)
• Post-2015: Sustainable development goals

23. Thanks!
• n.winters@ioe.ac.uk
• http://www.lkl.ac.uk/niall
• http://www.mCHW.org
• @nwin