Growth and Learning: Our Progress at HealthLearn

Published to the Blog

October 3, 2024

Summary

At HealthLearn, we’re advancing our mission to improve health outcomes by equipping health workers in Nigeria with accessible, high-impact training through our growing portfolio of free, mobile-optimized online courses. Our platform now hosts courses that cover essential topics like newborn care, hypertension control, and outbreak response. Since we launched in February, over 13,000 people have completed a course on our platform. We continue to upgrade our learning platform and are working to improve our impact evaluation. These efforts will address some key uncertainties in our theory of change. We're also building the sustainability of the organization through partnerships and hosting courses for other organizations.

A growing portfolio of courses for health workers in Nigeria

Since launching our platform this year, we now host three full courses for Nigerian health workers: one developed by HealthLearn and two by Resolve to Save Lives (RTSL).

  • Newborn Care Foundations was developed by HealthLearn. In a pilot we ran in late 2023, we found that this course leads to substantial learning gains and is very well received by the health workers to take it. Since we re-launched the course in February, over 4,400 people have completed the course, exceeding our 2024 target of 3,500 course completions. We continue to see strong learning gains in the course even as we conduct a more in-depth evaluation (described below).

  • Hypertension Control in Nigeria was developed by RTSL. The course trains health workers to diagnose and manage high blood pressure. This supports the government’s initiative to bring hypertension treatment services into primary health centers where such services had not existed previously. The course is a continuation and scale-up of a course that we piloted last year. In April, RTSL published a research paper demonstrating that this course leads to substantial learning gains and is very well received by the health workers who take it.

  • Clinical Integrated Disease Surveillance and Response (cIDSR) was developed by RTSL. cIDSR trains health workers to identify, report, and manage suspected cases of diseases with outbreak potential. The course has proven useful to prepare workers for outbreaks, but it also plays a role in outbreak response. At the request of Nigeria’s Centre for Disease Control and Prevention (NCDC), we partnered with RTSL to release a cholera “mini-course” in response to an evolving outbreak there. In the first few weeks of the outbreak, over 7,000 health workers accessed that course.

In the last seven months, well over 13,000 people have completed at least one course (counting both full courses and mini-courses) on the HealthLearn platform. Most participants have learned about the courses from government, health worker professional bodies, or our NGO partners. We’re going to be experimenting with direct marketing to primary healthcare workers in the next quarter, which we anticipate will further demonstrate the potential of the platform to achieve massive scale. 

Accreditation drives course uptake

All of the full courses we offer in Nigeria are now accredited by the Nursing and Midwifery Council of Nigeria and the Community Health Practitioners Registration Board of Nigeria, so nurses, midwives, and community health workers who take our courses earn continuing professional development credit units that they can apply towards their license renewal. We have seen that accreditation drives spikes in the uptake of the courses, which matches what we hear from health worker participants: these non-financial incentives are very valuable to them. Even with the official stamp of approval from health worker professional bodies in Nigeria, we continue to work in close concert with the government of Nigeria, particularly the Federal Ministry of Health and Social Welfare and the National Primary Health Care Development Agency, to ensure that every course we offer is aligned to Nigeria’s standards.

Improvements to our learning platform

We’re fortunate to have an incredible team of engineers developing, maintaining, and improving the HealthLearn learning platform. Since launching in February, we’ve made many improvements to the platform to optimize the learning experience, including:

  • Enhanced login: learners in Nigeria can now choose between WhatsApp and SMS-enabled login, which helps us to reach a modest (but meaningful) fraction of health workers who do not have WhatsApp on their phones.

  • Better retention features: we’ve added notifications to remind learners who have started courses to come back and finish them.

  • Improved navigation and access patterns: our work with RTSL and NCDC has demonstrated the benefits of the HealthLearn platform for just-in-time training in outbreak response. To better serve this use case, we’ve updated the platform to give health workers better ways to directly access outbreak modules within full courses on an as-needed basis.

  • Better backwards compatibility: we’ve continued to make improvements to the platform to ensure it works on even the oldest smartphones that some health workers in our target audience own. 

  • Improved speed and performance: our team is in the process of implementing a number of improvements to prepare the platform for volumes of hundreds of thousands, or even millions, of active users.

Challenges and opportunities in monitoring and evaluation

While we are excited by many developments that point towards strong demand for our courses and potential for massive scale, we are also very focused on the end-line goal of improving health outcomes. Many of our monitoring and evaluation efforts are focused on assessing the key uncertainties in our theory of change and developing a better sense for how leading indicators that we can easily measure (such as in-course learning gains) are associated with improved health outcomes. One of our greatest sources of uncertainty is the extent to which our courses drive improvement in health workers’ clinical practices.

We've initiated a clinical evaluation with our partner, Brooks Insights, to assess changes in health workers' practices after taking our Newborn Care Foundations course. Brooks Insights is observing birth attendants in selected primary health centers using a standardized checklist. Pre-course observations are complete, and participants are now taking the course and engaging in discussions. We expect to conclude data collection by year-end.

We are learning a great deal from this evaluation. It took longer than we anticipated to start, and ensuring high-quality data collection has required more coordination and troubleshooting than we planned for. In spite of these challenges, the evaluation should further our understanding of how the Newborn Care Foundations course impacts clinical practice, and we already have a much stronger understanding of how we can better monitor and evaluate our programs and assess our impact in the future. 

Progress towards financial sustainability

We are very fortunate that our newborn care training is supported by impact-minded donors and foundations who see the potential of highly scalable and accessible training for front-line health workers. At the same time, by hosting courses for other organizations, we are developing non-philanthropic sources of earned revenue that contribute to developing, maintaining, and continuously improving a learning platform that is tailored to the needs of our audience. As we move forward, we aim to bring more courses onto the platform to reduce the marginal cost per course we host and per learner we train. If your organization or government agency is interested in developing a course with us, please contact us.