Malnutrition is the leading cause of preventable deaths in children worldwide. Vitamin Angels fights malnutrition by delivering medication, vitamins, and nutritional counseling to more than 52 million children and expectant moms each year. The nonprofit organization serves some of the hardest-to-reach places on Earth, delivering its lifesaving treatments in 57 countries, many in Africa and Eastern Asia.
To do this, Vitamin Angels partners with 1,000 NGOs, seeking partners in areas where malnutrition, intestinal parasites, and vitamin deficiencies are most severe—and where residents lack access to national health services. The organization strives to fill in the gaps left by national health services, which fail to reach roughly 30 percent of citizens in developing countries worldwide, according to Vitamin Angels.
Working with local nonprofits enables the organization to reach more people, but it also means that tens of thousands of health care providers need to be trained to deliver the vitamins and medications and counsel citizens—in multiple languages and in far-flung, tiny, remote locations. According to TorranceLearning’s chief energy officer, Megan Torrance, many of the delivery sites have “a children’s health day or a community health day a couple of times a year, where all of the NGOs come together” to deliver badly needed services. The health care providers representing Vitamin Angels might be volunteers or practitioners who administer these treatments only once or twice a year. “It’s not like your local pediatrician’s office where, every time a kid walks through the door, you’re giving him a vaccination,” Torrance said. Those factors create training and performance challenges.
Training for health care providers has to be thorough and consistent. Vitamin Angels has relied on instructor-led training (ILT) and assessment, which requires getting people out to hundreds of locations each year. Even so, they’ve managed to train about 1,000 health care providers annually.
“Vitamin Angels’ challenge is to provide more opportunities to more health care providers each year to learn how to implement nutrition services consistent with best practice,” said Clayton Ajello, an epidemiologist and a member of the Vitamin Angels board of directors. The organization hopes to be able to expand its services to “tens of thousands of health care providers, many of whom reside in relatively remote areas of the world where Vitamin Angels cannot bring instructor-led training,” Ajello said.
The ILT approach is fraught with logistical hurdles, it makes consistency and tracking nearly impossible, and it is not scalable. If ever a situation called for an eLearning solution, this is it.
Most eLearning solutions assume at least some basic level of technology, though—a recent browser, a reliable network connection, an operating system within the past few generations, say Windows 7 or OS Yosemite. When they took on this project, the designers and developers at TorranceLearning knew that they could not make any assumptions about the equipment or networks of the learners who partnered with Vitamin Angels.
Not only are the communities served remote and poor, they lack physical and technological infrastructure. Most of the partner NGOs and their workers lack reliable Internet service or modern computers; many don’t even have mobile phones or networks. They certainly don’t all have the same software or Internet browsers available, and what they do have might be outdated by many years.
As if the logistical and equipment challenges weren’t enough, the program requirements could make the most devoted, ambitious instructional designer quail.
Health care providers have to be taught about dosing by the child’s age and weight, safe handling and proper administration of vitamins and pharmaceutical products, and nutrition counseling—a full range of health and safety best practices. They’re also taught to monitor and evaluate the moms and children they serve.
Vitamin Angels covers dozens of countries, so the organization needs to have the training available in several languages.
Health care providers who complete training are tested on their understanding and mastery of the material. They’re provided updated information and training as needed, including training on monitoring and recordkeeping tools. There’s a lot to remember, so fact sheets and other job aids are needed—also in several languages. Many of the trainees have low literacy and minimal computer skills, so any text elements must also be presented graphically or orally. Training and job aids rely heavily on images and visual instructions (Figure 1).
Figure 1: Visual checklists are provided for people with low literacy; performance checklists ensure that performance assessments are conducted using consistent criteria
Vitamin Angels registers and tracks its NGO partners and field representatives and assesses their understanding of training materials and their performance; the ability to maintain accurate records of these activities is an integral element of any solution.
The challenges were daunting. TorranceLearning’s solution? A radical twist on BYOD.
Bring your OLD device
The team at TorranceLearning code-named the solution “Project Popsicle … because everything goes on a stick,” Torrance said. The entire eLearning solution—including the LMS—is on a stick. An eight-gigabyte USB stick, to be exact.
A move to BYOD (bring your own device) in many corporate or student training environments means that eLearning is often developed to be used on a variety of devices—laptops, tablets, smartphones—and in Windows, Mac, and other operating environments. The TorranceLearning team kicked that up—or down—a level to support old devices by putting everything the solution needed on a single USB stick.
The USB-based eLearning module supports:
- Entering user and user-group records
- Playing the eLearning course, which includes videos and animations (Figure 2)
- Printing reference materials and job aids
- Printing proof that a learner has completed the course
- Storing each learner’s record, including progress and evaluation results
- Uploading learner records to a database when the USB is inserted into an Internet-connected computer
Figure 2: Much of the training consists of videos that demonstrate proper procedures; learners can watch the videos as many times as they need to
Older computers, even those running Windows XP or Mac OS Snow Leopard, are supported. Old browser? No browser? No problem. The USB stick includes a Chromium web browser and web server; it even contains a slimmed-down LMS that handles user and group tracking and uploading the records.
The “cool part” is the LMS
The eLearning itself is fairly basic, Torrance acknowledges. It has to be simple, both to be translatable and to keep the size down. “The cool part is not the eLearning,” she said. “It’s the LMS.”
The solution-on-a-stick is possible because it uses a “lightweight LMS” based on xAPI. As each learner creates a profile, takes courses, watches training videos, and completes assessments, the program generates xAPI statements. User data is formatted as extensions to the xAPI statements.
A single USB device can store data for several towns—dozens or even hundreds of users—uploading the data at the earliest opportunity to an LRS (learning record store) that Vitamin Angels maintains to ensure that all its partner health care workers have up-to-date training. Any time the USB is inserted into a connected computer, the program asks the user whether she wants to upload the records.
Figure 3: Any time the USB detects an Internet connection, the user is prompted to upload the stored records to the Vitamin Angels LRS
Acknowledging the unpredictability of intermittent electricity and network connections, the system is built to be robust and redundant. The USB can upload records quickly and verify that all have reached the target LRS. Each health care provider receives a receipt on completing a training unit; these can be scanned to upload, update, or validate the learner’s record. TorranceLearning plans to implement “language packs” to deploy the solution, on a single USB platform, in the languages needed for a geographic region.
The TorranceLearning team chose the dominKnow Claro development tool and the UL Compliance to Performance LMS because these tools offered necessary features like easy support of multilingual training and integrated xAPI support. Claro is an authoring tool that creates HTML5 fixed-size pages of eLearning content that learners can view on laptop and desktop computers and mobile devices. UL’s LMS offers global content delivery and translation support, including customizable portal pages, which make it easy for Vitamin Angels to oversee its worldwide training efforts.
Aiming for a sixfold increase in trainees
Vitamin Angels has great hopes for its new USB-powered solution.
“With expert assistance from TorranceLearning to develop a unique learning solution, we anticipate reaching at least 6,000 health care providers in just the first year of its rollout,” Ajello said.
Training results will be field-tested and validated to verify that health care providers demonstrate an ability to perform procedures. In addition to observing the performance of trained providers, Vitamin Angels is undertaking a formal evaluation to document whether health care providers trained using the eLearning show the same—or improved—levels of competence as instructor-trained providers.
Meanwhile, TorranceLearning is enhancing the solution by adding languages and expanding the content. The company will also add tools that will allow learners to record their practice sessions, document observed assessments and performance—and record this data in the LMS via xAPI statements. Future versions will also include performance support delivered to the mobile phones of health care providers who have them.