Community Health Worker

(CHW) Training - Total Cost of

Ownership (TCO)

Bobby Jefferson, Director, Center for Development Informatics, Futures Group

Mathew Taylor, Senior ICT Architect, Intel Corporation

Alice Borrelli, Director, Global Healthcare Policy, Intel Corporation

Rob Segan, Lead Business Analyst, Futures Group

Meena Chelvayohan, Business Analyst, Futures Group

Agenda

• Comparison of in-classroom vs

Blended eLearning

• ICT Comparison smart phone

with data plan versus feature

phone and Wi-Fi-only tablet

– Costs / Functionality

• Solution sustainability at scale

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www.dalberg.com/documents/

Power_of_Technology.pdf

All-Star Line-up

• mHealth Alliance

• MDG Alliance

• Jhpiego

• World Vision

• iheed

• UNICEF

• WHO

• Johns Hopkins

• BRAC

• Vodafone

• Dimagi

• Partners in Health

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• Save the Children

• Millennium Villages

• Open University

• AMREF

• Grameen

• Kenya MoH

• Nigeria MoH

• IntraHealth

• Gates Foundation

• HP

• Intel

The Power of Technology –

the Dalberg Report – May 2012• “Blended” approaches combine live training with multimedia

applications align with the most effective pedagogical techniques:

They foster interaction, repetitive learning, and supervision and

monitoring.

• Digital content, including videos, animations, and other multimedia

applications, is useful for engaging Community Health Workers

(CHWs), who have received limited if any education and have

limited levels of literacy.

• Multimedia can also enable faster and better training, according to

studies cited in this report. In turn, mobile training and resources

provide a link for repetition of training, supervision, and monitoring

remotely.4

Summary Findings

• Multimedia apps/content could enable the training of one

million new CHWs at less than a quarter of the cost of

disseminating conventional training– More effective training

– Up to 80 percent of training content could be standardized and shared

with “blended” approaches

– Could dramatically alter formal CHW training and fuel entrepreneurial

innovation and models that support continuous learning

• There are challenges to be overcome– < 10% using multimedia, most making own content from ground up

5

A forward looking model of two types of training of

CHWs

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Baseline

3 Months in-Classroom training

No eLearning

Smartphone

Blended

1.5 Months in-Classroomtraining

eLearning outside of theclassroom

Feature Phone and Tablet

Cost data sources

• Local costs in Nigeria for phones and connectivity (voice

and data) are based on information collected by Futures’

Nigeria based staff

• Training costs in Nigeria are based on Futures’

experience conducting local in-country trainings

• Tablet costs are based on Intel’s price quotes

• Inflation costs are based on average escalation in

Nigeria over the last 5 years

• Attrition rates and training time are based on CHW

training literature specifically “Deployment of community

health workers across rural sub-Saharan Africa”

(McCord, Liu, Singh, 2013)7

COST BREAKDOWN

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Comparison of Training Component for

100,000 CHWs in Nigeria

• 100,000 CHW trained

• 5% Attrition Rate

• 1 trainer per 50 CHWs =

20,000 Trainers

• 1 classroom per 50

CHWs

$19.5M (42%)

Savings

using the

Blended Model

Item Units Units Unit Cost Total Cost

Classroom Supplies /CHW 120,000 36$ 4,320,000$

Classroom Facility Costs /classroom 2,400 900$ 2,160,000$

CHW Per Diem Incentive /CHW 120,000 309$ 37,080,000$

Lodging for Trainers /trainer 2,400 950$ 2,280,000$

Travel/Transportation for Trainers /trainer 2,400 285$ 684,000$

Annual Refresher Course (Y2-Y5) /training 380,000 1.50$ 570,000$

Total Baseline Training Costs 47,094,000$

3 Month Baseline Classroom Training Breakdown

1.5 Month Blended Classroom Training Breakdown

Item Units Units Unit Cost Total Cost

Classroom Supplies /CHW 120,000 $ 18 $ 2,160,000

Classroom Facility Costs /classroom 2,400 $ 450 $ 1,080,000

CHW Per Diem Incentive /CHW 120,000 $ 185 $ 22,248,000

Lodging for Trainers /trainer 2,400 $ 475 $ 1,140,000

Travel/Transportation for Trainers /trainer 2,400 $ 143 $ 342,000

Annual Refresher Course (Y2-Y5) /training 380,000 $ 1.50 $ 570,000

Total Blended Training Costs $ 27,540,000

Nigeria Smartphone Device Costs and

Data Charges

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An average smartphone cost is $150 Average data cost is $40

Smartphone Model Data Allowance Cost

Airtel 4GB 25$

Etisalat 4GB 49$

MTN 4GB 49$

Gio 4GB 37$

Baseline vs. Blended Learning 5-Year

Device Cost - Nigeria Example

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Smartphone vs. Feature + Tablet

Smartphone Feature + Tablet Net Savings

Year 1 $85M $38M $47M

Years 2-5 $341M $93M $248M

Total $426M $131M $295M

$295M (69%) in savings

are achieved with a feature

phone + tablet as Wi-Fi is

used for data

$0K

$50M

$100M

$150M

$200M

$250M

$300M

$350M

$400M

$450M

Smartphone Feature + Tablet

Smartphone vs. Feature Phone+Tablet

Years 2-5

Year 1

Smartphone Feature + Tablet Feature Phone Tablet

Device Cost $150 $160 $0 $160

Connectivity $660 $180 $180 $0

Data Monthly $40 $0 $0 $0

Voice Monthly $15 $15 $15 $0

Solar Charger $40 $40 $40 $0

• Connectivity costs include voice plus data.

• Total costs are based on 100k CHWs

trained

Training and Device

Comparison - Nigeria Example

315M (67%)

savings in training

and device costs

Baseline Blended Net Savings

Classroom Training $47.1M $27.5M $19.6M

Smartphone $426.0M $0.0K

Feature Phone/Tablet $0.0K $131.0M

Total Cost $473M $159M $315M

Training+Supplies Cost Comparison Overview

$295.0M

TOTAL COST AT SCALE

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Total Cost Model – at 1,000,000 CHWs

• 1,000,000 CHW trained

• CHW Salary Year 1 – $960/yr

• CHW Manager Salary Year 1 – $9,600/yr

• Device (smart phone or feature phone +tablet), solar charger, device

connectivity costs, and backpack

TOTAL COST

Baseline Blended % Savings

Device $4.27B $1.32B 69%

Training $0.471B $0.28B 42%

Salaries $5.92B $5.92B 0%

Management $1.97B $1.97B 0%

Overhead $1.90B $1.42B 25%

Total $14.53B $10.91B 25%

3.62B (25%)

savings in total

costs

Total Cost by Year and by CHW

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Average annual savings of $724 (25%) per CHW

WHAT WE FOUND…

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Blended Learning Advantages

• Greater impact: recurring CHW knowledge

impression assessments and electronic health

records

• Cost savings: reduced travel, per diem,

accommodation, and facility costs

• Flexibility: scheduling and coordination

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Right Device for the Task(s)Costs & Usage Models Simple

Phone

Android

Phone

Android

Tablet

Windows Tablet

/ Laptop

Costs

• Device $20 $120-$180 $150-180+ $250-$400+

• Telco each SMS ~$20 /GB $0 $0

• WiFi -

Usage Models

• Voice / SMS

• Survey / GPS

• Email

• Photo / Video

• Skype Video

• USB Medical Devices - -

• File Sharing / Viewing -

• Office Suite -

• Multimedia Training -

• Medical Journals -

• HIS, Lab, Pharmacy

• Full EMR

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TCO = Device + Telco. Minimize telco to real-time needs.

Select device based on usage/sw to yield best productivity.

• Client (PC, Android tablet) app enables

rich eLearning anywhere, anytime;

publishing, tracking and assessment

capabilities

• Easy to administer and use world-wide

• Cloud or locally hosted

• Local language support, Customizable UI

• Deployment Model:

• No-charge software. Work with deployment

partners (e.g. Futures Group) for cloud or

local hosting.

• Content provided by customer or NGOs

No Charge Health Worker

Education & Training App

http://www.skooolhe.com

Email: info@skooolhe.com for more information

Complete Open-Source HMIS:

Patient registrations, scheduling,

referrals

Data capture and analysis

EHR (also work with OpenMRS, others)

Reporting MCH, FP/RH indicators to

DHIS 2.0, to MoH via IQtools

Commodity tracking and availability

Decision Support

Lab

Prescription

Mapping

Solutions for Windows, Android, SMS

Dahlberg Report Conclusions

• Create digital content for training of CHWs

• Share and collaborate on content

• Experiment with blended learning approaches

and recommended pedagogies

• Evaluate blended approaches and the use of

technology in training

• Advocate and support enabling environments

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Our conclusion: Offline e-learning with occasionally connected

tablets maximizes usage models and sustainability

Bobby Jefferson, Director Center for Development Informatics, Futures Group

BJefferson@futuresgroup.com; 202 775-9680

www.futuresgroup.com

www.facebook.com/FuturesGroup

www.twitter.com/FuturesGroupGbl

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Thank

you