Longer description of your proposed project

Summary

HealthLearn provides world-class online learning to health workers in developing countries. We’ve demonstrated we can deliver this training with excellent short-term outcomes, but major uncertainties remain. In the next year, we need to:

• gather better data to assess our program’s cost-effectiveness, and

• successfully navigate government approvals in Nigeria in order to scale up to train thousands of health workers.

ACX grant funding will be catalytic for helping us to overcome these two challenges, increasing our chances of success, adding substantial information value, and accelerating our timeline to impact.

The problem

Poor quality of care causes 5 million deaths every year in developing countries - this is much more than the 3.6 million deaths caused by non-utilization of care. More than 2 million newborns die every year and many of these deaths could be averted if health workers consistently followed evidence-based best clinical practices. Small, simple changes in practice - even those requiring no specialized equipment - can have an enormous impact on health outcomes. For example, waiting 1-3 minutes to clamp and cut the umbilical cord at birth (delayed cord clamping) reduces preterm deaths by ~32%. The universal practice of delayed cord clamping would prevent 140,000 newborn deaths per year. While readily preventable deaths have many causes, it is clear that health worker training can be a part of the solution.

The charity evaluator GiveWell finds that in-person training of health workers in newborn care is likely among the most cost-effective global health programs known. But it's challenging to bring such training to scale while maintaining quality and fidelity.

Our solution

HealthLearn is a nonprofit that provides simple, engaging, mobile-optimized online training to health workers based in primary health centers (PHCs) in Nigeria. Drawing inspiration from Duolingo, we rooted HealthLearn’s design in the science of learning: rather than passively watching videos, health workers engage actively by answering questions and receiving feedback on realistic clinical cases. Our modeling shows that HealthLearn has the potential to be as cost-effective as GiveWell’s top charities.

We have a track record of success with this approach. Several consecutive pilots demonstrate the effectiveness of our courses for training PHC staff in Nigeria in a variety of critical topics in primary care. We’ve now run courses on infection prevention and control, hypertension, and newborn care. In our most recent pilot, 87% of PHC staff who were asked to take a course on essential newborn care completed it, with robust learning gains and excellent learner feedback.

Challenges

Although we have made a lot of progress, we can’t yet be confident that HealthLearn effectively prevents newborn deaths. In 2024, we aim to assess two key questions:

• Impact: Does our training cost-effectively save lives by improving health workers’ adherence to best clinical practices?

• Scale: Can we successfully navigate bureaucratic approvals in Nigeria to lay the groundwork for scaling up to train hundreds of thousands of health workers?

What ACX funding will do

This grant will accelerate our timeline to impact by increasing the likelihood that we can answer both of the above questions. Specifically, we will:

• Gather real-world data on the impact of our training on clinical practice and the number of beneficiaries reached by our training,

• Feed those data into an improved cost-effectiveness model that links our program outputs (number of health workers trained) to outcomes (effect on clinical practice and number of beneficiaries reached) and impacts (number of deaths averted by the training).

• Hire a stakeholder engagement lead in Nigeria who will help us to navigate the bureaucratic approvals and barriers that we need to clear in order to effectively scale up our work.

If we are able to deliver on both of these objectives, we will be in a strong position in 2025 and onward to further scale our programs and save more lives.

Describe why you think you're qualified to work on this

HealthLearn’s team has the right skills and expertise to make this project happen.

Our Executive Director, Dr. Marshall Thomas, has a wealth of experience in developing and implementing online training for health workers in Nigeria, managing complex projects with many different stakeholders, and creating and evaluating innovative new approaches to teaching at scale. Dr. Thomas developed the HealthLearn approach to training through his consultancy work. Before then, he was a founding faculty member at Rwanda’s newest medical school, where he led academic accreditation, pre-clinical curriculum, and hiring.

Our technical team is led by Karl Keefer, who has developed dozens of web sites and web apps. Another contributing engineer, Jonas Wagner, worked at Google and developed software for the Against Malaria Foundation.

Our local partners in Nigeria have the right expertise to implement complex projects on the ground – this is evidenced by our success in collaborating with these partners to quickly complete the newborn care course pilot. Our advisors include leaders at USAID in Nigeria and the founders of New Incentives (a GiveWell-recommended charity) and Family Empowerment Media. These advisors provide us with excellent guidance, but can also open up doors for the introductions we need to get things done.

Thomas, M. P. et al. Development of a simple and effective online training for health workers: results from a pilot in Nigeria. BMC Public Health 22, 551 (2022). https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-12943-1

HealthLearn. HealthLearn’s first pilot: promising results. https://healthlearn.org/blog/first-pilot

Other ways I can learn about you

https://www.linkedin.com/in/mthomas47/

How much money do you need?

$10,000 in ACX funding would support data collection and development of an updated cost-effectiveness model that will give us a higher degree of certainty about the impact of our program. Specifically, this will allow us to conduct a more robust evaluation of the impact of our training on health workers’ clinical practice. We’ll do this by directly observing health workers’ practice before and after taking the course. In parallel, we’ll improve our cost-effectiveness analysis to take inputs from the clinical practice evaluation. This will allow us to give a more confident answer to the question: “does our program have an impact?”

$25,000 in ACX funding would allow us to conduct all of the activities at the $10,000 level, plus hire a half-time country lead who will take the lead on navigating the government bureaucracy and approvals necessary in Nigeria for us to scale up our work. Specifically, this involves clearing approvals with the Federal Ministry of Health and ensuring that our courses are accredited by the professional bodies that oversee health care worker licensure. The country lead would also work with implementing partners to complete the clinical practice evaluation and help us find more simple and efficient implementation models. This will allow us to more confidently answer the question: “can we bring this to scale?”

Links to any supporting documents or information

Kruk, M. E. et al. Mortality due to low-quality health systems in the universal health coverage era: a systematic analysis of amenable deaths in 137 countries. The Lancet 392, 2203–2212 (2018). https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31668-4/fulltext

Facility-Based Maternal and Neonatal Health Interventions | GiveWell. https://www.givewell.org/international/technical/programs/facility-based-maternal-and-neonatal-health-interventions

Fogarty, M. et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol 218, 1–18 (2018). https://pubmed.ncbi.nlm.nih.gov/29097178/

Larsen, D. P., Butler, A. C. & Roediger III, H. L. Test-enhanced learning in medical education. Medical Education 42, 959–966 (2008). https://asmepublications.onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2923.2008.03124.x

Estimate your probability of succeeding if you get the amount of money you asked for

These are overall probabilities (that is, not conditional on any other probabilities given).

$10,000 in ACX funding

70% - We will be able to complete an evaluation of the impact of our training on clinical practice and gather the necessary data.

50% - The evaluation will demonstrate that the course significantly and substantially improves clinical practice.

$25,00 in ACX funding

70% - We will clear all regulatory barriers necessary to scale to the whole country of Nigeria.

85% - We will be able to complete an evaluation of the impact of our training on clinical practice and gather the necessary data.

60% - The evaluation will demonstrate that the course significantly and substantially improves clinical practice.