Alelo

Public health emergencies such as COVID-19 require a surge capacity of trained public health workers. The WHO projects a shortage of 12.9 million healthcare workers by 2035, making it difficult to combat emerging public health threats. The key to effective healthcare emergency response is rapid training of sufficient numbers of public health workers who are trusted in the communities that they serve, e.g., community health workers (CHWs). Alelo’s AI-driven CHW Reskilling Course rapidly trains key CHW competencies, through practice and assessment with simulated patients that incorporate speech recognition and natural language technology. It runs on Alelo’s Enskill platform, which supports data collection as well as training. We use the collected data to improve training and adapt to evolving health-emergency conditions. Our cloud-based, multilingual platform can be applied globally to augment health system capacity. Women and members of disadvantaged communities train and qualify for living-wage jobs, which promotes economic equity.

Public health emergencies such as COVID-19 require a surge capacity of trained public health workers. During the COVID-19 pandemic, it was suddenly necessary to hire 100,000 contact tracers in the US alone. Public health workers are now needed to administer vaccines, overcome vaccine hesitancy, and control new outbreaks of infection. The WHO projects a shortage of 12.9 million healthcare workers by 2035, making it difficult to combat emerging public health threats. Distrust of health workers has contributed to health crises such as Ebola. The key to effective health security response is the rapid training of sufficient public health workers who are trusted in the communities that they serve, e.g., community health workers (CHWs). Such training could build local capacity and reduce the strain on public health departments and international public health organizations. CHWs must have communication skills that are critical for effective emergency response. Unfortunately, conventional training methods do not train people quickly in critical competencies such as communication skills. Academic programs focus on academic knowledge and do not provide enough training in practical skills that can be applied immediately in a health emergency. Moreover, health security crises can evolve rapidly, and so training must quickly adapt to keep pace.

The Alelo Community Health Worker (CHW) Reskilling Course is a cloud-based training course that trainees can access from laptop computers or mobile devices. It comprises self-study course learning content, webinars, message boards, background resources, and other social learning functionality. A Program Navigator monitors trainee progress.

The course runs on Alelo’s Enskill learning platform. Enskill’s conversation technology trains communication skills, which are essential competencies for community health workers and health professionals in general. Speech recognition and natural language processing technology enables trainees to interact with avatars in realistic situations, in a variety of languages. Trainees can express themselves freely, with a minimum of prompts. Enskill can be used for assessment as well as practice. In assessment mode, hints are disabled so trainees can demonstrate that they can apply competencies unassisted.

As trainees interact with Enskill, it automatically records and transcribes their responses. We use these data to iteratively train the natural language processing models and measure their performance. As a result, the performance of the system steadily improves as more trainees use it. We also plan to collect data from practitioners in the field, and use it to keep the training up to date with rapidly evolving health crisis conditions.

Our primary target population consists of workers who wish to be trained for careers in public health and healthcare, especially underemployed workers. Current enrollees in our program are at least 18 years old, unemployed or underemployed, and have less than college degrees. Many such workers lost jobs during the COVID-19 pandemic and have had difficulty finding new jobs. For example, in March 2021 the US economy added 916,000 jobs but only 7,000 went to workers with high school diplomas but no college degree. 

We are starting with trainees in urban areas and plan to expand soon to rural populations in Southern California and nearby states. We then intend to expand nationwide and internationally, starting in countries with national health systems and national training standards for community health workers. From there we will expand globally into countries with adequate Internet connectivity for online training.

Our community-health training offers economic opportunity to workers in economically disadvantaged regions. It particularly benefits women, who constitute the majority of the global community health workforce.

Our solution is informed by the workforce development agencies we partner with, such as the Hampton Roads Workforce Council, as well as the workers themselves. We interview trainees both before and after enrollment to understand their needs and make sure that our training is meeting their needs. Program navigators in our team work with trainees who are experiencing difficulties, to understand their problems and help them overcome them, and also to keep the team informed of recurring problems that our trainees are expanding.

Our work will affect the lives of people who have limited access to healthcare, such as people in rural areas, and vulnerable populations at risk of disease outbreaks. 62.93% of Primary Care Health Professional Shortage Areas (HPSAs) were located in rural areas. It will affect the lives of populations experiencing disease outbreaks; as public health workers, CHWs play a critical role in detecting disease outbreaks quickly, through testing and contact tracing, and then in responding by educating and connecting patients with services. Our rapid training will help health systems to become more resilient and able to respond to new health emergencies.

Our solution builds health system capacity and helps health systems quickly augment staffing to counter disease outbreaks. CHWs have intimate knowledge of and typically come from underserved populations that are at risk from disease outbreaks. This helps them to build trust and thereby improve cooperation with data collection efforts and treatment compliance. They are involved in education and outreach and help combat the spread of misinformation. They provide critical local support for health emergency response in countries with underdeveloped health systems. Our technical solution helps overcome the personnel shortages that continue to make health systems vulnerable to health security threats.

Our solution is being piloted in the Hampton Roads, Virginia area, in collaboration with the Hampton Roads Workforce Council (HRWC) and public health departments and community health centers in the Hampton Roads area. There are up to 350 trainees in the initial cohort. We are providing training free of charge to the participants. We are training them, assessing their competencies post-training, then placing them in jobs. We are collecting data on training time, training outcomes, job placement rates and job retention rates, to measure program effectiveness.

           We will continue to develop the program with HRWC and then replicate it with other workforce boards and health organizations across the country. We are partnering with organizations working in rural communities to provide training in the communities that they serve. We plan to partner with Social Finance to offer Social Impact Bonds to pay for training and job placement services.

Our training approach and technology are both innovative. Our experiential learning approach focuses on the competencies that CHWs employ in the field. It offers extensive opportunities to practice skills in simulated patient interviews. It is highly efficient and provides trainees with skills that they can start using right away. Trainees engage in task-based conversations with patient avatars and express themselves freely in spoken language. Spoken language is emphasized so that the interviews are realistic and help trainees develop core competencies in communication. Assessment is continuous and integrated throughout, and used to drive personalized learning. Training is self-paced but generates analytics which program navigators and instructors can use to track progress efficiently and scalably. Reliance on collaborative peer learning and program navigators makes it possible to eliminate conventional instructor-led training and increase scalability. 

As trainees interact with our Enskill platform it constantly captures interaction data. Our iterative, data-driven approach to content development contrasts with conventional development approaches that require all system options to be authored ahead of time. We intend to open our platform for use by instructional content developers, to accelerate adoption. It will facilitate adaptation and adoption of our CHW training in other countries, and application to additional occupations. We plan to capture interaction data from the CHWs in the field, and use it to keep training up to date with rapidly evolving health emergency conditions. Our goal is to encourage broad adoption of experiential learning as a training method, with Alelo’s Enskill as the training platform of choice.

Cumulative training enrollments for current Alelo online training courses are 540,000. This does not include courses which learners can access without enrolling. We currently are enrolling 350 trainees into our CHW Reskilling pilot training program. We are working with HRWC to obtain state funding so we can continue to provide the training program to underemployed workers in their region. We then plan to replicate the program with other workforce boards. After one year we expect to have provided at least some CHW training to 100,000 workers. After five years we will have courses available in multiple languages, with curricula aligned with training standards in multiple countries. We will offer continuing education courses so that practitioners can stay up to date with the updates in health emergency conditions and responses. Our goal after five years is to have at least 1,000,000 trainees train on our platform each year.

Key metrics of program success are training speed, course enrollments and completions, operational cost per trainee, and job placement rates. Training speed is important because it helps get trained workers into the field faster. Previous Alelo training courses have already demonstrated rapid training, e.g., an immersive training program for Arabic that trained functional communication skills in as little as 40 hours. In the current CHW pilot we are targeting a training speed of at least twice that of the typical CHW course.

Operational costs per trainee for Enskill courses incorporating speech and language processing are at most $0.50 trainee per month. Our program navigation and job placement services add to the cost, but we plan to reduce these costs by automating program navigator tasks and using chatbots to answer many common trainee questions.

Expansion will require reducing the time required to update content. We plan to extend Enskill so that healthcare partners and even healthcare workers can annotate and contribute data to training scenarios. This will enable us to rapidly retrain the avatar dialogue models and update training content to reflect current health emergency conditions.

The key financial metric we track is gross margin per trainee, which increases as the number of trainees in paid programs increases.

We will measure overall impact by the amount of access to healthcare in targeted regions and populations, for example from statistics published by ruralhealthinfo.org, and by the number of people receiving access to healthcare in normal conditions and in health emergency conditions.

The team currently comprises 18 individuals, including 9 full-time staff, 8 contractors, and one volunteer.

Since its inception, Alelo has been developing technology to promote rapid development of critical skills. It is a spin-out of the University of Southern California, from which it obtained an exclusive license to commercialize the foundational intellectual property. It has continued to develop and improve the technology and apply it in innovative training products which are in widespread use in multiple countries. Alelo’s data-driven development methodology is well recognized in the field of artificial intelligence in education, and Alelo’s and CEO Johnson’s work has been recognized with prestigious awards. Team members Robinson, Carreira, and Gallaway-Johnson have community health and healthcare case work experience, and have worked with teams of health workers at all levels. They bring the perspectives of public health trainees as well as public health professionals. Team members Broughton and Gallaway-Johnson are first-generation college graduates, and have experienced first-hand the challenges that are faced by workers who lack college degrees. Chiang, Broughton, Koffler, and Ynzynza are members of ethnic minorities. Broughton and Koffler have a Hispanic background – a key demographic for our solution. The design and implementation of our solution is further informed by interviews of members of the target population, and experts in partner organizations such as the Hampton Roads Workforce Council who have a deep understanding of the populations that we are serving.

Our leadership team is majority female and ethnically diverse, which is reflective of the target demographic of our solution and is a result of efforts to promote diversity, equity, and inclusion. Cultural humility is a central focus of our training solutions, which have provided cross-cultural communication training to over 500,000 trainees. We apply the same principles of cultural humility in our organization and in our hiring practices.

Winning this competition will give us added credibility when we reach out to potential sponsors and partners, and when we are looking for grant opportunities. As noted above, we are particularly interested in building relationships with international corporations that are active in this area, and foundations that sponsor work in this area. 

We also want to make connections with non-governmental organizations that are active in health emergency response worldwide, so we can support their efforts.

We welcome advice in how to implement successful business models in the social impact space, and wish to learn from peers that are working there.

Becoming a Solver will give us media exposure, and will give us added credibility when we pitch to investors.

We currently have a vacancy on our Board of Directors, and are looking for a suitable candidate to fill it. The ideal candidate would have experience with social impact enterprises and organizations that support underserved communities.

We are interested in advice and suggestions for generating revenue and paying our expenses within the social impact ecosystem, so we do not have to seek payment from the trainees themselves. 

We welcome suggestions of investors we can pitch to, and how to improve our pitch to them. We are looking for grant opportunities that could fund our work.

We seek to expand our base of international distribution partners and resellers. We seek advice and innovative suggestions for how we can market our solutions to employers, workers, and other organizations working in public health and workforce development.

We are always on the lookout for new technologies, particularly in artificial intelligence, data management, or edtech, that can add value to our solutions or vice versa.

We seek to partner with sponsor organizations interested in promoting health and wellness and increasing access to healthcare worldwide. One example in Solve’s social impact community is Clorox. We could provide training in disinfection best practices to community health workers, who in turn would educate their patients.

Another example is the Bill and Melinda Gates Foundation. Our efforts are well aligned with their global health efforts, and partnership with them could help promote global adoption of our solutions.

We currently use Amazon Web Services for managing our data in the cloud. Perhaps there is potential for us to take advantage of new Amazon technologies for data management, machine learning or speech and language processing.

If any organizations in the Solver network are developing technologies that are complementary and synergistic with ours, we would like to learn more about them.

Studies have demonstrated that community health programs promote health and wellness, particularly in underserved communities with insufficient access to healthcare. Our program expands the pool of trained community health professionals, particularly in underserved communities. If we win a Robert Wood Johnson Foundation Prize grant it will enable us to expand our sponsorship program and increase the number of people from underserved communities that we can recruit into our program and place into jobs.

Community health workers, and trainees in our program, are predominantly women. Our solution helps underemployed women who lack college degrees to qualify for jobs in community health. Women without college degrees, and especially minority women, suffered job losses during the pandemic and are experiencing difficulty finding new jobs. If we win the Innovation for Women Prize it will enable us to expand our sponsorship program directed at women and increase the number of women we can recruit into our program and place into jobs.

Our Enskill platform continually collects data from users, which we use to train and retrain the AI models integrated into our training solutions. A prize award from the AI for Humanity competition will enable us to expand our data collection and utilization efforts. Our goal is to extend Enskill so that CHWs in the field can annotate training cases based on their experiences. This will be particularly important for global health emergency response, in which appropriate responses may vary by country or region, and emergency conditions can evolve rapidly.

Our training solution targets community health workers, and we plan to use our platform collect data from community health workers on an ongoing basis. We could use this infrastructure for other data collection purposes, including reporting on availability of medicines and commodities. This would expand the utility of our portal as a resource for CHWs.