Immunization Academy’s IA Learn App

All immunization programs depend on the people who staff their clinics and their managers. If these healthcare providers have the skills and motivation to deliver high-quality immunization services, a country can achieve its service delivery goals. If these healthcare providers do not, it is difficult to implement the immunization program and reach people with life-saving vaccines. Training people using the traditional, in-person cascade approach is slow and expensive, especially to reach the hardest-to-reach facilities. And it takes providers away from their posts to be trained. Additionally, the COVID-19 pandemic exacerbated many of the challenges associated with in-person training.

The Democratic Republic of Congo, for example, has one of the highest rates of child mortality in the world. In 2017, only 1 in 3 children were fully vaccinated. And 1 in 5 children did not receive any vaccines at all. It is incredibly challenging to provide immunization services to children because DRC has one of the lowest population densities in the world. It is the second largest country in Africa, but it ranks 196th worldwide in population density. Half of DRC’s under-immunized children live in remote, hard-to-reach villages. Some villages are days away from the closest health center. In those health centers, there are typically not enough health workers and high staff turnover. There is a near constant need to reach and train new staff, especially in remote areas. 

Our solution is to bring the training healthcare providers need and want right to their fingertips, whenever and wherever they want to access it. The IA Learn Android app uses short, skills-based video lessons to teach health workers and immunization managers the skills they need to deliver and manage immunization programs. The curriculum is based on globally accepted WHO guidelines, and courses are fully customizable for each country’s goals. Countries can build training to address their unique performance gaps or immunization goals by selecting from 150+ short videos, each teaching a hands-on skill.

The app uses scenario-based assessments to test and reinforce knowledge in all immunization subject areas. The app also includes on-the-job practice activities that allow learners to apply what they have learned to a real-world exercise. Learners can earn certificates when they complete courses and pass the tests. This is a motivational support for learners.

The IA Learn app is self-paced and can be used offline or online. Once the app is downloaded onto an Android device, it can be used entirely offline making the training accessible to even the most remote and hard-to-reach health facilities and those in fragile settings.

Pre-test functionality in the app provides baseline data for measuring skill and knowledge improvement. IA Learn also offers a dashboard for managers to monitor individual progress and goals, aggregate data, and create reports. The app is available in English and French and can be translated into any language.

The IA Learn Android app overcomes many of the barriers to getting training to facilities, in particular hard-to-reach, remote facilities and those in fragile settings. It allows a health system to train healthcare providers quicker and at a fraction of the cost of traditional face-to-face training. 

Our solution serves health workers at the service delivery level. It impacts their lives by bringing the training they need and want right to their fingertips, whenever and wherever they want to access it. The IA Learn app measurably improves learners’ skills and knowledge which not only improves their ability to provide high-quality services but is also motivating and empowering. Because the app is self-paced and can be used entirely offline once it is downloaded onto a device, training is accessible to even the most remote and hard-to-reach health facilities and those in fragile settings. Like one of our users, a health worker in the Democratic Republic of Congo, said, “We don’t need to wait a month for a supervisor to come from Kinshasa and teach us something. We can teach and learn ourselves.”

Our solution serves sub-national managers by providing data on the skill and knowledge gaps of their immunization workforce. Managers can see individualized data for the health workers in their catchment areas and use that data to make informed decisions about how they prioritize resources and support.

Our solution also serves the health system. With the IA Learn app, the health system can more rapidly train their health workforce. It can get training and support out to remote, hard-to-reach areas, especially those in fragile and conflict areas where it is difficult to bring people together for face-to-face training and managers cannot frequently travel for supervision because of security or geographical challenges.

Ultimately, a skilled and motivated immunization workforce impacts the communities they serve by reaching children and individuals with the vaccines they need to prevent disease and death.  

Bull City Learning (BCL) is a learning consultancy based in Durham, North Carolina, USA. BCL has been assisting global health organizations in building workforce capacity through the creation and delivery of innovative learning solutions for over eight years. In that time, we have conducted twenty major global health projects, and produced hundreds of digital and face-to-face learning resources for our global health clients – largely focused on immunization. BCL’s flagship immunization and global health program is Immunization Academy (IA; https://watch.immunizationacademy.com/en). The Immunization Academy is an immunization-specific educational video platform that is currently used by over 700,000 health professionals in 195 countries. The Immunization Academy was launched in 2017 with the vision of providing instant access to high-quality training and support when and where healthcare professionals need it. In 2020, we developed the IA Learn Android app to expand the reach of our web-based platform. In partnership with local non-profit organizations and Ministries of Health, we have implemented the IA Learn app in the Democratic Republic of Congo (DRC), Ethiopia, Kenya, and Nigeria. Immunization Academy’s IA Learn app has a unique set of features not found elsewhere. And no one is reaching health workers like we are. 

The IA Learn app currently has 3,000 registered users across DRC, Ethiopia, Kenya and Nigeria. We are also working on projects to scale to additional users in DRC and Nigeria in 2023. 

We are applying to Solve to expand our reach and amplify our impact. We have created a tool that could be a game-changer for countries, especially those with remote, fragile, or conflict areas where it is difficult to reach health facility staff in-person for training and capacity building. We have demonstrated the impact and value of our solution, and now we need to share the capabilities of the IA Learn app and our country experiences with others.

We have three main goals for applying to Solve:

1. Strengthen our monitoring and evaluation – We have in-app capabilities for measuring knowledge gains. However, to demonstrate impact on performance and long-term knowledge and skill retention, we need a more comprehensive monitoring and evaluation plan. This piece is often not funded when we implement with our country partners. It is also the piece that could help unlock more opportunities because country governments and funders want to see impact data in order to inform their funding decisions.
2. Learn from others – As a learning organization, we deeply value learning from others’ experiences, both what has worked well and what has not. We see being a part of the Solve cohort as an opportunity to both learn from others deploying digital tools in fragile and conflict areas, especially in an age of evolving digital privacy requirements, and share our experiences as well.
3. Advance our business model – We have been implementing our business model since 2021 and have largely relied on the strength of our existing partnerships to expand our tool to additional countries. We have created a model that we think responds to what the “market” of country governments and other immunization partners wants and can fund. However, it works on a project-by-project basis without global funding for investing in the expansion of the app. We would like to build on this model and generate additional funding for further development of the app.

Traditional training for country immunization program relies on two main methods: in-person cascade training and supportive supervision visits from a manager. In the former, representatives from health facilities are taken out of their workplaces, asked to sit through days of didactic training, and then receive little to no follow up to apply what they have learned when they return to the job. For the latter, visits from a manager are often based on convenience rather than need, if they happen at all. And in some fragile or conflict settings, it is difficult to reach health facilities if there are safety and security concerns.

With the IA Learn app, a country can deploy an Android device loaded with the app to their health facilities. Staff can learn at their own pace, remaining in their workplaces. Managers can monitor staff progress from their district offices, and prioritize sites for supportive supervision based on learning data. As needed, the country could push additional training to health facilities – if they introduce a new vaccine, for example – without asking people to travel for an in-person training. The devices simply need to connect to the internet to download the new training.

In many countries, the IA Learn app would not replace in-person training altogether. In fragile or remote areas in which training or supervision are hindered by security concerns or geographic conditions, the IA Learn app can bring training to places that desperately need it and have not received it in a while. 

Our impact goals for every country in which we implement the IA Learn app are to 1. Improve the skills and knowledge of our target learner population, 2. Empower system managers with data to inform decision-making, and 3. Improve efficiency and accessibility of training in the country.

We hope that by achieving these three goals, we can have an impact on immunization staff performance which will contribute to improved service delivery and program management. A capable and motivated immunization workforce could improve immunization coverage and health outcomes. However, many factors impact a person’s ability to perform at their jobs; training is just one.

Ultimately, our goal is to reach more health workers – especially those in hard-to-reach, fragile, or conflict areas – with the tools and information they need to do their jobs well, starting with immunization and expanding to primary health care. We want to contribute to a health workforce that is resilient, can upskill and respond quickly to the next pandemic or natural disaster, and supports health workers with the resources they need to feel capable, confident, and motivated.

We measure change in skill and knowledge through pre- and post-training assessments within the app. Our assessment questions are scenario-based and meant to test a learner’s application of knowledge as well as serve to reinforce their learning along the way.

There are many factors that impact a person’s ability to perform at their jobs; training is just one.  However, as funding permits, we also work with our in-country collaborators to do a pre- and post-intervention performance assessment. This allows us to evaluate the impact on learners' job performance. 

The solution is centered around a custom-developed Android-based mobile application. This application is installable via the Google Play Store or can be delivered through other methods such as a downloadable APK. A back-end API provides the ability for the learner to validate who they are via SMS, WhatsApp, or email. Once validated, the system allows them to download specific course content tailored to their country, with video content that has been compressed aggressively to make sure bandwidth use is limited. After downloading the content, the learner can take the training online or offline, and only needs to have an internet connection to submit their data back to the API. After course completion, the server will generate a custom PDF certificate for the learner.

In addition to the mobile application, this solution has a web-based manager dashboard which reports in real time any of the data that has been submitted to the API. Managers are also able to subscribe to automated email reports of learner activity through the dashboard. 

Please access this case study to learn more about how the IA Learn app allowed DRC to reach and train vaccinators even in the hardest-to-reach areas: https://immunizationacademy.com/pdf/IA_CaseStudy_DRC.pdf. This case study details the rationale, approach, and impact of the IA Learn app in DRC. 

The IA Learn app is designed to be an affordable and sustainable training solution. The IA Learn app is available to country immunization programs on a yearly subscription basis. We start by working with a country to determine which courses will be most relevant for their workforce based on training needs or programmatic priorities, and then we build a training curriculum using our library of video-based lessons. Once the curriculum is developed, it can be deployed through the IA Learn app to as many learners as the country aims to train within the year. This means that the cost of training per learner decreases as more learners are added.