First Aid Blended Learning

Illness and injury remain significant contributors to mortality worldwide, with a particularly heavy toll in low- and middle-income countries (LMICs). It is estimated that approximately 54 percent, or 24.3 million, of the roughly 45 million deaths in LMICs each year are linked to conditions that could potentially be addressed through prehospital care. This underscores the critical importance of basic community care, which is the initial tier of prehospital healthcare delivery, when the 2nd and 3rd tier (emergency medical services) are weak, according to the World Health Organization. In many LMICs where EMS are not readily available, victims of illness or injury are mainly dependent on the first tier in which care provided by bystanders occurs in 94 percent of the cases.

The impact of first aid training is particularly pronounced in Sub-Saharan Africa, where it can play a pivotal role in reducing the burden of illness and injury. Recognizing its potential, the World Bank promotes first aid training as an affordable tool for addressing healthcare challenges in LMICs. Studies conducted in sub-Saharan Africa showed that training lay first responders in first aid techniques improved first aid knowledge, skills, and care provided.

First aid is not just a healthcare intervention; it is a humanitarian imperative essential for building resilient and healthy communities, whether in humanitarian crises or stable socio-economic environments. The International Federation of Red Cross and Red Crescent Societies (IFRC) emphasizes the need for accessible first aid services and education as part of a broader developmental approach to enhance community safety and resilience. This commitment to accessibility is underscored by the IFRC's declaration that first aid should be available to everyone, everywhere. As a testament to this commitment, all 191 Red Cross-Red Crescent National Societies (RCRC-NS) are actively engaged in providing first aid, making the Red Cross-Red Crescent Movement (hereafter ‘the Movement) the world's largest first aid provider. The Belgian Red Cross-Flanders (BRC-Fl) has accumulated extensive expertise in first aid over the years and has contributed to numerous scientific papers in the field as well as hosting the Cochrane First Aid-centre. Leveraging this expertise, BRC-Fl supports the development of first aid capacity in RCRC-NS in Sub-Saharan Africa, both institutionally and technically.

While the potential of first aid training is undeniable, its implementation faces challenges in humanitarian and development settings. Resource scarcity, a shortage of trainers, inadequate training facilities, and the need to maintain high-quality educational materials present substantial barriers to scaling up effective first aid training. Moreover, the comprehensive nature of first aid-trainings requiring typically 3-5 days for certification, demands significant time commitments from both organizers and participants. Despite being a cost-effective healthcare intervention, the perception of training costs can impede its reach in Sub-Saharan Africa. Additionally, regions with security challenges pose unique difficulties for first aid trainers who must access remote and dangerous areas to provide training, exposing both trainers and participants to heightened risks.

To address these challenges and to enhance access to high-quality first aid training for a broader audience, Belgian Red Cross-Flanders developed the innovative First Aid Blended Learning (FABL) training program. This program combines smartphone-based distance learning with a 1-day in-person training component, led by certified first aid-trainers. While neither blended learning nor smartphone applications are ground-breaking individually, their integration represents an innovative and scalable solution for increased dissemination of healthcare knowledge and skills, with the potential for far-reaching humanitarian impact, even beyond the field of first aid or basic healthcare.

BRC-Fl's FABL-program originated in 2019. After successful piloting with Rwanda, South Africa, Zimbabwe, and Tanzania, FABL showed promising impact. Encouraged by theseresults, BRC-Fl developed their own First Aid in Africa app and adapted training materials in 2021-2022. A current scientific study in Rwanda demonstrates similar learning outcomes between FABL and traditional 3-day courses, with retention after 6 months. Results of this study are pending publication.

The FABL program consists of three key elements: the didactic approach and the technical system, both supported by evidence-based first aid content.

Didactic approach

The blended learning-training starts with participants downloading the First Aid in Africa-smartphone app from Google Play Store or iOS App Store. More detailed technical information is provided in '1.2.2 Technical System.’ After installation, the trajectory includes two steps for certification:

1. Users learn 17 first aid topics in their local language, supported with quizzes and illustrations. An online, theoretical first aid test follows. Scoring 80% or higher grants an admission code.

2. Using the admission code, users book a 1-day practical first aid course from their RCRC-NS via a link in the app.

Technical System:

BRC-Fl developed the First Aid in Africa app, available on Google Play and App Store in countries where the Red Cross/Red Crescent partners with BRC-Fl.Users select country and language, consent to policies, and download country-specific content, optimized for cost-effective downloads.

The app offers emergency-oriented and learning environments, color-coded red and blue, respectively. In blue the learning environment, users can explore 17 topics and take quizzes. A 'Courses' page guides users through the FABL-training, using the following steps: 

1. Learn 17 first aid topics
2. Online admission test via Google Forms. Achieving 80% or higher results in an admission code sent through 'Certify’em.'
3. Book a 1-day training using the admission code. The booking tool is set up with the local Red Cross/Red Crescent partner.

The application serves various purposes, including disaster preparedness, data gathering, and lead- and generation for the Red Cross/Red Crescent partner.

Content

The content of the application and the training followed an evidence-based approach with guidelines developed by an expert panel of African first aid trainers. The process involved aligning content with scientific research, contextualised practical insights, and local expert recommendations. Gender-neutral language is used, and considerations for age, gender, disability, and minority status are addressed in content development. The guidelines developed in 2021 serve as the basis for FABL-innovation, emphasizing gender equality, respect for the human body, and psychosocial first aid.

The solution aims to directly and meaningfully improve the lives of individuals in low- and middle-income countries (LMICs), with a particular focus on Sub-Saharan Africa. The target population includes individuals who are often underserved in terms of access to prehospital care and first aid training. This population comprises community members, lay first responders, and potential first aid providers in regions where emergency medical services are not readily available. The current underservice in these regions is evident in the lack of access to timely and effective prehospital care, resulting in a high burden of mortality due to illness and injury. In many LMICs, victims of illness or injury are heavily dependent on basic community care, often provided by bystanders, as the second and third tiers of emergency medical services may be weak or unavailable.

The FABL program addresses the needs of this underserved population in several ways:

1. Accessibility: By utilizing a smartphone-based approach and reducing the amount of in-class training, the FABL program makes first aid training more accessible to a broader audience. The smartphone application, "First Aid in Africa," allows users to engage with first aid content in their local language.

2. Cost-Effective Training: The blended learning model combines smartphone-based distance learning with a 1-day in-person training component. This approach reduces the time commitment required for traditional 3-5 day first aid certifications, making it more feasible for participants and organizers, especially in resource-constrained environments.

3. Disaster Preparedness: The application's functionality extends beyond training, providing users with emergency-oriented guidelines in case of urgent situations. It enhances disaster preparedness capabilities by offering step-by-step first aid guidance tailored to specific emergency situations, helping users respond confidently.
   

4. Income-Generating Opportunities: The FABL program introduces an in-app reservation system, providing a potential income-generating opportunity for Red Cross-Red Crescent National Societies (RCRC-NS). This financial aspect can contribute to the sustainability of the program and the broader initiatives of RCRC-NS.

5. Scientific Data Collection: The application allows for the collection of valuable scientific data on first aid actions, injuries, and illnesses. This data can be used to refine and tailor first aid guidelines, ensuring that the content remains relevant and effective for the end-users.

The Belgian Red Cross-Flanders (BRC-Fl) and its team are well-positioned to deliver the FABL-solution to the target population for several reasons:

International expert in First Aid: The BRC-Fl has established itself as a national expert in first aid. The team has extensive experience in developing evidence-based first aid guidelines and didactic materials for both the Belgian context and, notably, for the African context. This expertise ensures that the FABL program is rooted in sound scientific principles and tailored to the specific needs of the target population.

Evidence based, localised content: BRC-Fl collaborated with an African expert panel to develop the Basic First Aid in Africa manual in 2022. This indicates a commitment to incorporating local knowledge and perspectives into the design of first aid products. The longstanding partnerships with multiple African Red Cross National Societies provide the team with an in-depth understanding of the African context, including both capabilities and challenges, making them well-informed about the needs on the ground.

In-house app-development : The IT department of the Belgian Red Cross has experience in building first aid applications, including a psychological first aid application. The fact that the app development is done in-house adds a layer of control and flexibility, allowing the team to adapt quickly to the evolving needs of the target population without being reliant on external firms.

Strategic emphasis on Digital Learning: The organization places a strategic emphasis on enhancing digital learning in its products. This indicates a forward-looking approach and a commitment to utilizing technology for effective knowledge dissemination, especially in regions where traditional methods might face challenges.

Extensive partnerships and local presence: BRC-Fl has longstanding partnerships with multiple African Red Cross National Societies, demonstrating a strong connection and collaboration with the communities they aim to serve. The widespread presence of Red Cross Volunteers, even in remote villages, ensures that the team is well-connected with local communities, understanding their unique challenges and needs.

Long term financing: The FABL program is sustained by theBRC-Fl's own funding, removing reliance on external institutional donors. The development of a sustainability roadmap for the project further ensures its longevity and continuity, making it less likely that the program will face disruptions.

The FABL- program already achieved some milestones, positioning it at the "Scale" stage, operating in multiple countries within Sub-Saharan Africa. The key accomplishments are as follows:

1. Geographical Expansion: The application is currently rolled out in seven Sub-Saharan African countries: Burundi, Malawi, Mali, Rwanda, Tanzania, Uganda, and Zimbabwe. This demonstrates a successful expansion of the program across different regions, reflecting its adaptability and relevance in diverse contexts.

2. User Adoption: The app achieved over 1000 downloads in the Google Play Store. Over 600 individuals have actively engaged with the FABL application, studying the first aid content and successfully passing the admission test. This showcases a substantial user base and highlights the program's appeal and effectiveness in reaching and engaging with the target population.

3. Training of Trainers: To ensure sustainability and scalability of the program, 5-15 trainers have been trained in each of the countries - Burundi, Rwanda, Tanzania, and Uganda. These trainers are now equipped to conduct the 1-day practical courses within their respective territories, facilitating the dissemination of first aid knowledge at the community level.

In summary, the FABL program has moved beyond the initial development and pilot phase, demonstrating implementation across multiple countries in Sub-Saharan Africa. The user base, coupled with the training of local trainers, positions the program at the "Scale" stage, with a standardized solution ready to operate in many communities and countries. 

The program aims to overcome the following barriers with the assistance of Solve and other Solvers:

1. The team seeks support in enhancing the business model of the FABL program to make it more sustainable. This may involve refining the revenue-generating aspects of the program, ensuring that implementing the program is financially viable for African Red Cross national societies in the long term. Solve and Solvers could play an important role in providing guidance and expertise to improve the overarching business model as well these of the implementing national societies, making it more effective and scalable.

2. Commercial implementation with National Societies: The goal is to support national societies in implementing and commercially utilizing the FABL program. This involves addressing potential legal and technical challenges associated with the commercialization of the solution. Solve can connect the team with commercial experts and advisors who can provide insights and strategies for successful commercial implementation, ensuring compliance with regulations and maximizing impact.

3. Marketing and market studys: The team is specifically seeking connections with individuals or organizations possessing expertise in marketing and market studies within the region and the sector. Solve and Solvers could facilitate these connections, linking the team with partners who have a deep understanding of the local market dynamics, enabling them to refine their marketing strategies and better navigate the unique challenges of the target regions.

4. Creating corporate training opportunities for implementing national societies: To overcome market barriers and promote commercial opportunities, the team aims to raise awareness among larger, international firms about the benefits of using the FABL program to train their employees. Solve and other Solvers can assist in connecting the team with corporate partners, fostering collaborations that lead to commercial opportunities for partnering national societies. This support may include strategic introductions, networking opportunities, and guidance on effective outreach to potential corporate clients.

By leveraging the Solve platform, the team anticipates receiving non-monetary support that goes beyond fundraising. The focus is on accessing expertise, mentorship, and partnerships that can address the identified barriers and propel the FABL program towards greater sustainability and humanitarian impact.

Although blended learning would not be much of an innovation in the global North, FABL addresses multiple challenges of providing effective first aid training in low-resource settings, particularly in Sub-Saharan Africa. The innovation lies in the combination of smartphone-based distance learning with a 1-day in-person training component, offering a comprehensive and scalable solution to enhance healthcare knowledge and skills.

Key Innovations:

1. The blended learning-program combines traditional first aid knowledge with modern technology. Participants use a dedicated smartphone application, First Aid in Africa, to learn first aid topics at their own pace. The content is presented in the local language, contextualized, and reinforced with illustrations and interactive quizzes. This blended learning approach makes first aid education accessible, even in areas with limited resources.

2. The in-house development of the First Aid in Africa smartphone application allows users to download country-specific content, with minimized data size for cost-effective and swift downloads. The application is designed to function offline, ensuring accessibility in regions with high mobile data costs. It provides two distinct environments: one for emergency situations, offering life-saving guidelines, and another for the learning experience, delivering comprehensive first aid education. The smartphone application serves multiple purposes for Red Cross/Red Crescent national societies (RCRC-NS), enhancing disaster preparedness capabilities by sending push notifications to users about (oncoming) disasters. It also facilitates the collection of scientific data on first aid actions, injuries, and illnesses, contributing to ongoing research and improving guidelines. Additionally, the in-app reservation system provides income-generating opportunities for RCRC-NS.

3. The content is developed through an evidence-based approach, involving a panel of African experts with hands-on experience as first aid trainers in sub-Saharan Africa. This ensures that the content aligns with the latest scientific research, respects cultural nuances, and addresses the specific needs of the target audience.

The FABL program has the potential to catalyze broader positive impacts in the following ways:

1. The blended learning approach makes first aid training scalable and accessible in regions with limited resources. The smartphone application can be adapted for use by RCRC-NSs globally, expanding the reach of effective first aid education.

2. The collection of scientific data through the application provides valuable insights into first aid actions, enabling continuous improvement of guidelines. This data-driven approach can influence broader practices in the field of first aid and emergency response.

3. The commercial possibilities created by the in-app reservation system offer financial sustainability for RCRC-NS, potentially inspiring similar revenue-generating models in other humanitarian and healthcare initiatives.

4. By overcoming challenges such as resource scarcity, shortage of trainers, and training time commitments, FABL has the potential to change the landscape of first aid training in LMICs, making it more feasible and impactful.

The long-term objective of the FABL-Program is to improve community resilience and reduce mortality rates in low-resource settings, particularly in Sub-Saharan Africa, by enhancing access to high-quality first aid training.

Program activities and outputs: Implementing the FABL-program

• Crafting guidelines grounded in local context and supported by scientific evidence to ensure relevance and effectiveness.
  • Output: Contextualized and evidence-based first aid guidelines are created 
  • Status : DONE
• Piloting the FABL-Program in Zimbabwe, Rwanda, Tanzania, and South Africa using an existing First Aid app, gathering insights for refinement.
  • Output: Evaluation report with insights and recommendations. 
  • Status : DONE
• Creating a learner-friendly smartphone app, "First Aid in Africa," to facilitate blended learning and engagement.
  • Output: Developed and functional "First Aid in Africa" smartphone application. 
  • Status : DONE
• Develop specialized manuals to guide the 1-day practical training component, aligning with the blended learning approach.
  • Output: Specialized FABL-training manuals for practical sessions.
  • Status : DONE
• Implementing the FABL-Program across targeted regions to ensure widespread availability and access.
  • Output: Successfully rolled out FABL-Program in multiple Sub-Saharan countries.
  • Status : DONE
• Undertake scientific research to measure the impact of FABL training on learning outcomes and helping behavior, informing evidence-based improvements.
  • Output: Scientific research report detailing impact assessment and recommendations. 
  • Status : ONGOING
• Continuously learning from implementation, user feedback, and research outcomes to refine and enhance the FABL-Program.
  • Output: Iterative improvement plan based on continuous learning.
  • Status : ONGOING
• Actively delivering humanitarian and commercial FABL trainings in the areas served by Red Cross and Red Crescent National Societies (RCRC-NS).
  • Output: Conducted FABL trainings in both humanitarian and commercial setting. 
  • Status : ONGOING
• Integrating the FABL-Program into the institutional first aid framework of RCRC-NSs to ensure sustainability and long-term impact.
  • Output: Institutionalized FABL-Program within RCRC-NSs. 
  • Status : ONGOING

• Creating a strategy for financial sustainability, exploring commercial avenues to support the continued success of the FABL-Program.
  • Output: Developed commercial strategy document outlining financial sustainability pathways.
  • Status : ONGOING

Longer-term outcomes :

• Enhanced access to high quality first aid training and evidence based  first aid guidelines in Sub-Saharan Africa through the FABL-program integration into RCRC-NSs first aid curricula. 
  • By reducing resource-constraints, the  accessibility to first aid-courses is increased. When this enhanced access is leveraged the right way, more people will benefit om first aid skills and knowledge, building more resilient communities. 
• Enhanced financial self-sufficiency of RCRC-NS for greater operational autonomy.
  • By reducing resource-constraints, the accessibility financial viability of the first aid-courses is increased when these are commercialised. Additionaly, the app will create more leads and a competetive advantage for the RCRC-NSs is created. More revenue through this kind of commercialised humanitarian action, will increase the fincancial resilience of the organisation, making them more powerful and stable for when the targetted population is in need. 

Improved community resilience and decreased mortality rates in Sub-Saharan Africa

The core technology that powers the FABL training program is the smartphone application named "First Aid in Africa." This application serves as a multifaceted tool designed to address various challenges related to first aid training and healthcare knowledge dissemination. The key technological components of the solution include:

• Smartphone application (First Aid in Africa): The application is developed in-house by BRC-Fl and is freely available on both the Google Play Store and iOS App Store. Users can download and install the application on their smartphones to access first aid training and emergency assistance.

• Country-specific content : Upon installation, users are prompted to select their country and preferred language. The application then downloads country-specific content directly to the user's smartphone, ensuring relevance and accessibility.

• Offline functionality: The application is fully functional offline, allowing users to access first aid information even in regions with limited internet connectivity. However, certain features, such as the database-connected admission test and booking tool require an internet connection.

• Two environments within the application:

  • Emergency-oriented environment: This section provides step-by-step, life-saving first aid guidelines tailored to specific emergency situations. Users acting as first-aiders can access user-friendly guidelines and decision trees to navigate appropriate steps during emergencies.
  • Learning environment: This section forms the backbone of the FABL approach, allowing users to engage in comprehensive first aid education. It includes 17 essential first aid topics presented in the local language, interactive quizzes, and a structured learning path.

• Interactive Learning Features: The learning experience is enriched by interactive quizzes, allowing users to assess and enhance their knowledge of specific first aid themes. The application also includes a 'Courses' page guiding users through the FABL training steps.

• Online admission test and booking system: Users who successfully complete the in-app learning can take an online admission test, and upon scoring 80% or higher, receive an admission code. This code enables them to book a 1-day practical first aid course through a form linked to an Airtable database.

• Scientific data gathering capacity: The application allows for the collection of valuable scientific data on first aid. This data includes information on the actions taken by first aiders, the most frequent injuries and illnesses addressed, and potential enablers and threats in first aid provision. This data can be used to tailor first aid guidelines and enhance the understanding of user needs.

  • At the moment of writing, this feature is under development

• Disaster Preparedness Features: The RCRC-NS can use the application to send push notifications, warning users about (oncoming) disasters and providing vital recommendations. This enhances disaster preparedness capabilities.

  • At the moment of writing, this feature is under development

• Evidence-Based Content: The content provided in the application is developed through evidence-based practice, aligning with the latest scientific research findings and considering practical insights from experts in the field. A distinguished panel of African experts actively involved in first aid education and emergency medicine contributed to the development of guidelines and content.
  

Project team : 

• 1 team lead (half-time)
• 1 assistant to the project manager (20% of jobtime)
• A steering commitee of 4 executives, the project team-lead and the IT-teamlead

IT-development team

• 1 team lead (20% of jobtime)
• 1 developer (33% of jobtime) 

The solution originated in 2019, and by 2020, a proof-of-concept was created and piloted in 2021 using an existing first aid app from The International Federation of Red Cross and Red Crescent Societies - Global Disaster Preparedness Center. In 2022, the development of a dedicated FABL app commenced and was completed by year-end. The app was officially rolled out in 2023. Currently, the project is in the scaling phase, starting in 2023, progressively expanding its reach to more Sub-Saharan African countries.

The solution team is exclusively comprised of employees from the Belgian Red Cross-Flanders. During the development of the solution, employees of partnering Red Cross/Red Crescent National Societies were consulted. 

The HR and recruitement policy of National Societies aligns with the fundamental principles of the Red Cross - Red Crescent movement. A detailed explanation of these principles can be found here. 

The FABL solution is funded by diverse income streams:

Donors
The program is integrated into various development initiatives secured by the organization. Institutional donors, such as the Belgian Government's Directorate-General for Development Cooperation and Humanitarian Aid and the European Union's Directorate-General ECHO, provide financial support for the application's rollout across multiple Red Cross and Red Crescent National Societies (RCRC-NSs), including examples like Rwanda, Burundi, and Uganda.

Own contribution
Designating the project as 'strategic,' the Belgian Red Cross-Flanders is fully invested in the solution. The organization covers the development costs of the solution and application using its own funds, underscoring a strong belief in the project's success and it's willingness to be an innovative actor in the humanitarian field.

Cost-Sharing model:
To sustain the ongoing operational and maintenance expenses of the application, Belgian Red Cross-Flanders implemented a cost-sharing model in collaboration with the implementing RCRC-NSs. This innovative approach ensures financial sustainability as the implementing RCRC-NSs contribute through commercial revenue generated by FABL. The cost-sharing model, characterized as a scalable and risk-free freemium model, offers different types of licenses for RCRC-NSs to choose from based on their specific needs. This approach is elaborated further in the accompanying illustration.