ICATT: Computer-based learning program for health professionals in developing countries

Infant mortality is one of the most urgent problems of developing countries. For years WHO has been trying to reduce mortality and morbidity rates in children under the age of five. One answer to the problem is Integrated Management of Childhood Illness (IMCI), an integrated approach for the management of the most common childhood diseases, including, among others, diarrhea, malaria, measles, malnutrition, and HIV/AIDS. IMCI has been introduced in more than 75 countries around the world. The generic IMCI clinical guidelines need to be adapted at the country level, which can be a long and cumbersome process.

Closer to the people 

IMCI contains a training program for health service staff that facilitates a rapid diagnosis of the most common diseases by applying simple basic principles. Every year, various IMCI courses are held around the world for doctors, nurses, and other healthcare professionals. The generic IMCI course lasts up to 11 days and requires a substantial effort on the part of the organizers. During the courses, however, the people to be trained are not available to the health service for up to two weeks. In addition, health services in developing countries show high staff fluctuation rates. The demand for IMCI courses thus far exceeds the number of courses that can be offered. There is therefore a case for training to be brought closer to the people who need it, and also for training times to be reduced or the training itself to be organized in a more flexible way.

A solution to this problem has been developed by the Novartis Foundation for Sustainable Development, together with WHO, in the form of a computer-based learning program for IMCI known as ICATT (IMCI Computerized Adaptation and Training Tool). At the national level, this program is aimed at professionals entrusted with adapting the IMCI clinical guidelines and/or designing training courses in IMCI. Once the adaptation is finalized, they can then close the tool and distribute it to other users in the country for training purposes. Using ICATT it is possible to introduce new learning methods (e.g., distance learning, self-study). The spread of this training program via computer thus offers the advantage of more flexible training possibilities in various settings.

Simple and fast

The training program has a simple structure, making it easy to understand for people who are not used to working with computers. Learning is based on the four components of “read,” “see,” “practice,” and “test.” The first part offers students key information about the training unit as well as further reading. In the “see” part, what has been described in texts is illustrated and explained by means of videos, images and sound. The third part offers simple practical exercises. The fourth part lets students test themselves on the knowledge they have acquired.

What makes ICATT such an invaluable tool is that the program can be quickly adapted to new developments or country-specific circumstances. Ultimately, the aim is for ICATT to be applicable worldwide. WHO provides a generic program, which can be supplied with relevant data by individual countries and kept constantly up to date. This considerably shortens the time needed for the regular adaptation of clinical guidelines. ICATT is thus a cost-effective tool through which human and financial resources can be freed up and deployed for other tasks.

Positive feedback

ICATT has been tested for its user-friendliness and functionality in various beta tests both in Basel and also in Zambia with representatives of all WHO regions, training experts, and first-level health workers. In 2008, the ICATT software was sent to all IMCI-implementing countries. With the support of the Novartis Foundation, Peru, Tanzania and Indonesia have already started the adaptation process. In those countries, first ICATT training courses were conducted. Close monitoring will be crucial to document the early findings and to share it with other stakeholders who are potentially interested in using the tool in the future.