ICATT: Innovative e-learning tool for training in childhood illnesses
In 2009, more than eight million children died before reaching their fifth birthday, most of them in developing countries. The majority of these deaths could have been prevented through a relatively small number of simple low-cost interventions such as pre-, ante- and post-natal care, vaccinations, and antibiotics. The technical guidelines for these interventions exist, but effective application by trained health workers at various levels in the health system is still lacking.
To support and scale up training of health personnel working with sick children, the Novartis Foundation for Sustainable Development (NFSD), together with the World Health Organization (WHO), developed an e-learning tool for Integrated Management of Childhood Illness (IMCI). IMCI is a WHO/UNICEF strategy that aims to significantly and rapidly reduce infant and childhood mortality. The new software is thus called ICATT (IMCI Computerized Adaptation and Training Tool) and is available free of charge. Tanzania, Peru and Indonesia have been the first to adapt ICATT and use the e-learning tool for training in IMCI. Results from these countries show that ICATT can reduce training time and costs and allows for faster and more flexible upscaling of IMCI training.
Integrated WHO strategy to improve children’s health
Deaths in children under five have declined steadily worldwide from 93 per 1,000 live births in 1990 to 72 in 2008. Nevertheless, even today eight million children per year die before reaching their fifth birthday. A child born in a developing country is over 13 times more likely to die within the first five years of life than a child born in an industrialized country. In sub-Saharan Africa, one in seven children dies before his/her fifth birthday. Most common causes are respiratory infections (mostly pneumonia), diarrhea, measles, malaria and malnutrition.
Source: UN Millennium Development Goals Report 2010
Seventy percent of these deaths could be prevented or treated through relatively simple interventions including pre-, ante- and postnatal care, childhood vaccinations, antibiotics for common infectious lung diseases such as pneumonia, zinc and electrolyte solution for diarrhea, and nutritional interventions. Several isolated interventions have proven effective, such as prompt malaria treatment or vaccinations to reduce measles. Many children, however, have overlapping symptoms of diseases and a single diagnosis can be difficult. What is therefore needed is an integrated approach addressing the overall health of children. Integrated Management of Childhood Illness (IMCI), developed by WHO and UNICEF, is one of the cornerstones of the drive to reach the child health-related Millennium Development Goals. It has three components:
- Improve case management skills of healthcare staff,
- Improve overall health systems, and
- Improve family and community health practices.
To date, more than 100 countries have adopted IMCI as a strategy to improve child and infant health. The introduction of IMCI at country level requires a great deal of coordination among existing health programs and services. Main challenges include the adoption of national IMCI guidelines on a regular basis as well as training and retraining of a sufficient number of staff in IMCI.
Innovative technology to scale up IMCI training
In order to scale up the IMCI workforce, the Novartis Foundation has supported the WHO Department for Maternal, Newborn, Child, and Adolescent Health in the development of an innovative e-learning tool. ICATT (IMCI Computerized Adaptation and Training Tool) enables a large number of health workers to be trained in IMCI in a cost-effective way without a loss in quality.
At the same time, ICATT is an open, flexible software and allows for technical updates, different languages and country-specific circumstances. The generic ICATT version is a starting point for creating national and local IMCI training courses according to the relevant categories of health staff and desired languages (see figure 2). This is done by the responsible department for adapting the IMCI guidelines at the national Ministry of Health and medical or paramedical schools, often supported by WHO. The number of training units can be varied. Videos, pictures, sounds and any document can be integrated into ICATT and, if needed, linked to the training course. The process of adapting the technical IMCI guidelines is facilitated and new guidelines can easily be incorporated.
Once ICATT is adapted to national requirements it can be “closed” and the training player can be distributed to IMCI training institutions. The software can then be used for both pre-service (students) and in-service use (refresher courses for health workers). Any medical and paramedical personnel including nurses, midwives, doctors and medical assistants can be trained through ICATT.
The software creates a profile of the user and monitors the trainees’ progress throughout the training. To run the software, a trainee has to have access to a computer but no specific computer skills are needed. The program can either be installed on a computer or run directly from a CD-ROM or memory stick. The most recent version of ICATT released in August 2011 is also equipped to run on intranets and internet sites as well as the World Wide Web, creating global access to the training.
The first English version of ICATT was released in May 2008 together with a moderated website (www.icatt-training.org) to assist and provide software updates for ICATT users. Russian, French, Spanish, Portuguese, Swahili, Indonesian and Khmer versions have been released and others are under development. The copyright of ICATT belongs to WHO and the Novartis Foundation but the program can be used free of charge by anyone for health-related training without commercial purpose.
Successful implementation to date
In 2008, the ICATT software was piloted and tested in Tanzania, Peru and Indonesia. Results showed that adaptation of national guidelines was facilitated specifically because ICATT allows the creation of several different training packages to serve different categories of trainees. Costs were reduced as ICATT does not require printing of hard copy training material. As for the training itself, three different approaches have been tested:
- classroom training with individual computers,
- classroom training with projector, and
- distance learning.
Each type of training showed some strengths but also bears some challenges. Classroom teaching with individual computers for example allows for working at individual pace while interaction with a facilitator is ensured. Though the need for a large number of computers is obviated when teaching with a projector, ICATT training is more demanding for both students and facilitators and monitoring training progress is difficult. Distance learning cuts down costs even more as no travelling and physical attendance is needed. Disadvantages, however, include the need for regular access to a computer and potential lack of motivation or interaction with the facilitator.
All in all, ICATT courses proved to be more cost-effective because no print outs are necessary and the course can be done in a shorter period of time compared to traditional IMCI training. This also allows more time for clinical practice. The feedback from students was also very positive, reflecting the user-friendliness and flexibility of the tool compared to other e-learning programs.
Global roll-out of ICATT
To date, a number of other countries have also started introducing ICATT for adaptation and training. WHO estimates that in total, 12 countries have completed adaptation through ICATT (Cambodia, Fiji, Indonesia, Kiribati, Malaysia, Mozambique, Peru, Philippines, Solomon Islands, South Africa, Tanzania, and Vietnam) and seven of them have started to implement training. To further scale up, the WHO conducted a Global Orientation and Capacity-Building Workshop at the end of 2010 and has organized several regional workshops in the course of 2011. The Novartis Foundation is supporting the regional workshop in Western Africa held in Mali.
Sirius Technologies has further developed ICATT to enable the training player to be run on an internet browser. On the one hand, this will allow training institutions to teach ICATT through their intranets or internet sites. On the other hand, as of 2011 the ICATT training player is also hosted on the World Wide Web, giving access to IMCI training to students around the world.
The potential of ICATT as an alternative training approach has also been recognized by other health programs which are not related to IMCI. The software is currently used to develop training courses such as on the Convention on Rights of the Child for WHO staff and on Chronic HIV care as part of the Integrated Management of Adolescent and Adult Illness course.
New partnership for maternal and newborn health
Apart from child diseases, one of the biggest challenges today is maternal and newborn mortality
. Every day, up to 1,500 women and up to 10,000 newborn babies die due to complications in pregnancy and childbirth. A woman in a developing country is 300 times more likely to die during childbirth or due to pregnancy-related complications than a woman in a developed country. To tackle these challenges, training in maternal and newborn care must be scaled up globally.
Thus, the Novartis Foundation and the WHO decided to continue their collaboration in order to develop an e-learning tool for training in Integrated Management of Pregnancy and Childbirth (IMPAC)
. The tool is based on the ICATT software and will comprise training modules in pregnancy care, childbirth, newborn care, postnatal maternal care and postnatal newborn care.
The tool will be developed together with a new partner, the Swiss Tropical and Public Health Institute (Swiss TPH)
. The first course module on Essential Newborn Care is under development and ready for testing by the end of 2011. To ensure sustainability and make use of synergies within Swiss TPH, the technical work of the software maintenance has been transferred from Sirius Technologies to the Swiss TPH.