In 2021, a pilot group of community health workers in Ethiopia began using a training app as part of a new blended learning curriculum. Developed in partnership between Last Mile Health and the Ministry of Health, Extension Essentials is an open-source learning app that delivers content directly to community health workers’ tablets, assisting them with building their knowledge and skills as well as improving quality of care and providing resources to share with their patients.
Today, the blended learning approach—which includes face-to-face and digital learning opportunities, including on the Extension Essentials app—is being scaled to all 40,000+ of Ethiopia’s community health workers (known nationally as health extension workers). The Ministry of Health has formally adopted this effective, affordable approach, and is working with Last Mile Health to develop blended training modules for each training topic in the community health worker in-service training curriculum.
Recognizing the transformative power of the Extension Essentials app, the Ministry selected it to be featured at the National Health Exhibition in Addis Ababa in summer 2023—an exciting moment for the future of blended learning in Ethiopia’s community health workforce. “Presenting the Extension Essentials application on the health exhibition as an illustration of an effective digital solution to a broad audience—including medical specialists, business leaders, policymakers, and the general public—allowed us to demonstrate our impact, fostered networking opportunities, and raised awareness of Last Mile Health’s work in Ethiopia,” explained Bezawit Mulugeta, Last Mile Health Ethiopia’s Multimedia Production Coordinator.
Digital solutions at the community level
The National Health Exhibition, “Harnessing the power of technology and digital solutions for a prosperous and healthier future,” showcased more than 170 projects on topics ranging from traditional medicine to digital health. Thirty-two digital health solutions were featured—but the Extension Essentials app was the only digital project representing the Health Extension Program, Ethiopia’s community health program. For more than 210,000 visitors throughout the Exhibition’s 37-day run, the Extension Essentials exhibit demonstrated the impact and power of innovation and technology on the community health system.
Wondesen Nigatu, the head of Community Engagement and Health Extension Service Desk with the Ministry of Health, said, “Our main objective in presenting the Extension Essentials app was to inform the public of the beginnings and status of the health extension program and the method used for health extension workers’ capacity building training.”
The visitors included members of the public, Ministry and regional officials, volunteers, health professionals, and community health workers who have not yet been trained on the app. “The exhibition taught us that the urban community needs to learn more about the health extension program as it is implemented in rural areas. As a result, we have worked to change this and demonstrate what we have been doing for the past 18 years, such as model households and the blended learning capacity-building app Extension Essentials,” said Wondesen.
The exhibition demonstrated the Ministry and Last Mile Health’s shared commitment to improving healthcare services in rural and remote communities. “It’s a huge opportunity,” Wondesen shared. “So far, we have been working on four regions, and showcasing the Extension Essentials application at the exhibition pushes us to commit further.”
Showcasing the app has introduced a new, larger audience to the proven impact of the app—and its potential at scale. “Before Last Mile Health and the Ministry of Health launched the blended learning training that includes the Extension Essentials app, we were using the traditional face-to-face training method, which had communication limitations and was ineffective,” Wondesen explained. “This training tool is cost-effective and time-saving for both the student and the trainer. Now, Last Mile Health and the Ministry of Health are discussing how to expand the training, prepare the other modules, and spread it to all regions and districts to fulfill the need.”
The crucial next step for blended training and the Extension Essentials app: scale. The Ministry and Last Mile Health are working to ensure its availability and accessibility to Ethiopia’s entire community health workforce, covering all training topics and expanding to include additional regional and local languages. Currently, the Ministry and Last Mile Health are finalizing the next blended training module, on noncommunicable and major communicable diseases. After a group of 100 community health workers tests the new module, it will be implemented with a group of 1,400—and then cascaded into the scale-up of the first blended training module in reproductive, maternal, neonatal, and child health. We will design the remaining modules in the near feature. “Expanding the blended learning approach to other integrated refresher training modules will allow health extension workers to access up-to-date learning content on even more content,” shared Last Mile Health’s Bezawit Mulugeta. “This can enable them to continuously update their knowledge, as well as to use videos as a teaching aid for delicate subjects like breast cancer physical examination.”
Once nationally scaled, the blended training approach will enable the Ministry to standardize high-quality training and improve quality of healthcare service delivery. “We aim to adapt the platform to serve as a blended learning tool for all modules and implement the blended approach on all woredas,” Wondesen explained. “Doing this is crucial because it is a tool that will allow health extension workers to update their knowledge constantly.”