Years ago I met Devaji Patil in Bangalore, India and … I related to his spirit and wisdom. Devaji is a philosopher at heart and a medical doctor by profession. In his new job he wants to set up mobile health projects, but at the same time he wants to make sure they will be durable and basically… make sense to the people it is designed to help. So he challenged me with some tough questions comprising ethics, meaningfulness, gender challenges and effectiveness of learning with mobiles. I could get some thoughts in, but I feel many more people are needed to answer his questions in full, so feel free to add ideas or send Devaji additional answers.
1. how are we sure that mobile learning is really empowering
For ages people, both philosophers and lay-people, have been discussing the empowerment of learning or education in general. Looking at the Millennium goals, I can see that most of us still believe in it, but even the most basic primary education is not reached yet. I think this is due to lack of durable, educational vision. Any learning, including mLearning will only be empowering if it is made accessible to all, inspiring, comprehensible, participative as well as collaborative, with guidance for those learners that feel the need to have a guide-on-the-side and most of all durable within a flexible learning environment. Looking at teachers that are real corner stones of education, they know how to appeal to their learners, lift their spirits, inspire them to reach their full potential. That type of teacher is creative, knows how to reach his/her learners and find the strength within the learner. This being said, I feel that every learning is based on inspirational, creative people with vision and trust in the future of their learners. As such I am sure Devaji that if you set up mLearning courses, they will be empowering.
2. how to actually negotiate the barrier of technology to an 'illiterate' health worker?
The best way to negotiate the barrier is by using what they use, or trying to reimagine new technology with how they use old or known technology. It is not necessary to read if you have a phone, in that case speech can be enough to exchange knowledge/information. So basic cell-phones can be used as help-lines, where patients phone in, and health workers phone back.
If the spoken feedback of the health care workers are than added to a data-base after ‘speech to text’ software, this database can be used for future cases. At the same time radio transmissions offer a great, non-reading, durable way of getting knowledge (continued medical education) distributed to large crowds in a less expensive way, and radio is a mobile device. A case study using radio for this reason (in Philippines for rural farmer women) is linked here (http://www.tistr.or.th/RAP/publication/1999/1999_08_rome.pdf ). What strikes me is that funding is much more difficult to get for this type of proven, mobile learning than small scale smartphone projects (but that is another discussion).
3. with rapidly changing technology ... what is happening to pedagogy? Does pedagogy change too ? As fast as technology ?
Good pedagogy stands apart from technology, but technology can be used to get good pedagogy out to the masses and via distance education (reaching the difficult to reach, in every sense of the word). I feel that pedagogy is very human, and as humans only change slowly, good pedagogy will also only adapt to the pace in which humans can reach their own bigger potential. However with the evolution of technology, the variety of teaching/learning that can be reached via distance education does evolve more rapidly than before: which means that more people can be reached based on the same concepts of good pedagogy (e.g. participation between rural health care workers is now possible by using simple cell-phones).
4. Are we in a position to make 'learning' a central theme of Health systems strengthening if we are then where is it being seen if not why not ?
The knowledge and application of durable and scalable mLearning is still in its early beginnings. In just a couple of years’ time mLearning starts to take off. This means that a lot of projects did not take off due to lack of knowledge about all the factors impacting a project or target population, other projects do take off but are sometimes stopped due to non-durable options… And sadly those projects not attaining what they were meant to obtain are rarely disseminated, although most of us are eager to learn from mistakes to ensure successful future endeavors.
To me learning or training should be at the center of any system, including health systems. The concept of Lifelong Learning did not come out of the blue, but came out of an awareness that constant education will be a must in a world where changes happen increasingly rapid.
A stable, durable health system will have learning and specifically continued medical education embedded in its core, for without keeping health care workers, health managers… up to date on latest changes, the patients will not be reached with optimal health care. In relation to this, I share this National Health Service (United Kingdom) paper focusing on 29 recommendations for embedding mLearning in their health care system http://ignatiawebs.blogspot.be/2011/04/how-can-health-within-clinics-be.html these recommendations do not always apply to more challenged regions, but some of them can indeed be implemented.
5 Why is human interface still important. ?
For trust, real understanding, and for reaching those that need some time to voice the problems they are facing, and to reach those that feel insecure or unable to share text.
6. How to / Why / Where/ When to place technology enhanced learning in health systems that are not just weak ... but actually in a disintegrated state?
That is something else, if a system is in a disintegrated state it needs to be rebuild from the ground up I guess. In that case technology might be used to start communicating about most urgent issues but … if a basis is unstable, you can be sure that any rapidly designed technological addition will only amount to even more disruption.
7. Is technology gender sensitive ? Technology is definitely gender sensitive. It has the old stigma (male’s are better at it), the new social-economic realities (women have less access to technology) and the gender digital divide. There are exceptions, but it is an uphill battle to get women on an equal opportunity base regarding technology or its related solutions. To that topic I refer to GSMA’s woman mobile initiative: http://www.mwomen.org