MobileActive.org

This guest-post is by Arturo Morosoff who completed recently a project with D-Tree International and BRAC Tanzania to provide videos on mobile phones to assist Community Health Workers (CHWs) for health education. It is posted here with permission.

I recently completed a five week volunteer project working with Irene Joseph and Gayo Mhila of D-Tree International to provide videos on mobile phones to Community Health Volunteers with BRAC Tanzania in the Mbagala district of Dar Es Salaam.

A bit about me: I have no formal training in ICT or public health. My background is in technology and business and I live and work in the San Francisco Bay Area in California.  I was on a two month trip in Tanzania and volunteered to help D-Tree with this project.  As such, the project needed to be completed in a short time and we began with modest goals.

Among BRAC’s programs to help alleviate poverty is its health program, which relies on an all-female team of Community Health Volunteers (CHVs) to conduct monthly home visits to provide health education and support. Each CHV visits 150 – 200 homes each month, asking health related questions and providing healthcare information.  In Tanzania, D-Tree has been collaborating with BRAC to provide the CHVs with a mobile phone-based tool called Commcare, to help improve the effectiveness of their home-based programs.  About a year ago there was discussion with the CHVs of providing them with health education videos suitable for use on phones to provide additional support for their home visits.

This idea was inspired by Divya Ramachandran’s work with the First Day’s Project in India. (Thanks Divya!). My project was to help create these videos. The initial goal was to work with the CHVs to develop some video concepts, develop a process/workflow to create videos and possibly complete one to two initial videos to get the project started. I had five weeks to complete this, but thought that it would be feasible to get at least one video done.

After a kickoff meeting and a handoff of some video equipment (a Canon Vixia HF-10 FullHD video camera and a tripod), the project began.  I had some limited prior video experience and thought that I’d be able to figure out the technical aspects of file conversion and editing required to get the videos onto the phones (Nokia 3110 and 2700). The first week we had a meeting with the CHVs to discuss the project and the video concepts they would like to see.

This turned out to be a very productive meeting and I was impressed to see how much enthusiasm the CHVs had for the project.  They had many ideas and the conversation was lively.  They were also very receptive to my input and in the end, we emerged with eight video concepts, seven of theirs and one that I introduced.  They wanted to have a video to introduce BRAC and its various programs, a video to cover each of the health issues that they deal with regularly, and one on entrepreneurship (to help explain the BRAC micro-finance program). Additionally, I suggested we produce a video to explain how the BRAC/CHV process works since I had heard that they often encountered resistance in some households when people didn’t recognize the benefit of hearing the same questions every month. The video concepts were:

• Video 1:  Introduction to BRAC
• Video 2:  Tuberculosis and HIV (since these often occur together)
• Video 3:  Malaria and Diarrhea (since these often occur together)
• Video 4:  Immunization
• Video 5:  Family Planning
• Video 6:  The BRAC / CHV Process
• Video 7:  Safe Drinking Water
• Video 8:  Entrepreneurship

The CHVs also had definite opinions about who would be the best speaker for each of these topics.  We agreed that the video format would be very simple, just 1-3 minutes for each topic, typically with just one speaker per video (head and shoulders shot).  The speakers selected were nurses, doctors, BRAC staff (a doctor, CHVs, and the office director), and members of the community who would provide testimonials. 

The CHVs wanted an assortment of characters:  people that would be seen as authority figures as well as people they could trust and relate to.  We decided that the content for the videos would come from the CHV training manual for consistency.  Irene and I would develop the scripts, which were then approved by one of the BRAC TZ doctors.

I was so impressed with the enthusiasm of the CHVs that I decided at the meeting that I would try to get all eight of the videos created by the time I left.  I felt that much of the work was going to be in sorting out technical issues and that there were efficiencies to be had from grouping many of the tasks (script creation, filming, etc.) so that we would be able to pull it off.

In the days following the meeting, we laid out a plan of attack and began completing all the steps to prepare for filming and editing during my final week.  We procured the training manuals, developed a script template and scripts for each of the videos (first in English, then Swahili), and in tandem sorted out all the technical issues.  We decided to keep the script fairly simple and to focus on communicating a few concrete actions that viewers could both remember and execute to improve their health.  I’ll spare you the details, but it took quite a bit of time to find the proper conversion software to convert the files from our Full HD video camera to files that could be edited in Windows Movie Maker (we tried to use free/simple software tools as much as possible). 

By the last week of my trip, we had a full set of scripts, we had scheduled three days of video shoots with our speakers, had all the software tested to convert/edit video files, and had all the video equipment tested and ready to go.  We filmed one video on Tuesday, five on Wednesday (at BRAC), and the final video on Thursday.  We were unable to complete the Entrepreneurship video only because the speaker wasn’t able to prepare her script on time.  Each evening, we converted the video files and finished all editing on Thursday and Friday. We then tested the videos on the Nokias and additionally tested videos on the Google Nexus One that will be used in a separate e-IMCI project.

The speakers were all extremely cooperative and easy to work with. The CHVs in particular were very excited (and nervous!) to be filmed and seemed to particularly enjoy the review of each take as we filmed, showing great support for each other.

In addition to leaving the videos behind, I hoped that this project would be only the beginning of the video project and wanted to pass on what we learned.  To this end, I created a “Video Creation Guide” that explains in brief all that we learned and some practical tips to using the D-Tree equipment set and the software used.  This guide and supporting materials are attached, in the event that you might find it useful in creating your own videos.

In the two weeks since I’ve left, Irene has met with the CHVs and provided each of them with videos on their mobile phones.  CHVs were instructed to pause the videos and check for understanding.  So far the feedback from the CHVs is quite good, they like using them with their clients, found that people were very engaged and ask many questions about the topics and may ask to see the video several times.  This has been quite encouraging, as we hoped that the videos would serve as a conversation starter, increasing community interest in discussing and learning about ways to improve their health.

Going forward, the hope is that D-Tree can do some more thorough studies of which videos work best, the impact of the videos on clients’ health behaviors, and incorporate some of the learnings into future videos in this and other projects.

Some additional thoughts:  We elected to use primarily head and shoulder shots (talking heads) in our videos for simplicity in filming and because we thought that would make for easy viewing given the limited screen size of the Nokia handsets (3110 & 2700 models).  Despite the small screen size, we did use text slides to help prompt the CHVs and to reinforce the desired actions. It was our feeling that larger screen sizes might lend themselves more to use of “action” shots and more interesting composition.

While we have yet to do any thorough testing of the videos, we have a few ideas for simple ways in which these videos might be improved:

• Incorporate images to serve as memory joggers
• Include summary text slides to reinforce desired actions (we did
• this)
• Insert question slides
• Insert pause prompts to help CHVs remember to pause the video to ask
• questions (currently the CHVs have to pause the videos manually.  Note
• that Divya uses software that actually pauses the video at the
• appropriate points.)
• Include “action” shots that reinforce the actions we hope viewers to
• adopt (e.g. video of someone boiling water to purify it)
• Include more concrete actions that we expect people to take (e.g. as
• opposed to encouraging people to drink clean water, define how to
• access/make clean water)

You can find the videos here: (Note:  All videos are in Swahili)

• 1 - Introduction to BRAC
• 2.1 - TB/HIV + Summary (~9 minutes - far too long!):
• 2.2 - TB/HIV (No summary, but there is a brief conclusion at the end
• of the TB section and at the end of the HIV section ~7min):
• 2.3 - TB (~4min)
• 2.4 - HIV (~3:30min)
• 2.5 - TB/HIV Summary (~2min): 
• 3.1 - Malaria/Diarrhea (~2min)
• 3.2 - Malaria (~1min)
• 3.3 - Diarrhea (~1min)
• 4 - Vaccination (~2:30min)
• 5 - Family Planning (~2:30min)
• 6 - The BRAC/CHV Process (~3min)
• 7 - Safe Drinking Water (~2min)

Photo courtesy BRAC Tanzania