Four examples of methods of showing MAF Films
Example 1: Community Education Using Portable Projectors, Chitambo, Serenje District, Zambia
Equipment Used
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Acer Pico Projector
Portable speakers
Portable Screen – locally made
Dark material/reed mats to block light from doors and windows
Knowledge change questions to engage in discussion
Solar charger for pico/in car charger for pico
Multiple plug charger with surge protection to charge equipment
Dry storage bags
USBs pre-loaded with MAF films (formatted for projector use)
Focus of Training
Outreach education is delivered each month by nurses, midwives and environmental health
technologists as part of the Ministry of Health’s strategy to improve health care education and child
immunisation in rural communities. In Chitambo, outreach is carried out in schools, and other
building or structures centre around 14 rural health posts.
Education on topics such as safe delivery, nutrition and warning signs in pregnancy already form part
of the outreach education so the films are now being used in place of standard talks from health
workers on various topics. These have been implemented into outreach in Chitambo since June
2012 and continue to be closely monitored.
Method of Screening
Nurses were trained in usage, storage and upkeep of the equipment and provided with support
guides for the equipment (including importance of shutting off equipment between screenings to
maintain battery life). They travel with the prepared screening pack to the outreach set up the
screen in the designated structure and screen the material. Various methods are adopted:
1. Nurses pause the film at certain points throughout the film to translate and engage the
audience in discussion as well as highlight key learning points.
2. Nurses translate over the entire film without stopping and then engage the audience with
discussions after the film has finished.
The various methods have however raised important next steps to provide support for health
workers on screening the films.
Our current advice is to ensure that, prior to using the films, the health workers conducting the
screening:
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Watch the film in its entirety: to familiarise themselves with format and language, and to
understand what is relevant to their setting and audience. Country guidelines vary so there
may be elements of the films that they may not want to show or may need to make sure
that they are well prepared to respond to questions.
Watch a second time: noting down when they feel they would like to pause and why.
Sometimes this allows an image to remain on screen and they can interact with the audience
and the image
Watch a third time: noting down key health messages or points of discussion they would
like to have with the audience during or after the film to make sure they are reinforcing
messages
Equipment details for purchase (based on our project):
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Acer C20 Pico projector – estimated cost GBP259
Speakers (portable – size dependant on audience) – est. cost GBP50 to GBP200
o speaker quality is important - as acoustics are poor and background noise inevitable
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Materials and cloth locally sourced to darken rooms – GBP100
o (heavy and dark, or if possible reed mats)
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USB (varying GB storage) – GBP10 to GBP15
White sheets for screens – GBP20
o Make these locally and to be free standing with white sheets time taken at location
Health workers’ perspectives as highlighted from our external review by Anthrologica include:
The health workers participating in the evaluation, all confirmed their feeling that ‘it was much
easier to get health messages across’ using MAF’s films. The films provided focus to their health
education sessions and enabled them to give consistent messages. They found community women
were more engaged with the films and believed that use of film (both seeing an image and hearing a
message) made it more likely that community members would retain the key information. As one
nurse concluded, ‘The films are great. When women in the communities see the messages they stay
in the minds much better. It works two ways. They understand the messages better, and are able to
remember them much longer…The films really make my job easier’. A number of health workers
stated ‘seeing is believing’ and felt that there was greater trust in the films as compared to verbal
messages, particularly when they included the depiction of Europeans.
The health workers suggested that the most effective films were ‘Warning signs in pregnancy’,
‘Management of post partum haemorrhage’ and ‘What and when to feed your child (6 to 24
months). ‘Warning signs in pregnancy’ was seen to fill an important knowledge gap. Very few
community members were thought to have knowledge of what the warning signs were in
pregnancy, and this film was thought to demonstrate them well. It was also suggested that this film
was particularly helpful in combatting potentially harmful traditional beliefs. ‘Management of post
partum haemorrhage’ was thought to be effective in teaching women in the community the point at
which bleeding was considered to be unsafe or abnormal. ‘What and when to feed your child (6 to
24 months) was regarded as helpful as many health workers felt there was a problem with
malnutrition in the area, a topic the film addressed. They suggested that showing images of food
and hearing key messages was more impactful than just discussing food needs with the mothers.
Case study 3: Susan
Susan is a 22 year old midwife with no children. Her husband works in the Copper Belt and she would like to
leave Chitambo so that she can be nearer to him. She studied for one year to become a midwife, and
eventually would like to receive more training. Susan participated in both the midterm review and final
evaluation. Her favourite film is ‘Warning signs in pregnancy’ because she feels that it saves women’s lives.
‘The films definitely are effective. Now the women are coming in much earlier with complications. For
example, one woman did not feel foetal movement, so she came in. They checked with a foetal heart monitor,
and there was none. She knew that it was a danger sign, so she came in. She knew this was a danger sign
because she had seen the films. Another woman from a health post far away came in because she had a severe
frontal headache. I checked the blood pressure, and it was normal. I checked the blood and tested for malaria.
She had malaria. The woman was treated, and discharged. She knew this was a danger sign, and came in
because of this. We also find that women who have a haemorrhage are recognising that they have a problem
and coming in earlier’.
Community perspectives
All community respondents felt that the films were very effective and concluded that seeing images
rather than being told information was a much more effective way of learning. As one mother
explained, ‘Before I didn’t know how to hold my baby when I was breastfeeding. Now that I have
seen it, I know how to. Seeing it helps more than just hearing it’. Another asserted, ‘I had heard the
messages before in ANC, and while I thought that I understood them there, I understand it much
better now that I have seen it in the film as well’.
Suggested Improvements
Our external review of this training by Anthrologica has provided us with some great insights for
improvement on these topics and our methods in order to support scale up of this initiative.
Engaging the audience at various points is very important. Images for “graffiti walls” and supporting
trainer packs with images to prompt memory with answers on the back would be excellent additions
to be included in these sessions.
There are many other suggestions in the full report please email MAF for more information
Example 2: Classroom based learning of Community Midwives, Hargeisa, Somaliland
Equipment Used
 College Projector
 Portable speakers
 Laptop
 Knowledge change questions to engage in discussion
 DVD’s and USB’s pre-loaded with MAF films
Focus of Training
This project aims to use educational films as a sustainable and impactful medium to support the
effectiveness, efficiency and scalability of training and education for nurses, midwives and
community midwives in Somaliland. The films are being used in the Community Midwife College in
Hargeisa, where they are forming part of the training curriculum.
Students are currently being education on topics such as safe delivery, nutrition and warning signs in
pregnancy and these films have been incorporated into formal training since November 2012. MAF
has collaborated with the Somaliland Nursing and Midwifery Association on the production of 4 new
training films for skilled health workers on the following topics which will be incorporated into the
training curriculum later this year:
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Administration of Parenteral Antibiotics
Manual Removal of the Placenta
The use of the Partograph
Focused Antenatal Care
Method of Screening
Films are being played on laptops and projected using college equipment onto a projector screen
with either DVDs or a memory stick preloaded with films. The lecturer is well prepared and prompts
lengthy and detailed classroom discussions on the issues shown. Time codes of films are noted to
ensure that certain elements that are deemed more/less appropriate for their audience and needs
are either ignored or paused for further discussions.
Suggested Improvements
MAF has now translated our suite of films into Somali. We are currently working on gathering more
detailed feedback on best methods of screening and will keep our users updated.
Example 3: Community and TBA education, Tororo, Uganda
Equipment Used (various)
 Television set, DVD player & Generator or portable DVD player or laptop
 Portable speakers
 Knowledge change questions to engage in discussion
 Dry storage bags
 MAF DVD’s
Focus of Training
The team at Hands of Hope in Uganda are working to improve the lives of women in the district
using MAF training films to deliver community education on pregnancy and childbirth to TBAs and
women in the community. In rural areas, nurses travel to inform the communities of upcoming
cervical cancer screening days. During these screenings, the Visual Inspection of the cervix with
Acetic acid (VIA) film is shown as women wait to been seen, ensuring that women understand why
they being screened and what the process will entail. This has been shown to reduce the fear of
screening and increase uptake of services.
Hands of Hope in partnership with the local Tororo Hospital have run cervical cancer screening days
since 2010 to educate women about the VIA technique. The film has also been shown to the nurses
at the hospital to remind them of the key steps involved at a VIA screening.
As well as cervical cancer, Hands of Hope have been showing community education films on to
improve maternal health education in the district and to improve understanding of services available
and uptake of these services.
Method of Screening
In this setting films are often screened outdoors using a either a portable DVD player or a laptop
with or without portable speakers as in the picture above. Staff at the Hands of Hope centre, have
been trained to use, store and maintain the equipment safely and correctly, however minimal
equipment makes for quite a simple set up. More recently the number of women attending to watch
the films has grown and a TV with DVD powered by a generator has been used.
The films are all in English and are shown in the presence of a nurse and project manager from
Hands of Hope who translates over the film to the community members. The nurse present
subsequently engages a discussion about key messages, questions and points of clarification from
the film, whilst assessing knowledge change amongst the group.
Suggested Improvements
Outdoor film screenings often draw large crowds, which although a positive does mean the image
size needs to be larger or groups are split, however this is not a good use of healthworker time – a
projector would work better if inside a closed structure such as a classroom with good speakers
however due to the cost, currently a TV/DVD player is used with a generator to be able to reach
larger audiences. The generator is expensive to run however so not the ideal situation.
The films are shown in shady areas to improve picture quality and as outreach workers translate
over the film ensure that all present can engage with the dialogue and participate in the audience
discussions after the film has finished.
Local translations would be ideal, and this is a common need when using films in similar settings
with community audiences. MAF is currently investigating best methods for local language
translation in various locations.
Example 4: eHealth/mHealth
The field of eHealth and mHealth is continually evolving and the impact on health worker training is
constantly being evaluated and improved. mHealth in particular is continually evolving to include
multimedia in pockets of the developing world where there is access to smart phone technology.
MAF films (among many other multi-media health content providers) have been loaded onto a
variety of e-learning platforms and mobile devices for both in- and pre-service health worker
education and community health worker education. We are yet to fully understand the ‘best’
format for presenting media to learners on these platforms but we are fortunate to be part of
others’ evaluations, which support MAF to continually inform and update our processes and work to
adapt our films to fit this growing demand.
Other NGOs, for example Jhpiego and AMREF, have integrated some of MAF’s films into their elearning modules. As this develops we will work to ensure that lessons learnt from these endeavours
will be shared.
The current download capabilities of mobile phones limit the size of file which can be downloaded.
MAF has begun the process of ‘chunking’ its current and future films to address this, where the films
are broken into smaller more digestible ‘chunks’ which will be easily downloaded and which will also
facilitate better incorporation into e-Learning projects and classroom delivered training.
You can also download smaller file sizes of our films from our VIMEO site – we find google chrome a
good web browser to access and download these films and you may need to ‘join’ vimeo to gain
permission which is free: https://vimeo.com/medicalaidfilms
Tablet learning, Health eVillages, Various Countries
Health eVillages, a program of the not-for-profit Robert F. Kennedy Center for Justice and Human
Rights, provides state-of-the-art mobile health technology including medical reference and clinical
decision support resources to medical professionals in the most challenging clinical environments
around the world.
In Lwala, Kenya, Health eVillages has grown to be one of Lwala’s most engaged partners, where they
have provided the iPad’s to clinicians. This allows them to use the reference library and materials
when they can to access information as and when they need and includes the full suite of MAF
skilled training films on their devices. They also use the devices with their clients delivering key
health messages and advice with the support of MAFs films aimed at community health workers and
communities in general.
Their partnership began when they provided iPods and iPads loaded with the Skyscape medical
reference app to clinicians and community health workers in Lwala. Out of this effort, Health
eVillages connected Lwala Community Alliance to Apple, who created a short documentary film
highlighting Lwala’s innovative use of iPads and Skyscape as tools in recruiting and enrolling all
pregnant women to participate in the entire continuum of maternal and child health care.
You can read here how nurse Okari Denzil, from Health eVillages, was able to successfully resuscitate
his patient’s, Katherine, newborn baby having used the skyscape software on his tablet to review
this topic and watch MAF’s neonatal resuscitation film the night before her delivery.
And this video also shows Okari describing his work in
and discussing how he also uses his tablet to
disseminate information, showing MAF films to women
in rural communities
(look closely to see cameos of our breastfeeding film).
Mobile phone, Oppia Mobile, Digital Campus, Ethiopia
Digital Campus is one such provider who is currently embarking on a formal evaluation of their
Oppia Mobile application on Health Extension Worker (HEW) training in Ethiopia on which MAF’s
films are being incorporated (blog).
http://digital-campus.org/
Equipment Used
 Mobile Devices
 OU Heat content mobile app developed by Alex Little
 Pre-loaded SD cards
Focus of Training
Digital Campus is committed to promoting learning research,
innovation and developing capacity through the use of
appropriate technology in Ethiopia. Acknowledging that
technology solutions can only be effective when run alongside a
quality training and research programme, Digital campus works in
close cooperation with local researchers and trainers to build capacity and improve long-term
impact.
Method of Screening
In the case of Digital Campus this has been taken a step further with the development of an
application that incorporates the Open University (OU) HEAT content for revision and out of
classroom learning purposes. This training content is further enhanced by the inclusion of interactive
self-assessment exercises. All the activities are stored on the device such that all content and
activities can be accessed and used even when a mobile internet connection isn’t available. Reports
can be pulled off easily to measure usage which helps the trainers to monitor students’ revision of
materials and scores of their tests.
Suggested Improvements
MAF’s current films have been reformatted in order to be compatible with mobile phone devices,
however these formats can differ across devices. MAF is currently working with Digital Campus to
adapt the content for their needs. Once developed, these resources will be made readily available
for others.
Online Video Reference Library, HealthPhone, Global
HealthPhone is a personal video reference library and guide to better health and nutrition practices,
for families and communities, including the illiterate, in their language, distributed on mobile
phones.
MAF Channel on HealthPhone:
http://www.healthphone.org/maf/index.html
Equipment Used
 Mobile device
 HealthPhone content
Focus of Training
HealthPhone works to reduce maternal death by preloading health education and training materials
onto mobile devices for health workers and community members. The health messages they
promote is developed on content from UNICEF, WHO, UNESCO, UNFPA, UNDP, UNAIDS, WFP and
The World Bank. HealthPhone provides health workers, communities and families with a personal
reference library and guide to better health practices which is available in real time whenever they
may need it.
Method of Screening
Medical Aid Films along with a host of other multi-media health information is located on the site
with its own channel. HealthPhone also offers the opportunity to have all their content pre-loaded
on low-cost models of mobile phones so that the content functions without network signal as the
films are pre-loaded onto phones so there is no need to download videos and other media.
This initiative is still in its testing phase and we believe they would be happy to supply the content
on SD to any partner willing to undertake a pilot. Please contact HealthPhone directly for more
information.