Background: Digital learning tools have proliferated among healthcare workers in India. Evidence of their effectiveness is however minimal. We sought to examine the impact of the Safe Delivery App (SDA) on knowledge and confidence among frontline health workers (HW) in India. We also studied whether facilitation to address technical challenges enhanced self-learning. Methods: Staff nurses and nurse-midwives from 30 facilities in two states were divided into control and intervention groups through randomization. Knowledge and confidence were assessed at baseline and after 6 months. Three rounds of facilitation addressing technical challenges in downloading and usage along with reminders about the next phase of learning were conducted in the intervention group. A user satisfaction scale along with qualitative interviews was conducted in the intervention group at the endline along with qualitative interviews on facilitation. Results: The knowledge and confidence of the healthcare workers significantly increased from the baseline to endline by 4 percentage points (P < 0.001). The participants who received facilitation had a higher mean score difference in knowledge and confidence compared to those who did not receive facilitation (P < 0.001). The participants were highly satisfied with the app and video was the most-watched feature. They reported a positive experience of the facilitation process. Conclusion: The effectiveness and acceptability of the SDA indicate the applicability of mHealth learning tools at the primary healthcare level. In a time of rapid digitalization of training, facilitation or supportive supervision needs further focus while on-ground digital training could be invested in to overcome digital illiteracy among healthcare workers.

BackgroundOne of the main drivers of maternal and newborn mortality and morbidity in India is a lack of quality of care in health facilities. Inadequate competencies of health workers, insufficient quality of training and infrastructure, and the financial challenges of providing training across the country impede quality care provision. To this end, the Government of India began exploring cost-effective tech and IT-based solutions to support existing quality improvement (QI) initiatives.MethodWe describe the process and approach of scaling the Safe Delivery App (hereafter referred to as the App) throughout India. The App is an mHealth learning tool for equipping health workers in managing obstetric and neonatal emergencies by placing evidence-based, and up-to-date clinical guidelines in their hands through their mobile devices. The use of the App was supported by the Ministry of Health and the Department of Health at the state level. Both parties were actively involved in the roll-out of the App and had a clear vision of how the App can complement existing structures/systems/programmes.ResultsThe App was successfully integrated and implemented in various government-led QI initiatives. Approximately 20 000 healthcare workers (HCWs) have been trained on the App and selected clinical topics since its launch, and between 2018 and 2021 over 86 000 HCWs across all states and union territories used the App. Moreover, project-specific data show a significant increase in the knowledge level of users of the App.ConclusionScaling such a tool within existing programmes is not a linear process. In India, the approach, government buy-in and flexibility of implementation modalities led to the successful roll-out of the App. We have demonstrated that an mHealth tool can be used to support the growing desire of governments to use tech in support existing QI initiatives and supporting the improvement of quality of care provided.