PC2119: The Data Burden of Online Learning in Global Health Settings

Background: The COVID-19 pandemic resulted in restrictions to travel and in-person gathering and reduced resources for training healthcare workers globally. At the same time, the increasing availability and accessibility of video conferencing platforms has led to their widespread application in healthcare telementoring e.g. ECHO project and virtual training e.g. Essential Newborn Care (ENC) Now! online course, utilizing common platforms such as Zoom [Zoom Video Communications], Webex [Cisco Systems], MS Teams [Microsoft] and Whatsapp [Meta Platforms]. Despite this expansion, little is known about the data costs to end-users in low resource settings.

Methods: To assess data costs associated with online training, two devices (an iPhone 7 and a Samsung Galaxy Note 8) were connected by video conference call for a 36-minute test period using WIFI and a local mobile network provider (Globacom Nigeria). All background apps and updates were disabled to accurately assess data use. Device A hosted the call and had video enabled throughout the test period (“continuous”) while Device B had video enabled for 2 minutes in 10 minutes intervals ("intermittent"). The test was performed for four platforms: Zoom, Webex, MS Teams and WhatsApp. The bandwidth was monitored in real time using the MikroTik Userman hotspot monitor application to determine total data download and total data upload during the call for each device. Country specific data costs were accessed from public sources. The average cost of one gigabyte (1GB) was calculated and normalized to US dollars. Using the job description “registered nurse”, we conducted a search for the median hourly wage in each country and then converted the figures to 2021 USD.

Results: Cost analysis by region identified wide range with the highest cost in Northern Africa and the lowest cost in Asia. Scenarios in which facilitators have their video on and expect learners to participate with video on throughout resulted in the greatest data burden, while use of intermittent video by both facilitator and learners can significantly lower data use (Table 1). Specifically, reducing video to 1/6 the time resulted in nearly 1/10 the data burden. The choice of a platform also impacts the burden of teleprogramming (Zoom > Webex > Teams > WhatsApp). Average hourly wage for representative countries along with country specific GB costs were used to determine the relative number of work hours needed to cover the expense of participating in a 12-hour online training session (Figure 1).

Conclusion: The costs of participating in online training programs that rely on video conferencing varies by mechanics of use and the specific platform. The use of intermittent video can significantly lower data use. As virtual meetings have become prevalent, it is critical that data burden is adequately considered by program directors and funders.