Research Front Arnab B Chowdhury – Founder and Knowledge Architect, Ninad Consultancy Services www. ninad. in, arnab@ninad. in When Technology Meets Health Care in Knowledge Society... Aurosiksha: online learning platform for blindness prevention workers “Intelligence and capability are not enough. There must also be the joy of doing something beautiful. Being of service to God and humanity means going well beyond the sophistication of the best technology, to the humble demonstration of courtesy and compassion to each patient. ” - Dr. G Venkataswamy (Founder Chairman - Aravind Eye Care System) Abstract: This case study (www. urosiksha. org) is about two great movements one in Technology (the FOSS) and the other in Health Care - the Aravind Eye Care Systems (AECS) and LAICO that trains blindness prevention workers. At the con? uence of the two is an eLearning platform called Aurosiksha, which is based on Moodle. Aurosiksha seeks to reach out to the global user, share its rich knowledge base, and in the process create a community of lifelong learners. Keywords: FOSS, ICT, LMS, MOODLE, mLearning, Mobile Moodle, AECS, Aravind, Aravind Eye Care System, Vision 2020, WHO, LAICO, Aurosiksha, eLearning Platform, knowledge society, ocial health care. Introduction As we all know, the Free and Open Source Software (FOSS) movement began as a renegade call to what was felt to be increasing restrictions on collaborative development, distribution, and ownership of software[2]. Free software focuses on the philosophical freedoms (a matter of liberty rather than price) it gives to users, whereas open-source software focuses on the perceived strengths of its peer-topeer development model. Openness, coownership, and transparent collaboration continue to drive the FOSS movement. Development, modi? cation, ownership, and redistribution of software could now e cohesively managed by communities of like-minded developers. This also led to an evolutionary model of copyright and licensing (GPL) ensuring community ownership. The FOSS movement has evolved from the stages of philosophy and licensing into a complex and pragmatic ecosystem for software production and distribution bene? ting humanity globally. FOSS has introduced technological self-reliance, efficient use and sharing of resources, and C SI Communications | June 2012 | 12 collaborative innovation and development. One of the most signi? cant areas where the FOSS movement has made strides is in the ?eld of education.

During the past decade, education has been rapidly reorganized to leverage information and communication technology (ICT) within the classic teaching-learning-assessing cycle. At the foundation of FOSS is a desire for an equitable and open model of access to knowledge. If one of the aims of FOSS technologies is dissemination of educational content, then Aurosiksha is a case in point. The Case Aurosiksha is an online learning management system (LMS). An initiative launched recently (25th July, 2011) in its beta version by Lions Aravind Institute of Community Ophthalmology (LAICO), established in 1992 with the support of he Lions Club International, SightFirst Program, and Seva Sight Program. LAICO is Asia's ? rst international training facility for the broad range of blindness prevention workers from India and other parts of the world. It contributes in improving the quality of eye care services through teaching, training, capacity building, advocacy, research, and management consultancy. It offers university-affiliated long-term courses in Eye Care Management, with eye care management programs for directors of eye hospitals, program managers, as well as several skill development courses in the areas of instrument maintenance, community utreach and social marketing, counseling in India, Africa, and South East Asia. LAICO accomplishes this objective within the broader environment of Aravind Eye Hospitals and Aravind Medical Research Foundation - all aspects of AECS. Headquartered at Madurai, India, AECS is the world’s largest eye care service provider, which performs 300,000 surgeries per year. Aravind Eye Care was founded and directed by the legendary Padmashree Dr. G Venkataswamy known as Dr. V. Fig. 1: Inspiration and Inspirer www. csi-india. org Fig. 2: LAICO's global reach Designated by the World Health Organization as a Collaborating Centre for

Prevention of Blindness, Aravind is studied as a model in prestigious business schools around the world, including Harvard, Stanford, Michigan, IMD-Lausanne, and the Indian Institutes of Management. Currently, LAICO works with over 270 hospitals across the developing world replicating Aravind model of high-quality, low-cost eye care service delivery. Followup studies have shown that several of the programs exposed to the Aravind model have doubled (and in some cases even tripled) surgical productivity and as a result are now ? nancially self-sustaining. • • 270+ hospitals (and still growing) that are partnering with Aravind?

How do we create courses that cover the broad needs of our trainees that include paraprofessionals, ophthalmologists, eye care program managers, administrators, and others? How do we continue to empower our all-women team of paraprofessionals who form the backbone (about 60%) of Aravind’s workforce? Since • • most of them come from humble, rural background and are trained as assistants and nurses, can this eLearning platform give them the opportunity for continuous training? How can eLearning work consciously toward the empowerment of women and gender equality - an important objective within the Millennium Development Goals?

How do we collate, aggregate content to create an interactive Knowledge society The Challenge The real challenge for knowledge society then is in creating equal opportunity in offering the ability to access, to create, to develop, and to utilize the right information at the right time in a cost-effective manner. This applies to the public (consumer) as well as the service provider professionals. In this case study, we focus on a decisive initiative with the objective of providing quality training and management skills via the virtual medium for eye care, which is an important area of social health care. • How do we train more than 10,000 lindness prevention workers worldwide, year after year, across Education FOSS ICT Aurosiksha AECS LAICO Education & Management Fig. 3: The case for Aurosiksha C SI Communications | June 2012 | 13 ophthalmic technology evolving so quickly, everyone recognizes the importance of keeping our eye care management skills and knowledge up-todate for the bene? t of our patients. The eLearning solution will allow especially the paramedics to access continuous educational opportunities over the Internet and provide a valuable forum for our members/experts to exchange views and tap into the expertise of their colleagues and fellow olleagues around the world. ” Aurosiksha has leveraged ICT in an inclusive way. It is meant Fig. 4: Aurosiksha home page and introduction to provide a one-point Internet access to eye training mechanism that does care training for professionals worldwide justice to the enormous data and with the premise that ‘up to 80% of experiences that Aravind has the world's blindness is avoidable... ’ collected over decades and share it where ‘avoidable blindness is de? ned as with the world so that other blindness blindness which could be either treated prevention professionals and social or prevented by entrepreneurs may feel inspired to nown, cost-effective create Aravinds elsewhere? means’ (VISION 2020 • How do we create a viable way Action Plan 2006to share this ocean of aggregated 2010 © World Health experiences into meaningful content Organization). harvested since 1976? The Solution • How do we instill the Aravind model into our courseware? Especially since Aurosiksha - the the Aravind model needs to be ‘lived’ need of the times and ‘experienced’ as a broad set of LAICO came up values of service, compassion, and with Aurosiksha to self-reliance at its core, along with enhance the reach and management principles that identify quality of education uality care and efficiency that drawn from the rich Aravind stands for? knowledge base that These were perhaps the broad AECS has harvested questions that LAICO asked itself after it since 1976. In this age trained and consulted 60 hospitals in 29 of knowledge society, [1] countries and 213 hospitals in India . its four essential On the eve of the launch of characteristics Aurosiksha, Mr. R D Thulasiraj, Executive digitization, Director (LAICO) said, “I think this immediacy, is a very important development and virtualization, and underscores the AECS’s commitment globalization - drive to continually enhance the range of nowledge sharing. services we offer to eye care service. With C SI Communications | June 2012 | 14 Aurosiksha was developed and implemented by the LAICO team with the help of instructional designers who joined the AECS as volunteers for the sole purpose of developing its own online educational program. Promoting lifelong learning The goal is to allow all users to take highly engaging and interactive units in order to learn about the theories, techniques, and practical aspects of both clinical and nonclinical management. The idea is to provide an online space where AECS staff can learn, share, and develop their nowledge of providing the best eye care services in all aspects ranging from fundamental concepts to advanced skills using assessed, accredited, and selfre? ective activities and resources. The program The program includes: • Courses & stand-alone sessions: These have been developed by internal and external subject matter experts (SMEs) with the assistance of instructional designers and technicians by using standard training curriculum. They are also assisted by JCPHO, ICO, and other professionals from leading noneye care institutes, such as the Indian Institutes of Management (IIM). Quality Fig. 5: Course on cataract ww. csi-india. org Camstasia studio Moodle environment MOODLE usability Pedagogy Technology: MOODLE Information transfer • Add resources (docs, web links) • Forum • Wiki • Glossary • Lessons • Assignments Communication and interaction Assessment of learning • Tests • Discussion forum Co-creation of content • Quiz (self-test) • Lessons • Assignments • Discussion forum • Wiki • Database Articulate quizmaker Fig. 6: The Moodle-based Aurosiksha environment check is performed by including sessions in Aravind’s acclaimed training program. The material is interactive with voice narration, with short quizzes in between ideos to assess the learning. • Assessment with immediate feedback: Assessment is featured in different ways like an organized discussion forum, Q forum, blogs (students are allowed to create), and exercises/quiz. After quiz/exercises, immediate feedback will be given to the student on each submit. For example, if a student chooses a wrong answer, the feedback will spell out why the answer is incorrect and give the correct answer to ensure learning is happening with each and every activity. • Course completion tracking: The tracking feature controls the student/ teacher to provide a better learning/ teaching experience.

The tool gives accurate course completion and grading report. This includes customized reports for the bene? ciaries on the impact side. Selecting the tool - a con? uence of spirit and values LAICO’s systems division began with an open mind and explored various Content Management Systems (CMS) and related technologies (Course Management Systems) both proprietary and FOSS, such as WizIQ, Joomla! , ConferenceXP (an open-source videoconferencing platform from Microsoft Research), and MOODLE (abbreviation for Modular ObjectOriented Dynamic Learning Environment). Echoing Aravind’s values - quality, compassion, self-reliance - Aurosiksha’s bjectives resonated with Moodle. At its core, Moodle is an educational software grounded in a philosophy of collaborative learning, often referred to as social constructionist pedagogy. Additionally, Aurosiksha’s pedagogical approach matched with that of Moodle. The organization and design of Moodle’s interface supports learners and learning tasks, rather than technology and tools. Moodle presented the ideal vehicle for Aurosiksha. LAICO adapted its knowledge resources to the Moodle mould; customization was minimal. It was a happy con? uence of technology and LAICO vision; both shared the same spirit and values.

Moodle is based on a social constructionist approach, which helps us understand how learning happens in a group and how learning is a product of innumerable human choices. Moodle was built with elements and tools that embody pedagogical understanding. A Moodlebased course can consist of lessons, including reading materials, activities (such as quizzes and projects), and social events that encourage participation between students. In Aurosiksha, one ? nds the Camstasia Studio software to be integrated in Moodle for quality and streaming-like videos for the audiovisual elements in its courses. Similarly, Articulate Quizmaker andles the self-test modules at the end of the lessons. An open (institutional) learning environment Cloud environment Educational institutional environment WEB PAGES Student ID database se Student information system WEB 2. 0 apps Assessment tools Proprietary and licensed content Collaboration tools Student generated content Personal publishing tools Open content Fig. 7: Open learning environment C SI Communications | June 2012 | 15 Fig. 8: Beta users statistics As Aurosiksha grows in terms of content repository, user base, and feedback from users, it will trigger a proportionate scaling in features, tools, and technologies ithin and outside Moodle. The following pointers can be considered for Aurosiksha’s future: • Interoperability: Aurosiksha may want to communicate and share its data with that of other medical research institutions. It also needs to be SCORM-compliant (Sharable Content Object Reference Model). • Deeper reach with low-cost handheld devices and low Internet bandwidth leading to low footprint m-learning: With greater penetration of ICT and hand-held devices ranging from tablets (such as Akash) to mobile phones (voice and short messaging services), a strippeddown version of Aurosiksha can be An open learning environment:

Moodle and Aurosiksha Apart from being part of FOSS family and therefore free, Moodle is an Open Source Course Management System (CMS). It is also known as an LMS or a virtual learning environment (VLE) and is very popular among educators around the world as a tool for creating online dynamic web sites for their students. Aurosiksha as the learning arm of LAICO-AECS is an experiment in a similar space, moving from Constructionism to Constructivism - an environment in which human beings don’t just act (Construct) but also make sense of their actions as a group (Constructivist). This happens as humans make sense of reality, learn and reate new knowledge continuously while learning. Effective learning happens while learners are in an actively constructing knowledge mode rather than in a passive reading, viewing, and memorizing mode. The kind of knowledge generated impacts attitudes of learners, which in turn re? ects in their actions (practice). Aurosiksha is a Community of Learners in the making, offering insight and reaching out with a sense of service. Future Direction Aurosiksha, in its beta stage, is currently being tested by over 500 beta testers worldwide that range from paraprofessionals, managers, eye care professionals to faculty members.

C SI Communications | June 2012 | 16 Fig. 9: Course creation www. csi-india. org • Mentor-guided courseware • Turnitin (functionality to let the student submit assignments) Acknowledgment Fig. 10: E- and M-learning: logical system architecture • a source of knowledge to especially paraprofessionals on the ? eld. Extensive reach with browserbased handheld devices leading to m-learning: With proliferation of 3G and upcoming 4G, Aurosiksha can be experienced on devices, such as iPhone, iPad, and Android-based phones quite extensively with Mobile Moodle (a set of mobile apps and server components from Moodle). • •

Right now, Google Analytics and Google Maps are being applied to study the online learning behavior of the beta users. This initiative could be further explored with other statistics generated dynamically. Relevant pedagogical applications that can be included (already available in Moodle) are as follows: • Grade report • Timer-based courseware Fig. 11: Google maps: geographical spread of beta users We wish to thank Mr. R D Thulsiraj (Director - Operations, AECS; Executive Director - LAICO) and Dr. R D Ravindran (Chairman and Director - Quality, AECS) for all the insightful and frank conversations we had with them. We thank Prof.

R K Shyamasundar (Faculty of Technology & Computer Science - Tata Institute of Fundamental Research) and Mr. M D Agrawal (President - Computer Society of India) for their encouragement. We acknowledge the spirit of FOSS and the World Wide Web (WWW) to continue to grow as active members of the knowledge society they foster. Finally we wish to acknowledge the spirit and values of Dr. G Venkataswamy (Dr. V) that pulsate through everything that Aravind is and does. We bow with deep reverence to the spiritual teachers of Dr. V: Sri Aurobindo and the Mother. References [1] P. Mehta, and S Shenoy, In? nite vision: how Aravind became the orld’s greatest business case for compassion, 1st ed. , Berrett—Kohler Publishers Inc. San Francisco [2] Satish Babu, “The FOSS Movement and its impact on Education”, CSI Communications, vol. 35, Issue 6, September 2011, pp. 19-20 [3] http://moodle. org/about [4] http://aravind. org/ [5] http://laico. org/ [6] http://aurosiksha. org/ [7] h ttp://en. wikipedia. org/wiki/Free_ and_open_source_software [8] h t t p : //w w w. i f o s s f. o r g /i f o s s f _ library_0 [9] h ttp://www. vision2020india. org / orbiscourse/homepage. htm [10] h ttp://www. vision2020. org/main. cfm? Type=NI=4460 [11] h ttp://www. ats-pyjamas. net / wp-content /uploads/2010/05/ M o o d l e To o l G u i d e fo r Te a c h e rs _ May2010_JS. pdf n Selected among the top 4 papers expressing 'Collaboration for inclusive growth' at  SEARCC 2011  seminar (South East Asia Regional Computer Confederation, Mumbai, December 2011) [With inputs from Prarthana Kalaskar – Design Principal (Ninad), Remi Boutinet – Outreach Consultant (Ninad), Shwetav Agarwal – Solution Architect (Sri Aurobindo Institute of Culture), LAICO team (Deepa Krishnan – Senior Manager – Operations; Vinoth Palanichamy – Online Manager – Education)] C SI Communications | June 2012 | 17