The Impact of Stepping Up the Quantity and Quality of E-learning to Address Challenges of Human Resources for Health (HRH) in Kenya

Human Resources for Health (HRH): Can technology be the magic bullet in LMIC?

Photo credit: Titus Muhu Kahiga, Kenyatta University, 2016.

The Human Resources for Health (HRH) challenges continue to pose a major headache to governments in many LMIC (lower middle-income countries) in Africa. Many traditional models (like increasing the number of medical schools) have been tested but face serious quality of training gaps. Some successes have been recorded with a symbiotic relationship of north and south, and south and south, collaborations but this has not gone far enough. The WHO recommended ratios of doctor to patients continue to be unachievable in spite of deadlines by many governments in sub-Saharan Africa making periodic commitments. This is aggravated by emigration of health workers to developed countries where conditions of work and remunerations are superior. Within country, the distribution of available health workers is uneven and is not based on specific local health needs but on economic and social considerations. The ultimate consequence of this are poor health indicators. Can there be a solution to this state of affairs?

The IDS Learning Event at Strathmore University (25th to 28th July 2016)

The African Universities’ Research Approaches (AURA) Programme was mooted on the premise of bringing expertise and experience from around the globe to co-create a context specific educational framework and support locally generated research knowledge and its dissemination. In view of human resources for health challenges, approaches to mitigate this based on innovation then becomes a relevant area that demands deep reflection and concern. We can only thereafter ‘talk research’ once we have personnel with basic knowledge who then can be taught to become skilled researchers.

Many universities in Kenya have e-learning programmes mainly in liberal arts and basic sciences. In health professional education there has been a palpable resistance to e-learning by traditionalists (although some acceptance of it has occurred partly by nursing professionals). This is not unexpected given that most of the trainers are products of old systems and practices. A strong legal and policy infrastructure to support e-learning is also lacking. However, where e-learning has been accepted, it has basically been interpreted as loading PowerPoint presentations on the institutional LMIS (Learning Management Information System).The interactivity aspect, the objective assessment need and the need for an examination to be a benchmark of evidence of learning, are clear gaps. We have had lots of conversations about the use of technology and many faculty members accept that it can make teaching an easier experience. Of course, instructional strategies differ from one institution to another one but all have one convergence: that ultimately, individuals will need to be fully trained to manage patients.

Drawing on the work of the AURA Programme, the Institute of Development Studies (IDS) convened a learning event at Strathmore University in July 2016. This provided an opportunity to start questioning the quality of material, and the e-support, being given to the students taking these modules. The need for training the trainer on e-support facilitation became apparent. While the need to have many health workers is welcome, we also need to start a robust system of increasing the capacity of quality facilitators skilled in delivering e-learning. I was certainly encouraged by the sensitization given by the two consultants at the learning event.  It made me wonder if big funders who are interested in health professional education would be interested in the approaches.

A critical mass of facilitators skilled in delivering e-learning would then need to be trained and appropriately exposed so that they can train other health workers. I propose that this be piloted in one university and be done as a collaborative effort with regulatory bodies, in order to have their buy-in. Many curriculums in health disciplines have pre-clinical phases where subjects like physiology, biochemistry, and anatomy can be taught very effectively on an e-platform. These subjects do not have our trendy language (like ‘evidence base’) and are basically static. They can be taught in one ‘command zone’, as it were, and broadcast to thousands of medical, nursing, pharmacy and other allied health professionals, in one go. This can create a lot of time that can be utilised for face-to-face interactions. Certainly technology would not train, or assess, the psychomotor aspects of health professional learning, however it can have a valuable place in other areas.

The learning event at Strathmore University also reflected on the difficult terrain of assessment. As we increase numbers it becomes a necessity to devise objective methods of confirming that learning has taken place. It is now accepted that competency based learning is the future of learning, and how to best use technologies to assess the same, needs serious interrogation.

Conclusion

Investments in infrastructure to support e- learning are already going on in many LMIC,and are being supported by funders. The investment in e-support capacity development, and the need to build a cohort of expert facilitators on e-learning, is of utmost need and urgency. This could well be the answer to addressing the human resource capacity needs in health in sub-Saharan Africa. I urge the funding community to consider paying attention to this gap, much as they continue to give infrastructural support. The learning event at Strathmore University was an ‘eye opener’ in terms of exploring and exposing this need. This will be of particular use in health related disciplines where the numbers and the quality of health workers fall far short of global recommendations.

Dr Kahiga is a pharmacologist currently working as member of faculty at Kenyatta University, a public funded university in Kenya. He also serves as principle investigator (PI) in many donor funded projects including NIH and USAID. He has a special interest in health professional education and in the past has served as master trainer in a CDC/PEPFAR funded project called PACE. At Kenyatta University, he is currently the Head of the Ethics Review Board.  In the past, Dr Kahiga has served in the National Drug Regulatory Board and in the Pharmaceutical Society of Kenya, rising to the position of National Vice President. In his free time he serves as a volunteer pharmacist in a community based setting in the central part of Kenya.