E-learning program for nurses increases access to training by 1,400%
CanadianHealthcareNetwork.ca
May 19, 2011
Ten years ago, Kenya’s Ministry of Health and National Nursing Council took a bold step, pledging to transform the country’s nursing education system—there was simply no other choice.
In Kenya and across all of Africa, where there is a dire shortage of physicians, nurses play a critical role in the delivery of health services. The need to train and upgrade the skills of essential mid-level health workers is urgent.
There are three levels of nurses in Kenya. Two-thirds, or 22,000 in total, have an enrolled certificate, the most basic nursing qualification. Just over one-quarter are registered nurses (RNs), while only 6% of the country’s nurses have a nursing degree.
In a country where up to 60% of public hospital beds are occupied by HIV/AIDS patients, enrolled nurses have no training in diagnosing and managing the disease.
A further constraint to skills upgrading, Kenyan nursing schools can only accommodate about 100 people annually for full-time studies in Nairobi, leaving many nurses waiting 10 to 15 years to upgrade their skills, while also robbing the clinics of their services as they study.
“The government urgently needed to upgrade these nurses to enable them to handle complex diseases and manage rural health facilities, but using traditional classroom methods would have taken 150 years,” said Adesuwa Akinboro, a health education manager at AMREF.
To tackle the problem Kenya’s Ministry of Health approached the African Medical and Research Foundation (AMREF), one of Africa’s oldest and largest African-based health development organizations, for a solution.
AMREF decided to harness the power of technology to upgrade the skills of enrolled nurses.
An African solution with 21st century tools
Information technology has already transformed many African countries. Wireless providers now service urban slums, isolated villages and even camps for internally displaced persons. Farmers and traders in rural areas get up-to-the-minute information on cattle and food prices, while Internet kiosks link millions of Africans to social media.
Unlike in Canada, however, information technology is only now being widely adapted to local curricula and infrastructure to improve both health service delivery and the training of health professionals across the continent.
The World Health Organization (WHO) defines eHealth as “the cost-effective and secure use of information and communications technologies in support of health and health-related fields, including healthcare services, health surveillance, health literature, and health education, knowledge and research.”
With 25% of the global disease burden and only 3% of the world’s health workers, e-health technology-based innovations are transforming health education across Africa.
To upgrade the skills of 22,000 Kenyan nurses, AMREF and the Nursing Council of Kenya and Ministry of Health designed an e-learning curriculum and partnered with the global management consulting firm Accenture to set up the required infrastructure.
“The scale of the challenge was daunting,” says AMREF’s virtual nursing school co-ordinator Angela Nguku. “Even though AMREF was a leader in this area, we had never designed a program of this magnitude before.”
All partners were optimistic about the benefits. Electronic course materials eliminated textbooks, which are expensive to update, print and distribute. Every student received their curriculum on CD, offering flexible study to fit their schedules.
Computer labs were set up in every nursing school across Kenya and AMREF guaranteed additional computers to any health clinic or hospital with five or more nurses taking the course.
Kenyan nurse Anne Kamene expanded her skills via the AMREF e-learning program.
The two-year course covers everything from community health, pediatric care and midwifery to mental health care and infectious disease treatment and prevention. Before graduation students are also expected to perform a clinical placement.
If students have difficulties with course materials there are tutors to assist them at every nursing school to enroll and upgrade their skills.
One of the first students to join AMREF’s e-learning program was Anne Kamene. Like many enrolled nurses in Kenya, prior to the program there weren’t enough spaces at her local nursing college.
“I tried twice, but both times I was not selected. Then in 2006 I saw an advertisement in the newspaper for the course, and I was accepted,” she says.
A mother of two, the program’s flexibility was ideal for Anne. She was able to continue working, care for her children, study on her time off and immediately practise the new skills she was learning while on the job.
E-learning challenges and opportunities
There are still many challenges. The course costs more than $1,600 and most students working as enrolled nurses only earn $200 a month. Some of the nursing schools face technical problems and clinical placements can be hard to find.
Despite this, the program is proving to be a success. Johnson & Johnson has recently announced funding for a financing facility to reduce the burden of tuition costs.
In 2007—two years after the program began—the AMREF virtual nursing school was formally established in Nairobi to enhance the program, provide additional technical support and train more nurses.
The pilot phase of AMREF’s e-learning program included four nursing schools, with 145 students in 12 computer-equipped centres. Today the program has enrolled more than 7,000 students across 34 schools, with access to 105 learning centres in Kenya’s eight provinces.
With the schools enrolling an average of 1,300 students every year, access to the training has increased by 1,400%. More than 400 tutors and mentors have been trained to support the students as they learn.
The program’s success in Kenya has also led to interest in its replication in other African countries, including Uganda, Sudan, Tanzania, Malawi, Rwanda, Zambia and South Africa.
For Anne, the course has had a profound impact on her career, and by extension on the patients she sees.
“I am more competent and responsible. What I had learned as an enrolled nurse was very shallow, but now I have studied topics like management and research. I am able to use rationale to ensure that every action taken is best for the patient,” she says.
Rx Africa: Prescriptions for Better Health is a seven part editorial series between Rogers Healthcare Group and AMREF Canada on AMREF's innovative solutions tackling Africa's health care worker crisis.
Read past articles in the series;
Surgical Outreach Leaves Lasting Legacy in Underserviced Africa (April 29, 2011)
African Roots: Bringing Traditional Medicine into the Fold for Better Health in South Africa (April 7, 2011)
Bringing Care to Africa from Above (March 22, 2011)
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