Technology based learning – an international perspective: development and evaluation of resources for health workers in sub-Saharan Africa

Introduction: E-learning is a familiar feature of health worker education in developed countries and there is interest in its use in developing regions, including sub-Saharan Africa, to overcome health workers’ lack of access to information, learning and professional development opportunities. However, there is limited evidence to guide such developments. The issues are complex, more so due to the size and diversity of sub-Saharan Africa and its health workforce, and rapid technological progress. Objectives: - Understand issues affecting the development and implementation of e-learning for health workers in sub-Saharan Africa. - Develop and pilot an e-learning resource in eye health. - Evaluate its impact on clinical skills. Methods: Qualitative and quantitative methods were used to explore issues including infrastructure, skills, health systems, learners’ needs and preferences related to e-learning design, development and implementation. This was integrated with evidence from a study of patients’ journeys of care to develop a novel e-learning resource in eye health using a quality improvement approach. After piloting, the impact on medical students’ clinical skills was assessed using a ‘low stakes’ Objective Structured Clinical Examination in a randomised trial. Results: A holistic view of the current situation related to e-learning in sub-Saharan Africa was achieved. Piloting of the resource confirmed its broad acceptability and gave recommendations for final refinements and implementation. In the trial setting, students exposed to the resource demonstrated better clinical skills (mean scores: 71.6% and 68.4%, (p=0.048); pass rate 90.0% vs 64.5% (p = 0.032) with significant improvements for ‘differential diagnosis’ and ‘making a management plan’. Conclusions: E-learning can be successfully applied in sub-Saharan Africa and a quality improvement approach integrating research with resource development is proposed. From this experience, an algorithm for e-learning development is presented.