AudiencScapes

By Dinfin Mulupi
(Nairobi, Kenya )

Kenya’s newest export is an ambitious electronic learning program for nurses. The program tackles the challenge of training health care workers who may not have access or time to attend in-person nursing classes. It started with computers and, more recently, is employing mobile phone technology to reach more nurses. Nursing students receive health information as text messages on their phones. With thousands trained so far, the e-learning program is equipping nurses – rural Kenyans’ primary care providers -- to respond to emerging diseases.

Targeting Nurses
Five years ago, the African Medical and Research Foundation (AMREF) was wrestling with how to boost Kenya’s ability to manage new and re-emerging diseases such as malaria, tuberculosis and HIV/AIDS. Angela Nguku, coordinator of the AMREF Virtual Nursing Training School, told AudienceScapes that they decided to focus on improving the skills of nurses and midwives. Kenya faces a severe nursing shortage at the same time that the existing nursing corps lacks advanced training. AMREF found in 2004 that 60 percent of Kenya’s nurses were trained only at the certificate level and thus not qualified to treat major diseases. Only two government nursing colleges offered courses to become a registered nurse.

“We noted that the nurses lacked skills in research, leadership and management, instruction, and task shifting. Yet in Kenya, nurses provide nearly 90 percent of primary care in rural areas,” Nguku says.
Nguku says AMREF confronted the reality that there was “no way” nurses would be willing to sit in class for the training. They embarked on a long-distance learning program to reach nurses.

Enter a Corporate Partner
After a print-based distance training course failed because of the expense involved in printing books and the limited space, AMREF sought an approach that would be affordable and easily accessible to nurses in rural areas. AMREF partnered with Accenture, a global management consulting company, which donated $2.9 million to develop content and install an e-learning program through the AMREF virtual nursing school. The target Is to train Kenya’s 22,000 nurses.

The success of a pilot project at the AMREF Nairobi offices led to the replication of e-learning centers across the country. Tutors would hand enrolled students CDs with the modules to be covered, then communicate with them through e-mail.

The program boasts a 93 percent pass rate

From its inception, Nguku notes, the program faced resistance from both tutors and enrolled nurses because of its reliance on computers. Most of Kenya’s nurses were computer illiterate.

“We trained the tutors on the new model of e-learning, as well as took the nurses through computer literacy classes, introduced them to e-mail accounts, and banned any form of communication between tutors and nurses through letters or any other print materials,” says Nguku.

The program succeeded in helping nurses attain the computer literacy necessary to participate in health education. Nguku explains that the program -- which initially faced threats of mass dropout by computer-illiterate nurses -- records a 93 percent pass rate now.

A Nurse’s View
AudienceScapes talked to e-learning graduate, Anne Kamene, who last year became a registered nurse after completing the e-learning diploma in community health.

Kamene works at the Kangundo District Hospital in Machakos, a rural town. Kamene, who has been a nurse for 15 years, says she felt incapable of treating patients with diseases like HIV and TB because she received little training on the management of these diseases when she enrolled for a nursing certificate in the early 1990s. Despite her desire to upgrade her skills, she could not leave her young family in Machakos to register for a full-time residential course in Nairobi.

" I feel independent I can work alone and be able to handle patients effectively.” – Anne Kamene

“The e-learning program proved to be flexible,” Kamene says. “I didn’t have to resign to go to class, neither did I have to abandon my young children so as to come to the city for training. I would only travel to Nairobi for a week or two for exams. Otherwise, all through, I carried on my duties at the hospital and at home as usual.”

She explains that while enrolled in the course she would go to the e-learning center at the hospital during her lunch break and after work to study. Kamene adds that she would also sign up for more night duty sessions at the hospital so she could take off time during the day to study at the e-learning lab.

“I am equipped, and feel independent I can work alone and be able to handle patients effectively. I am no longer just a nurse; I am a manager, a decision maker and a researcher. I have been given more responsibilities at the hospital since graduation,” says Kamene. Kamene would like to do another degree in nursing and hopes AMREF will roll out a similar learning module in the near future.

Promising Results
“In five years, we have increased access to health education. As of May 2010, we had 32 schools with an enrollment of over 7,000 nurses and 105 e-learning centers across the country. We have trained 300 tutors and mentors on e-tutoring,” Nguku says.

The success of this program has led to an important policy change. The Nursing Council of Kenya has requested that information and communication technologies (ICT) now be incorporated as part of the basic training for nurses at all government-run medical training schools.

Next Challenge: Going Mobile
Despite its success, it emerged that nearly 46 percent of nurses who enrolled for training could not access the e-learning centers, especially in rural areas. AMREF has turned to mobile phones to increase the number of health workers who could participate in training. Nurses have much greater access to mobile phones in Kenya than to computers. The organization has created a pilot program that will offer e-learning through mobile phones.

The AMREF virtual nursing school found a means for contacting student nurses via their mobile phones. Through its software, Frontline SMS, tutors are able to send group text messages to students, reminding them of upcoming exams or transmitting information on how to access relevant medical documents.

              

“The mobile support network is a more reliable source of communication than e-mail because internet connectivity is poor. Also most nurses don’t check their e-mail since they need to go to a cyber café to access internet,” says Nguku.

Beyond Kenya
Last year, the e-learning course was launched in Uganda. Plans are underway for replication in Malawi, Zambia, South Africa, Ghana, Angola, Sudan, Mozambique, and West African nations (after translation to Portuguese and French) -- and later in all other African countries.

AMREF’s Nairobi staff is being deployed to customize the e-learning course to meet the needs of each country as well as support the training of tutors, clinical instructors and mentors.

“Across Kenya, Uganda and Tanzania, more than 100 million people are served by approximately 7,500 doctors and 70,000 nurses and midwives,” says Nguku. “Hence the upgrading of nurses’ skills in tackling diseases like HIV and TB is very crucial to the continent’s development and achievement of millennium development goals.”

References

AMREF: Upgrading 20,000 Nurses in Kenya

Dinfin Mulupi is a journalist based in Kenya