Using ICTs to enhance the skills of health workers in rural areas

Healthcare providers are the most important asset of any healthcare system. However, they need to continually learn and apply new skills and knowledge. Without such learning opportunities, healthcare workers, particularly those in rural or remote areas, will experience a decline in skills and knowledge, professional dissatisfaction, low morale, disillusion, lack of commitment, and reduced interest in their work. They miss opportunities for career advancement and they frequently look to urban areas for work. Most important, ‘disconnected’ from learning, knowledge and information, the quality of the care they provide is suffering.

A recent WHO/World Bank meeting in Addis Ababa highlights this problem, saying that “there is an emerging crisis of health manpower in Africa. The situation threatens to defeat the efforts of African governments, private health care providers, NGOs, and donors for health improvement. Training programmes unsuited to changing health conditions, inadequate cooperation among the many parties concerned, and the losses of staff to opportunities outside Africa risk making Africa's health care facilities barely able to function for lack of qualified, motivated doctors, nurses and other health workers. This situation is made even worse by the AIDS epidemic, which reduces further the availability of trained health workers by staff deaths and increases the demand for care.”

In response to these problems, many countries are looking at continuing medical education (CME). This umbrella terms refers to all learning by healthcare providers, after basic training. It encompasses in-service and post-graduate learning by all trained healthcare providers, including doctors, nurses, midwives, clinical officers, public health staff, etc. It is essentially a way to ‘connect’ rural health workers to education and information thus enhancing their capacities and motivations. Over the years, various approaches to CME have been tried, including:

• Out-of-country training courses;
  
• In-country training workshops (dominant method for last 20 years, many disadvantages: uncoordinated, carried out by multiple agencies, expensive, take essential staff away from place of work);
  
• CME activities at place of work (more challenging to organise, but can be done);
  
• CME activities at home (requires individual ownership of learning materials);
  
• Information and communication services that circulate information and ideas, making them available electronically, on paper or in other forms.

However, experiences from the five countries indicates that CME activities are falling behind and cannot keep up with the demand. Moreover, current paper and workshop based approaches are quite inefficient and costly, they are poorly coordinated, supply driven, and that the content of the information and learning provided is frequently not relevant to the diverse needs of today’s rural health care workers. Finally, the motivations and incentives of the health workers to participate in CME efforts were queried.

The question discussed in Tanzania was therefore whether and how ICTs can be used to develop and deliver more effective CME services in the countries represented.

ICT opportunities

With the arrival of new ICTs, health educators and health information specialists are beginning to see many new opportunities to deliver CME. Examining some of these during the three-day conference, participants concluded that the ICTs can help to overcome or reduce barriers associated with distance and isolation. ICTs can bring learning resources and information to the learners, instead of making the learners travel to the places of learning. This allows health workers to learn in their own workplace and in their own time. ICTs can also provide opportunities for interactive communication and networking. They also offer opportunities for health information to be generated locally to suit local situations, thus enhancing its relevance. Finally, they offer many opportunities to bring new information and ideas from around the world to the individual workplaces of even the most isolated heath workers.

Participants also considered the added value of ICTs to continuing medical education, examining why ICTs should be used. Four important reasons could be discerned. First and foremost, the ICTs can make CME more efficient - by reducing duplication, by enhancing coordination, and by facilitating collaboration. Second, ICTs can make CME more demand responsive - by decentralising content development and delivery and by empowering the health workers themselves to understand and influence efforts in this area. Third, ICTs can make CME more sustainable - by reducing costs (of travel for instance), and by helping to scale up CME efforts to reach all health workers. Fourth, by making CME more attractive - participants argued that the incorporation of ICTs itself is a significant motivator for learners.

Grandiose ideas were kept in check during the meeting as participants reviewed lessons and experiences so far. It was clearly recognised that ICTs can only make a difference to CME when certain conditions are met. These included:

• CME itself should be recognised as a high priority at all levels, including by government and health workers. The political commitment is critical; the health workers need to be motivated;
  
• The local education and information needs of the health workers should be clearly defined and understood so that CME producers or suppliers are responding to real demands. Moreover, the health workers themselves need to participate in these demand assessment processes;
  
• The content available and the delivery mechanisms used must be relevant and appropriate and well-targeted to the demands that have been identified;
  
• The ICT and information/communication skills of the health workers need to be enhanced to make most effective use of the ICT-enabled CME on offer;
  
• The abilities of the suppliers/producers to develop and deliver relevant content needs to be upgraded to address the digital environment;
  
• The suppliers/producers should work together, locally, nationally, internationally, ensuring maximum coordination and value on the ground;
  
• Necessary ‘infostructures’ - hardware, software, connectivity, infrastructure, etc. needs to be present;
  
• The application of ICTs in CME should be guided by visions, plans, and policies developed in consultation with all stakeholders, especially with governments;
  
• The actual introduction of ICTs in the local situations needs to be carefully managed, particularly with regard to issues of local ownership and local hierarchy that often restrict access to ICTs that are actually available.

Next steps

The final sessions of the conference brought participants together in different configurations, providing ‘country’ and ‘actor’ perspectives on the issues and further follow up. Each country group outlined a process by which it would take the ideas forward in their own countries - usually through some kind of wider stakeholder consultation processes leading to projects ad capacity development. The educational institutions present decided to continue working together to survey current efforts in the respective institutions, to jointly develop some CME modules, and to enhance their capacities in this area. More generally, participants plan to continue the dialogue electronically and to update each other with plans, proposals, and results.

A report of the discussions will be available in the near future. The proposals and plans from the countries will be taken up by IICD and Cordaid through their partnership to promote ICT-enabled health programmes and projects in Africa.

See also:

• CORDAID - www.cordaid.nl
• CEDHA - www.cedhatz.ac.tz
• INASP Health - www.inasp.info/health

Contact: Deem Vermeulen (dvermeulen@iicd.org) or Arjanne Rietsema (arjanne.rietsema@cordaid.nl)