By Valencia LYLE and Andrew MUHIRE, Rwandan Ministry of Health
When Rwandan health workers and Ministry of Health (MoH) staff require training, they frequently endure a disruption to their work schedules. Traditional, in-person trainings typically require staff to travel to a central location which is often far from their homes and workplaces. Furthermore, travel and room rental fees render in-person trainings costly. In recognition of the high demand yet insufficient supply of healthcare workers and high costs associated with in-person trainings, Ministry of Health senior management deemed the current system of solely providing traditional, face-to-face trainings to the health sector workforce unsustainable.
Rwanda’s Changing Health Landscape and its Strain on the Health System
As Rwanda enters a new phase of the epidemiological transition- shifting from infectious diseases to non-communicable diseases- there is a growing strain on the health system’s human and monetary capital. While life expectancy continues to climb and diseases shift from acute to chronic, there is an increasing demand on health workers to remain at their work stations to provide services to the steadily expanding list of clients they receive every day. This suggests a need for a cost-effective, innovative solution to the rising costs and health worker absenteeism associated with in-person trainings.
The Electronic Solution
After conducting extensive research and numerous consultations with health system strengthening experts, in November 2017, the MoH opted to implement eLearning as an effective strategy for significantly reducing training costs, slashing health worker absenteeism, and standardizing the high-quality trainings provided to all health workers.
While eLearning is still a fresh program at the MoH, it begets the question: is this the solution to reducing health worker absenteeism and rising costs associated with traditional trainings?
Piloting the E-Learning Program
The first course piloted on the MoH eLearning platform was the Fortified Blended Food (FBF) program eLearning course for FBF focal points. The FBF focal points were enrolled in the eLearning course to solidify their understanding of the importance of the FBF program- a program implemented by the Government of Rwanda in which highly nutritious porridge is provided to vulnerable children 6 to 23 months of age to reduce the prevalence of childhood stunting.
The two-week eLearning course was commenced amongst 30 FBF focal points representing the 30 districts in Rwanda. A pre- and post-test was administered to the focal points at the start and conclusion of the course to assess their learning outcomes. Calculations of the differences in pre- and post-test scores determined that, on average, participants’ scores increased by 10-percentage points after completing the course.
At the conclusion of the course, 28 out of 30 focal points completed a 13-question course evaluation. The course evaluation included 9 close-ended questions and 4-open ended questions. Of the respondents, 71.4% (n=20) indicated that they were very satisfied with the overall course and the remaining 28.6% (n=8) simply indicated that they were satisfied.
The four open-ended questions included in the course evaluation revealed the most pressing modifications to the course that needed to materialize. While the most common response to the question requesting negative feedback from responders was “none,” many focal points indicated that they found lessons on statistics and nutrition science confusing. Some students even indicated a desire for face-to-face instruction and bringing course participants together to learn the course material.
Looking to the Future
Feedback from the course evaluation suggests that, while the online learning component of the MoH eLearning platform was efficacious, participants still yearn for interaction with other learners and facilitators. In response to this feedback, the MoH resolved to incorporate the blended learning approach into the deployment of future eLearning courses. The blended learning approach will merge online learning with video conferencing and limited face-to-face facilitation at the decentralized level. The face-to-face component will transpire at the local level to reduce costs associated with traveling to training facilities. It will also be supplementary to the online learning component provided that in-person sessions will last only a couple of hours as opposed to several days.
Although it is too soon to label this initiative a success, the MoH eLearning program is promising nonetheless. The blended learning approach recently adopted by the MoH offers a cost-effective, practical resolution to the issues captured in the course evaluation: training costs are reduced through online training, yet eLearning participants can still interact with fellow participants and instructors through abridged in-person sessions. Through frequent monitoring and evaluation, the MoH will continuously refine the eLearning program as a cost-effective model for training health workers throughout the country. It is anticipated that- after putting the finishing touches to the MoH eLearning program- other countries in sub-Saharan Africa similarly confronting high costs associated with trainings and overburdened health staff will draw inspiration from this innovative, exciting, solution-oriented initiative.
