It is in Africa where people are more exposed to a heavy and wide-ranging burden of disease – partly because of the region’s unique geography and climate.
Nowhere has the HIV/AIDS epidemic killed such large proportions of the population; and nowhere has the old scourge of tuberculosis re-emerged in such big numbers. Poverty is very prevalent – about 40 percent of Africa’s people live below the poverty line; agricultural productivity is lower due to unreliable water supply, inadequate irrigation and poor soil quality.
A child born in Africa faces more health risks than a child born in other parts of the world, has more than a 50 percent chance of being malnourished, and has a high risk of being HIV-positive at birth.
That child is more likely to lose his or her mother to complications at childbirth or to HIV/AIDS; that child has a life expectancy of just 47 years. Other challenges are that malaria, diarrhoea and acute respiratory diseases account for 51 percent of deaths.
The human resources available for the health crisis that sub-Saharan Africa faces has been brought on by a weak health care systems in many countries, and this is also the case in several member countries of the World Health Organization.
The region carries 25 percent of the global burden of disease, but has only 3 percent of the global health workforce and 1 percent of the resources spent globally each year on health.
The region suffers from a shortage of 800,000 physicians and nurses, suffers a loss of 20,000 skilled workers per year and is currently producing only up to a third of the required amount of health workers.
There are many factors that are contributing to the crisis and they include years of chronic under-investment in the health workforce during the period of structural adjustment programmes (SAPs) as well as a loss of health workers (due to migration, poor conditions of service, etc.).
Other factors are low production capacity (lack of comprehensive health workforce policies and plans), inadequacies in training and lack of institutional capacity, lack of trainers – as they are concentrated in densely populated countries – lack of relevance of the training against the needs as well as a limited use of ICT.
Dr Emil Jones Asamoah-Odei, the coordinator for knowledge management at the WHO Regional Office for Africa, says innovative and cost-effective solutions are required to scale up and retain the health workforce.
He says eLearning, or eHealth for that matter, offers an opportunity to rapidly scale up the production of the health workforce and to upgrade the skills of health workers in districts and peripheral areas.
He defines eHealth as “the delivery of health services, where distance is a critical factor, by all health professionals using information and communication technologies (ICTs) for the exchange of valid information for diagnosis, treatment and prevention of diseases.” ICTs, he says, would also aid research and evaluation, and the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities.
Asamoah-Odei says training networks between training institutions in capital cities can support sharing of regional-training capacity and fill gaps through remote learning to expand and support training capacity.
He says the WHO Africa Regional Office, which is based in Congo Brazzaville, is promoting the use of web-based conferencing systems to ministries of health in efforts aimed at bridging the skills gap for health workers that has been caused by migrating health workers. “Use of electronic tools like web-based conferencing systems and eLearning offers opportunities to upgrade the skills of health workers and to enhance collaboration amongst member states of the WHO African region,” says Asamoah-Odei.
At the next eLearning conference, slated for Accra, Ghana, Asamoah-Odei will make a case for the use of eLearning as one way of responding to the human resource for health crisis in sub-Saharan Africa and also review experiences from Member States.
He will argue that the adoption and implementation of eHealth policies and strategies will help strengthen health systems – thus improving health outcomes and contributing to the achievement of the health-related Millenium Development Goals.
There are examples of working eLearning practices. In Kenya, some 20,000 nurses have been trained over a period of five years.
The Kenya eHealth plan has been made possible through the ministry of health, African Medical & Research Foundation (AMREF), the Nursing Council of Kenya as well as Accenture – a global management consultancy, technology services and outsourcing company with many years of experience in eLearning solutions. The programme involves more than 25 nursing schools and about 100 hospitals and medical training colleges.
The pluses with an eLearning platform are that many nurses are trained at a lesser cost, which helps save money.
In the Gambia, eLearning is used for training in ophthalmology, where the students far away from the operating tables see actual operations being performed. eLearning is also used for training community doctors.
In South Africa, nurses were given a one-week training in dermatology, then given laptop computers and cameras and sent out to field hospitals and clinics to provide services, with remote support from specialists, via tele-dermatology.
The experience demonstrates the power of eHealth to not only support health workers deployed in services, but also to transfer skills among clinical staff.
The Francophone African Network for Telemedicine – Réseau en Afrique Francophone pour la Télémedecine (RAFT) – webcasts interactive courses, videoconferences and tele-consultations. RAFT was started in Mali in 2000 and has since been extended to cover 10 French-speaking countries.
In Seychelles, despite the lack of a university, nurses have graduated using eLearning and distance learning in collaboration with the Indira Gandhi National Open University. If adopted, eHealth will lead to improved access of health workers to appropriate knowledge for prevention, improved access to knowledge at the point of care as well as disease surveillance and health promotion for the general public and specific target groups.
Other approaches are formal online training through networks of institutions, treatment and care and support and rehabilitative services, online learning opportunities for in-service self-development and sharing of experience and best practices through Internet networks.
According to Asamoah-Odei, governments interested in going into eHealth need to constitute a national task force/committee on eHealth, conduct national needs assessments for eHealth, develop national policies, standards and norms for eHealth, and prepare national strategic plans for eHealth.
Governments also need to build national capacities for eHealth, mobilise resources and build partnerships to support implementation of national eHealth plans, and implement, monitor and evaluate those national eHealth plans.
You can meet Dr Asamoah-Odei in the session MED49 eLearning in Medical Education on Friday, May 30th, 2008, 14:00 – 15:30.
By Edris Kisambira