1. EAST AFRICA COMMUNITY eHEALTH WORKSHOP November 8-10, 2010 eLearning Nurse Upgrading Programme: Kenya’s Experience Presented by: Caroline Mbindyo - AMREF HQ 8 November 2010

2. Current HCW Density: Nursing Global distribution of the health workforce (per 10 000 population)

3. eLearning Programme Background Moratorium on hiring new nurses Inadequate facilities to up-skill nurses in Kenya – Shortage of qualified nurses – As at 2004, over 80% of nurses in Kenya were ENs – Only 4 government nursing colleges offering upgrading from enrolled to registered nurse as at 2004 (100 nurses / annum) – Health facilities in rural areas run by EN who did not have the requisite skills to offer quality services (clinical, managerial, research) Cost of training

4. A health system under extra-ordinary pressure requires extra-ordinary effort Address the shortage of qualified nurses in Kenya rapidly and cost-effectively Improve standards of nursing care and the health of disadvantaged people in Kenya quickly Increase access to affordable, higher education for professional development of practicing nurses, majority of who are women and located in the rural area. Provide skills to enable nurses perform new tasks shifted to them Work towards health-related MDGs (4, 5 & 6)

5. The Programme at a Glance Regulations & Examinations Standards & Guidelines definition Coordinating school activities Policy issues Release of nurses to learn Course approval Student enrollment Programme implementation Tutoring, assessments & examinations Content development Programme management Infrastructure deployment Capacity building Advocacy Public Private Partnership Funding in cash & kind Skills transfer

6. The Programme Design LEARNER SUPPORT LEARNER SUPPORT Tutors trained in schools Mentors in the clinical areas Face-to-face sessions End of module examinations DEPLOYMENT COURSE STRUCTURE COURSE STRUCTURE Over 1,100 hours of learning 52 weeks of clinical experience eContent development LMS & CD-ROMs ACCESS Setting up eCenters 12-hour access for students Help Desk set-up at AMREF MODULAR CURRICULUM MODULAR CURRICULUM General Nursing Reproductive Health Community Health Specialized Areas

7. The Story So Far Increased access to health education – 34 schools with an enrollment of over 7000 nurses – 108 eCenters across the country Over 400 tutors & mentors trained to support eLearners Improved nursing care - immediate application into practice. Reduced cost of learning Increased demand for eLearning from countries and organisations eLiteracy

8. The Story So Far Established of AVS to test innovative teaching methods Rolled out Diploma in Community Health accredited by Moi University. Registered 53 students from 10 African countries since 2009(Moi/AMREF) Management training for NACC staff and sub-grantees. Goal is train 7,000 within 3 years. (UCLA/NACC/AMREF) Rolled Infection Prevention & Control course for all provincial hospitals in Kenya (CDC/MoHs/AMREF) Replicating the programme with the Ministry of Health in Uganda which targets to upgrade 11,000 EMs to RMs to tackle maternal mortality mLearning @ AMREF

9. Programme Challenges Resistance to change Techno-phobic students & teachers Large scale maintenance of IT Infrastructure Limited IT support at decentralized centres Limited access to Internet connectivity in rural locations Inadequate approved clinical placement facilities

10. Programme Evaluation BEHAVIOUR CHANGE Practice As Performance institutionalisation Level 4: Results Eg –Improvements in health outcomes, improved health service efficiency (mortality, morbidity, healthcare utilisation) Level 3: Behaviour Eg – Improvements in health worker performance (peer review, observation, patient exit surveys) Competence COMPETENCE Level 2: Learning Eg – Improvements in competence (pre-test vs post-test, self-assessment)  Feedback  Self-directed learning  Problem based learning  Simulations and case based learning  Distributed learning Engagement ENGAGEMENT Level 1: Reaction Eg – Positive response to training  Interactive  Competency based  Clear learning objectives  Relevant assessments ENABLING FACTORS

11. eLearning Capability Maturity Model

12. Conclusion & Looking Forward 1950’s -1960’s AMREF is founded core activities – Flying Doctors Services delivering health care to remote areas 1960s -1970s Introduction of Radio programmes on national Radio for health workers 1980s -1990s Introduction of print-based distance education 2000 & beyond Introduction of technology supported learning including telemedicine, eLearning and mLearning Africa may have complex challenges but we are finding simple way to resolve these challenges.

13. Thank You! caroline.mbindyo@amref.org www.amref.org @shakwei