E-Learning Boosts Medical Training

As a midwife in Entebbe hospital, Sarah Achom delights in delivering mothers and ensuring that they and their babies are fine. It is, she says, something she does on a daily basis.

Haste and carefulness are Achom’s daily companions. In her snow-white dress complete with a blue apron, she moves about the hospital’s private maternity ward, examining expectant mothers and ensuring a suitable delivery environment.

“For the six hours that I work daily, I deliver about two mothers. But while I was still in the general maternity ward, I would sometimes deliver up to six,” says Achom.

It is this skill, agility and unwavering commitment to excellence that made Achom to be selected as one of the pioneer students of a groundbreaking learning programme in Uganda’s medical education history. In 2012, the African Medical and Research Foundation (now Amref Health Africa) launched its e-Learning project, which would allow medical workers like Achom to get further education without leaving their work stations.

In a country where the number of patients outmatches the number of nurses and midwives by a whopping tenfold, becoming a mother in Uganda might pass as a matter of life and death. The Uganda Nurses and Midwives Union (UNMU) says that on average, the ratio of a nursemidwife to patients is 1: 3,000. The recommended standard by the World Health Organization is 1:5 for nurses and 1:4 for midwives.

According to Uganda’s 2011 Demographic and Health Survey, the maternal mortality rate stands at 438 deaths per 100,000 while neonatal deaths stand at 90 per 1,000 live births.

“Dampening the situation further is the fact that 11,000 midwives and nurses need training to be registered as professionals and 58 per cent of women deliver without the help of a midwife,” says Janet Obuni, president of UNMU.

Amid such dark statistics, Amref’s e-Learning project is a huge silver lining, allowing serving nurses and midwives to upgrade to diploma level.

About the project

In many health facilities across the country, information technology is often considered a management tool and not a resource for clinical care. This is attributed to the limited computer knowledge and computers among health workers. In effect, Amref launched the e-Learning project in 2010 after its documented success in Nairobi, Kenya.

It was first piloted in Arua School of Comprehensive Nursing, Masaka, Mengo and Nsambya schools of comprehensive nursing and midwifery. Today, it has been implemented in 10 institutions countrywide, including Mulago School of Nursing, Lira and Jinja schools of comprehensive nursing, and the Public Health Nurses College in Kyambogo.

Enrolled nurses and midwives receive a continuum of training, including diagnosis of diseases, care for newborn babies, management of labour and its complications, growth and development of a child and provision of adolescent-friendly services, among others. Electronic learning (e-learning) refers to learning delivered using electronic means through internet, intranet or CD-ROM to access the education curriculum outside of a traditional classroom.

To make this viable, Amref has established e-centres, equipped with desktop computers at students’ workplaces. In their first semester of study, students interface with tutors, mentors and IT trainers to acquaint themselves on how to use computers, access course material and how they will be supervised.

How it works

To access course material, a registered student logs in to www.learning.amref.org and herein accesses the learning management system (LMS). LMS is a software application for the administration, documentation, tracking, reporting and delivery of e-learning education courses or training programmes.

“It is fitted with different school calendars and a number of tabs such as course units and assignments for students to access and download course material,” explains Patrick Bigirwa, the project manager.

He adds that calendars are fitted in order for the students to know dates when they will have face-to-face interactions with their tutors, when to do practicals and when exams at their schools will be conducted. They carry out practicals and sit for exams with the regular students at school.


Students also have the option of receiving video and audio lessons which are uploaded by the tutors.

“To ensure that students keep up with the tide of study, each student has a mentor responsible for supervising them as majority of them are already working,” Bigirwa says.

Lillian Nalugonda, another beneficiary of the training, credits e-learning for its flexibility.

“You continue working at your job while you take classes, thus allowing you to earn a living, gain work experience and applying course skills in your work,” says Nalugonda, a midwife at Lubaga hospital.

E-learning also saves on the time and costs of moving to school every day and allows one to study at their own pace and convenience. As a result of improvement of their skills, nurses are becoming more involved in multi-disciplinary care coordination and management of complex and chronic conditions.

So far, the programme has attracted 67 midwives and nurses. This cohort, who enrolled for the training in April 2012, is set to graduate in November. The project’s target is to train 3,000 midwives and nurses in the next five years. It is part of the ‘Stand up for the African Mother’ campaign that seeks to address maternal mortality, launched by Amref in 2011.

The trainees

For eligibility to participate in the two-year e-learning training, one ought to belong to a nursing or midwifery school as a registered student.

“We aertise the training vacancies through the media and shortlisted candidates are interviewed. Successful candidates are then distributed to different training centres on precepts of easy reach and supervision,” says Bigirwa.

During their first semester of study, they spend at least three weeks meeting their tutors and clinical instructors in person to discuss aspects on how to do coursework, conduct practical lessons, modules to be covered and how to access materials on computers.

In the two year course duration, participants cover 21 modules.


Although the uptake of information technology by Ugandan nurses and midwives has so far registered success, limited face-to-face interaction with the teacher remains a concern to the students.

“We are supposed to meet our mentors once in a while but for the two years I have been on the programme, I have not met mine,” says Achom.

For Nalugonda, limited availability of tutors at the school was a challenge. She says she would interface with them only in the first week of the semester and this prevented her from going to school unless she had exams and practicals. Also, students complain of high tuition and equipment costs owing to the fact that they are self-sponsored.

Each student pays Shs 1.3m annually and some students like Achom have been forced to purchase their own laptops as computers are not always enough and available.

“Using a loan, I bought a second-hand laptop that I have used throughout the two years,” she says.

Other challenges include a student feeling a sense of detachment from school and not always being self-motivated which e-learning demands owing to its student-centred learning nature. Achom says there is need to sensitise senior midwives and nurses at different health centres on the relevance of online training as many think it is irrelevant and substandard compared to in-class training.

To leverage sustainability for the e-Learning project, Amref annually spends $686,980, which goes towards training of clinical instructors and tutors, steering committee meetings, covering support supervision, procuring, installing and maintaining computers and facilitating operational research.

Source : The Observer

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