ICTs and continuing education for rural health
SOURCE: 'HIF-net at WHO': working together to improve access to reliable information for healthcare workers and health professionals in developing and transitional countries. Send list messages to hif-net@who.int. To join the list, send an email to health@inasp.info with name, organization, country, and brief description of professional interests. The following is a summary of a meeting held in Moshi, Tanzania, in April 2003. The full report is available at http://www.ftpiicd.org/files/research/reports/report17.doc In April 2003, IICD (International Institute for Communication and Development), Cordaid and CEDHA (Centre for Educational Development in Health Arusha) jointly organised a conference to explore ways in which ICTs (information and communication technologies) can be used to develop and deliver continuing medical education to rural healthcare workers in Kenya, Malawi, Tanzania, Uganda, and Zambia. With the support of PSO, representatives from universities in the region also met to explore opportunities to collaborate in the development and delivery of postgraduate and CME courses and materials for doctors. This report presents some of the background materials prepare for the meeting as well as the results of the discussions in Moshi. The overall aim of the meeting was to identify concrete strategies and approaches where ICTs can be used to develop and deliver continuing medical education to healthcare workers in rural areas. At the same time, it was important to identify the limitations of ICTs in CME, in order to define realistic programmes. Specific objectives of the meeting were: * Validate and understand the needs and demands already expressed (by CORDAID partners, by others). Clarify the demand and the problems to be addressed; * Explore ways in which the application of ICTs can contribute to more effective CME. Under what conditions is each applied and what might be critical success and failure factors. Test any assumptions; * Take stock of current e learning, health education, health information, and distance learning initiatives in the five countries. Identify current approaches, strategies, lessons, successes, and failures. Map gaps and opportunities; * Establish vision(s) and actions that might be elaborated at the national and regional level. Set out an agenda for further work. * Discuss with specific groups of stakeholders their role in Continuing Medical Education in the context of their regular activities. * Provide an opportunity for networking and dialogue among the various parties present. About 40 participants came from Kenya (5), Malawi (3), The Netherlands (6), Tanzania (12), Uganda (9), United Kingdom (2) and Zambia (3). Participants came from health services and information or education providers and represented universities, training institutions, non-governmental organisations (NGOs), church-related and other umbrella organisations, and the public sector. Much regretted by several participants, invitations to Ministry of Health personnel in the five countries to attend were not taken up. THE PROBLEM Healthcare providers are the most important asset of any healthcare system. To ensure that they can deliver high quality levels of care, they need to be 'connected' to learning, knowledge and information. In most developing countries however, rural health workers are mostly disconnected from such learning and educational opportunities and, aside from the threat to quality of care, this leads to lower levels of morale and commitment to their work. 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 * CME activities at place of work * CME activities at home * 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 participating in the conference indicate 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 main question discussed in this conference 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. Amidst all the positive ideas on the potential application of ICTs to CME, several constraints and limitations were also mentioned. It was clearly recognised by participants that ICTs can only make a difference to CME when certain conditions are met. These included: * That 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 also 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. 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. The regional collaboration proposals from the universities will be taken up by Cordaid and PSO as part of their efforts to enhance CME and postgraduate training capacities in the region.