Project Title: Building capacity for elearning for nurse training in rural Zambia and Ghana
Zambia must double its health workforce to meet basic health needs. Ghana shares similar workforce challenges. In both countries, nurse tutors are scarce and recruitment and retention is problematic, especially in remote and rural areas. Limited
training resources create heavy tutor workloads and can result in rote learning. In addition, increased reliance on inexperienced tutors (essentially new graduates) has implications for training quality and constraints on regulatory processes are an added factor. There is an urgent need for better supervisory and mentoring links. However, these are limited by distance and costs. Our 10-month (June 2011-March 2012) THET-funded Multi-Link project on ‘Building capacity for elearning for nurse training in rural Zambia and Ghana’ is addressing these issues in order to give access to shared learning resources and professional supervision.
Aims: The main project goal is to build capacity of Nurse Training Schools (NTS) in remote and rural areas to deliver nurse education, including continuing professional development (CPD) to improve evidence based nursing practice in two main areas
- Maternal and child health
- Mental health
Project activities include:
- Building elearning networks
- Piloting elearning resources and activities between NTS
- Training ICT Champions to embed elearning at NTS
- Conducting ICT assessments
- Monitoring and evaluation, including exchange visits between participating NTS Meetings (actual and virtual) including:
(1) 3 formal project meetings by Skype:
Scottish and Ghana partners meet at Edinburgh University’s elearning suite
Ghana and Scotland Skype Zambia
Please also see the following telechat link: Chipata NTS partners, Zambia, attend by Skype Out
(2) A mini-conference at Macha Works (September 2011):
Project update (November 2011):
Much has happened since our inaugural meeting in June. We have:
- hosted a mini-conference on e-learning in southern Zambia, bringing partners from Zambia, Ghana and Scotland together
- developed The Africa Knowledge Network (AKN), a virtual library portal
- explored and utilised electronic systems for management of knowledge resources (Dropbox, Moodle, Huddle, AKN)
- distributed computer hard and software to nurse training schools (NTS) in Zambia and Ghana
- assessed ICT needs at 3 NTS in Zambia and 1 in Ghana
- trained 4 ICT Champions to manage computing needs at NTS in Zambia and Ghana
- distributed a range of existing e-learning resources (CDs, DVDs, websites, e-publications etc) to participating NTS
- provided 2 Articulate software licences to Zambian partners, to allow them to begin to develop their own e-learning resources
- developed two e-learning networks, one on mental health and one on maternal and child health
- conducetd formative project evaluation
Now, at the project’s mid-point, we paused to reflect on this progress at our mid-project meeting which took place by skype between the different countries concerned. In Edinburgh, Scotland, we were fortunate to have project partner Charles Turner (THET Volunteer Nurse Tutor, Kasama, Zambia) participating in person. Charles was on leave from Zambia and made the effort to come north from Birmingham to take part at Edinburgh Univesity’s e-learning suite. Charles was able to meet Scottish partners and, in turn, his presence helped to cement links and bridge the gaps with partner countries. Please see the following updates on our progress:
Project update November 2011
Macha conference report
Anne Mason Presentation
THET- eLearning DIY
THET Presentation RW PPT Malawi Overview
NTS consultation reports
Progress with development of the e-learning groups:
Elearning group progress
Membership of these groups is expanding and we now have a global Mental Health expert from Bangladesh and an experienced Midwife from Oman on board.
In addition, we have made some remarkable educational connections, not only with the University of Edinburgh’s Malawi e-learning link (http://malawi.mvm.ed.ac.uk/) but also with Dr Daisy Manza-Simwami, Lecturer at the Open University, UK. Dr Mwanza is a global expert on Activity Theory and Activity Oriented Design Method:http://www.slideshare.net/LeRoyH/activityoriented-design-method-july-2010 . These are theoretical models which could help to inform aspects of our project e.g. obstacles to enabling the e-learning groups. e-learning and Open Learning are Daisy’s specialsit areas: http://iet.open.ac.uk/people/d.mwanza-simwami. We have held a skype meeting with Daisy and there is potential for her to advise us further on use of the models. It just so happens that Daisy is from Zambia. In fact she is related to one of our project partners at Macha Works! This is a perfect example of South teaching North .
Ours is a small-scale pilot project. There has been much enthusiasm from all partners involved. We have much still to do to meet our objectives on ‘building capacity of nurse training schools (NTS) to deliver evidence-base training.’ Despite the challenges, we believe we have made a good start and, in our small way, we are dedicated to addressing the HIFA2015 slogan ‘People are dying for lack of knowledge’. Recent publications by our project partners, Macha Works (www.machaworks.org/en) suggest that this will best be achieved through slow, steady, community-driven solutions and new internet software architectures geared towards African technical and relational priorities. Please see the the following links:
An analysis of the factors affecting the sustainability of ICT4D in
Network trafﬁc locality in a rural African village, ICTD2012
Sustainabililty of projects like ours depends on such long-term approaches.
Update May 2012
No sooner have we started than our short, 10 month project is over! At least the initial funded part of it…as far a the work and collaborations is concerned, we have only just begun! It has been a roller coaster of a 10 months with many unanticipated outcomes, both positive and less so. On the plus side, we have:
-Built strong collaborative relationships as a platform for ongoing developments
-Provided some ICT infrastructure, including 8 desktop computers, and 4 laptops (1 for remote, rural Chitambo nurse training school, central Zambia; 3 for remote, rural Jirapa midwifery college in Upper North Western Region, Ghana)
-Piloted clinical supervision for mental health nurses by skype links with NHS Highlands in Scotland
- Initiated 3 e-learning networks on mental health, maternal and child health and interdisciplinary health
-Created a Dropbox filestore as an interim measure for sharing global health resources
-Built an interactive ICT portal (the Africa Knowledge Network, AKN) for accessing, storing and sharing global health resources: http://www.africaknowledge.org
-Partnered with eGranary on providing (by kind donation) digital library units to 4 partner nursing schools in Zambia and training key staff on using the system: http://www.widernet.org/egranery
-Partnered with Medical Aid Films (MAF) on piloting of a range of Maternal and Child Health films at one partner hospital and newly re-opened nursing school in central Zambia, using portable DVD players: http://’www.medicalaidfilms.org/
Here is what some project partners said about the project:
Chipata Nurse Training School, Eastern Zambia:
The many benefits to the Chipata NTS and hospital included:
Skype Clinical Supervision (CS) sessions: Mental health clinicians at Chipata District Hospital have benefited from participation in global discussions about clinical matters of mutual interest and concern, enabling them to expand their clinical networks, and critically reflect on their nursing practice and patient health outcomes.
Project development and collaboration: The NTS librarian and NTS were exposed to project management processes by participating in local project meetings and wider project management skype meetings with other partners.
ICT infrastructure: Computers were provided to the NTS and hospital MH unit, by Macha Works; other project funds, for e-learning purposes, are being used to purchase a computer router, modem, and a hard disk drive (HDD), as well as a printer cartridge and paper for the admin /photocopying work undertaken. These items will improve internet access, especially within the MH unit and will help to facilitate the ongoing skype CS sessions with Scotland, Ghana and elsewhere (Anne Mason, e-learning Lead; Jo Vallis, Project Coordinator; Peter Thompson, Volunteer Nurse Tutor) “(As a result of the ICT Champion training at Macha Works) Mental Health department in particular, they have been able to access internet which they never how to go by and they have learnt basic computer skills.” (Mr Pearson Moyo, Librarian/Information Officer)
Mr Moyo, in yellow, breakfasting at Macha Works
Chitambo Nurse Training School, Central Zambia: “We’ve set a platform for knowledge exchange between Zambia, Ghana, the countries which were there, and also Scotland…..Then also we were able to communicate, go through emails and internet (and) we managed to secure some computers, desktops for our institution…2 computers. ..then also the project has given us the link to eGranary which is a fantastic knowledge exchange platform because we have a data base within our vicinity and students can access the knowledge, the information they need before the internet is installed. And then, again through the project we have managed to get a router. A router is beneficial because personally I have used the router to download some teaching materials for the students, from the internet…even at Chitambo. So it’s been beneficial and we’ve set the foundation for a greater elearning project. So we’ve created that great and brilliant link…. we’ll keep moving on that.” (Levi Chifwaila, Nurse Tutor)
Levi hard at work at his desk! (The Airtel bag contains the router purchased from project funds)
Levi masterminded the re-opening of remote, rural Chitambo School of Nursing. This was his dream and he has manifested it. He is passionate about child health and, thanks to the HIFA-CHILD Network, he is applying for the Masters in International Child Health at University College London: http://www.ucl.ac.uk/cihd/postgraduate
With such a qualification, he will be able to make even more difference at Chitambo and elsewhere than he is already doing. WELL DONE LEVI, WE WISH YOU GOD SPEED!
Kasama Nurse Training School, Northern Zambia: “ It is believed that the most beneficial aspect of the project was that of eGranary. The CD ROMS supplied were (also) invaluable.” (Charles Turner, Volunteer Nurse Tutor)
Charles hard at work at his desk!
Jirapa Midwifery College, Upper West Region, Ghana: “I’m sure (e-learning) would be good for our students if we are able to take part in this elearning, to introduce our students to other programmes which other schools are doing, which will help our student to also get knowledge and (find out) what other people are doing through elearning. Some of the other benefits, thy were we were able to travel to Zambia and then they have given us a bit of funds and that one we were able to get 2 more laptops for the school. And if we’re able to get an internet connection, then maybe we’ll be able to get the elearning. So I bought 2 laptops for the school.” (Sister Elizabeth Ansotinge, Principle)
Sister Elizabeth taking to the ‘airwaves’ at Macha
MOH Ghana, on behalf of Jirapa Midwifery College:
Please find the benefits and challenges as below:
1. clarity on way forward for elearning
2. assurance of possibility
3. Introduction to possible infrastructure & technologie .eg. moodle
4. Gain knowledge of sources of large e-learning materials
5. support for development. money
6. served as a platform to launch additional e-learning initiatives
7. meeting partners and collaborators
8. Personally enlightening as it gave me exposure i didnt have previously
1. short duration of macha ICT champion trg
2. Poor internet infratructure hindered communication
3.Limited scope (emphasis on midwifery & mental health) made wider stakeholder buy-in difficult
4. Small size of project (limited to Jirapa) as opposed to nationwide coverage (as favoured by the MoH Ghana) made it difficult pushing it through (Kofi Afari-Deyki, Information Manage
Kofi shares his extensive ICT ‘know how’ at Macha
Macha Works Zambia: “That THET project did benefit Macha Works in various ways. The collaboration in the THET project did expose our rural Zambian organisation with peers and experts in the field in Africa and Europe….With THET’s subscribing to the value of ‘listening to the local voice’, and keen interest in the Macha Works model, there was a distinct challenge to provide for that voice. In this case it was not ‘window dressing’ but a real and level playing field. …. This was, again, due to close cooperation and a willingness to listen from each other. The use of the ‘living laboratory facilities’ at rural Macha has been appreciated. In that way the benefits of the cooperation was spread more wide, for instance helping in the sustenance of the whole organisation. No doubt the rural-to-rural exchange has benefited all involved, and certainly has left a lasting impression in Macha. It was felt that the resources available for the project did – to a higher extend then ordinary ‘foreign aided projects’ – arrive in the rural community. As such the project felt more ‘balanced’ for the rural community, and thus has more chance for impact.” (Gertjan Van Stam, Initiator/Research Lead)
Gertjan reflects on our project journey
Consider Mudenda (left) was the perfect Macha conference host and ICT Champion trainer…Consider now has a BSc Computing! CONGRATULATIONS CONSIDER!
NHS Education for Scotland (NES) Remote and Rural Educational Alliance (RRHEAL): “RRHEAL has been delighted to engage with the ambitions of the THET multilink project. RRHEAL were happy to assist by providing access to content that supported educational development which included:
- RRHEAL VC education guide- with methodologies supporting distributed education
- RRHEAL QA guide to distributed education -which includes detail of approaches to supporting mentor ship and supervision at distance, as well as delivering education to dispersed teams.
- RRHEAL offered detail of how file production opportunities and skills and simulation work could be used to develop re-usable learning tools of high utility to different teams associated with the THET partnership.
- RRHEAL gained insight and perspective to both the challenges faced by THET partners. But importantly RRHEAL gained from the knowledge exchange regarding solutions: regarding manpower/ workforce consideration and innovative approaches to educational support.
- The discussion supporting the application of support workers was enjoyed tremendously considering the rural approach that is being actively pursued in Scotland.
Overall, involvement in this project has been highly useful and productive for RRHEAL. It shows by example, to NES how technology can be used to assist with international communications and conferencing, supporting knowledge exchange and highly innovative approaches to significant challenges.” (Fiona Fraser, Programme Lead)
ChallengesThere have been many challenges, too, of course, not least the the technicalities and costs of accessing the internet. This is partly overcome for us by the donation of the eGranary Digital Library (non-internet dependent), as a complementary measure to the dynamic, interactive Africa Knowledge Network (AKN), which requires the internet.
THANK YOU TO CRAIG WILSON AND HEATHER LEE (UNIVERSITY OF ALABAMA AT BIRMINGHAM, USA) FOR THEIR GENEREOUS DONATION OF eGRANARY DIGITAL LIBRARY UNITS TO OUR PROJECT. THESE ARE INVALUABLE
Other challenges included the short length of the project (10 months); participant workloads; and the time needed for NTS staff and students to embrace the idea of e-learning (See the following link for partners’ own observations on challenges): Appendix 6 Partner feedback on challenges
Unforeseen circumstances: There were other unforeseen challenges and our project was dealt a devastating body blow when our key project partner, Gordon Urquhart, passed away at Mwami Mission Hospital, near Chipata in eastern Zambia, on Friday 10th February 2012. Gordon was both evaluation and technical lead for the project. His partner, Anne Mason, is e-learning Lead, so understandably this was a great loss to the project.
Messages of condolence flooded in from project partners across the globe. Everyone was unbelievably shocked and saddened. Here are some examples of the love and concern which was expressed in typically African fashion:
“Hi Jo, I am saddened to inform you that Mr. Gorden Urquhart Husband to Anne and the project partner has suddenly died of Cardiac condition. he passed on Friday 10th Feb 2012. Anne she in Lusaka en route to Uk to take the body. May His Soul rest in Peace. It was very shocking to her because she was even in class teaching the very day and staff here are saddened with what has happened. we just pray that the almight God will strengthen the family. Thank you” (Mr Pearson Moyo, Chipata, Zambia)
“Jo, greetings from SR Lizzie and Ghana. It was so shocking when i got a text message from Anne announcing the death of her beloved husband. I was so sad. My question was why is it that good people does not keep long on earth. Gordon was such a hard worker.I am praying for him and Anne and the entire family. It is actually a great blow, we believe that God will fill in the gab created .My condolence to Anne and the children.When is the burial? I will continue to pray for Anne and the family. Love. God bless you.Sr LIzzie.” (Sister Elizabeth Ansotinge, Jirapa, Ghana)
Text message: Have been informed it’s very sad and unbelievable. I was told by a tutor from Chipata about Gordon Urquhart passing on in Mwami …what happened it’s very sad. (Levi Chifwaila, Chitambo, Zambia)
What now follows is a tribute to a wonderful couple:
Tributes to a wonderful couple
Tribute to Gordon:
Gordon takes to the air at Macha
Formative evaluation in progress
Our project encountered a devastating blow when project partner Gordon Urquhart (Evaluation and ICT Lead) passed away suddenly at Mwami Mission Hospital, near Chipata, Zambia. Although not an official THET volunteer, Gordon supported Anne Mason (e-learning Lead) in all project activities, specifically evaluation and technical aspects. Gordon attended the e-learning conference at Macha Works, in September 2011, where he is fondly remembered for both his formal and informal contributions, including his Scottish country dancing and excellent recall of the Scottish ‘anthem’, Auld Lang Syne. Gordon also participated in exchange visits to partner nursing schools (Chitambo and Kasama) where he collected formative evaluation data. He was a great traveling companion and is on record as being amongst the first to test the beds at the new Chitambo nurse training school (pictured). From Chipata, Gordon explored a range of technical solutions for the e-learning project, including computer access, ICT platforms, mobile devices etc. He developed the evaluation plans and was planning some telephone interviews to gauge partner and participant feedback on e-learning activities. More recently, he contributed to discussions surrounding further development of the NES- built Africa Knowledge Network (AKN), and potential collaboration with the eGranary digital library. Both of have potential to leave a real e-learning legacy. These are only a few of Gordon’s valuable contributions. His friendly, helpful, easy-going manner helped to smooth the way and made him a pleasure to work with. As messages from project partners demonstrate, he is sorely missed (See below).
Mutende mukwai Ba Gordon, peace be with you.
Tribute to Anne:
Anne with Mrs Dorothy Banda (PT, left) and other NTS staff
Anne with Mr Jonathan Mwale (Nurse in Charge, centre) and another member of the Chipata MH team
Patients’ garden, Mental Health Unit, Chipata District Hospital
Despite her profound loss, Anne has remained as committed as ever to the project goals and, after her immediate period of mourning, has provided real, continued input and support to the project evaluation, reporting and dissemination. It would not have been possible to reach this level of project completion without her. For this, we are profoundly grateful.
THANK YOU ANNE
Project evaluation: As mentioned, Gordon was leading the project evaluation and without him we were struggling. However, here is where Anne rallied to the rescue. Between us, we developed some evaluation instruments surrounding th skype clinical supervision (CS) sessions and the Macha ICT Champion training. See: Skype Sessions Evaluation Form ; ICT Champion Training Evaluation Form
These, and a few telephone interviews with willing partners, have enabled us to get even a very small amount of useful feedback on some very preliminary developments resulting from our project. In particular, Anne’s evaluation report on the skype supervision sessions makes good reading:Appendix 1a Summative Evaluation Report CS
Reporting on the ICT Champion training is underway and quite positive. The report will be posted shortly.
Our dissemination plan is developing well and we have a number of conferences and publications in the pipeline.
We will strive to find funding to enable project partners to co-present at the Alternative Technologies (AHT) Conference in London, in September (See abstract: AHT – Abstract Template Jo Vallis et al
Meantime, all interested partners will be involved in co-authoring papers related to the project.
Where to now?
Our project has been a very small start to building capacity for e-learning in Zambia and Ghana. Our greatest success is the genuine friendships and collaborative links which we have built. We have only just begun. According to project partners, we need another project (or projects) to keep the momentum going. In particular, we need opportunities to build on existing initiatives such as the skype clinical supervision initiative piloted by Anne Mason at Chipata, Zambia, and the Africa Knowledge Network innovated by NHS Education for Scotland. For this, we need further funding. Look out for us, we’ll be out there with the best of them!
Last words (for now)
In many ways our project has, as said by Levi Chifwaila (Chitambo) ‘come full circle’ . Little has happened as we might have predicted but we have ended the project on a high note with 6 Zambian partners and contacts attending a 2-day eGranary workshop in Lusaka, and each taking away an eGranary Digital Library unit for piloting at their nurse training school. This at least gives interim access to useful health training resources until such time as partners can more easily access the internet and obtain such resources via the Africa Knowledge Network (AKN). There has also been real reciprocation throughout the project and, whereas the Project Co-ordinator was able to visit Zambia and meet key partners in person (September 2011), African partners have made exchange visits to Edinburgh, Scotland, at 4 stages in the project:
- Inaugural project meeting: As above, Dr Kuganab-Lem and Mr James Antwi (University for Development Studies, Ghana) attended in person, in Edinburgh (June 2011)
- Interim project meeting: Mr Charles Turner (Volunteer Nurse Tutor, Kasama NTS, Zambia) attended in person, in Edinburgh (October 2011)
- Teleconference meeting about the Africa Knowledge Network: Gordon Urquhart (Evaluation and ICT Lead), attended in person, in Edinburgh (January 2012)
- Project closure: Mr Gertjan Van Stam (MachaWorks Zambia) and Mrs Anne Mason (e-learning Lead) visited Edinburgh. We met at the Elephant House cafe and reflected on the project journey as well as talking about project dissemination and other future plans. By the way, for those who know the Harry Potter children’s books, the Elephant House is where author J.K. Rowling penned these!
Anne and Gertjan at The Elephant House Cafe, Edinburgh
We also met with Jenny Ure, another valuable Global Health contact linked to departments of informatics and computing at both the University of Edinburgh and Edinburgh’s Napier University. Jenny has tele-health links with Venezuela, in Latin America and initiated some South-South interaction between Hector Arachadere (University of Venezuela) and Gertjan Van Stam (Macha Work, Zambia). Jenny enabled us to gate-crashed an mhealth seminar at Edinburgh’s Napier University, where we handed Gertjan’s paper on ‘Network traffic locality in a rural African village’ (See: Network Traffic Locality in a Rural African Village, ICTD 2012 to the slightly bemused Microsoft speaker! The speaker was obviously impressed because he went away clutching Gertjan’s paper! Outside, the rain poured down in typical Scottish fashion. However, for us, the visit was a perfect rounding off of what has been a very exciting, if also challenging, project.
Jenny and Gertjan gatecrashing the Napier University m-health conference!
THANK YOU TO THET FOR THIS VALUABLE JOURNEY
Ongoing project dissemination:
Although the funded part of this project is over, the work continues in various ways:
-through other successful grant applications in Zambia and Ghana
-through dissemination of project experiences as joint papers, posters and news articles
Our paper, 'Building capacity for e-learning for nurse training in Zambia and Ghana: Appropriate computer technologies? was published as part of proceedings of the Appropriate Health Technologies (AHT) for developing countries, 2012 and continues to attract interest and invitation from other journals to publish related papers .g. the Open Access Journal of Information Technology and Application in Education (JITAE).
Our poster on ''Building capacity for remote, rural knowledge exchange: a global health collaboration' was accepted for presentation at the prestigious NHSScotland Event 2013, to be held in Glasgow on 11-12th June, 2013: http://www.nhsscotlandevent.com/Home
The conference theme is 'Collaborating for Quality in Healthcare' and it is good news that the Scottish Government recognises the value of global collaboration both to share Scottish expertise and learn from other global health regions.
A minority of posters were accepted for presentation at this venue. Not only was our abstract accepted but it was given the highest Scottish Government rating (10/10), with the following Reviewer feedback: "Fabulous example of an initiative aimed at knowledge sharing to improve outcomes for patients -demonstrates partnership working internationally which could bring the benefits of the quality ambitions to other nations -look forward to seeing further information around the outcomes from this initiative."
The designed poster pdf can now be viewed here:
Teaching resources of any kind e.g. powerpoint slides, lecture notes, CDs, DVDs etc, relating to maternal and child health and/or mental health training
Dr Jo Vallis
Research Officer/UK Project Coordinator
NHS Education for Scotland
c/o The Lister
Tel: +44 (0) 131 650 9382