Nigeria recorded its first case of COVID-19 in February 2020, and like most other countries, the government activated all of its health systems to prevent rapid and further spread. Immediately, the government coordinated efforts at the highest levels, setting up a presidential task force (PTF) to provide strategic direction for the country’s response.
The PTF ensures delivery of national and state-level priorities to control the outbreak, and reviews, approves, and provides recommendations to support the response. It also monitors progress of nationwide activities, ensuring that the public is kept abreast of emerging developments. The Nigeria Centre for Disease Control (NCDC) has also concentrated efforts on improving testing, infection prevention, and control and active case management.
While the government carried out this robust response to the pandemic, it also understood that other critical health issues could not be neglected.
COVID-19, a threat to essential health services
Based on guidance from the the World Health Organization (WHO) the Ministry of Health through its National Primary Health Care Agency (NPHCDA), swung into action to protect critical health services such as maternal and newborn care, lifesaving vaccinations, and nutrition and HIV programs, ensuring that the threat of COVID-19 would not create a greater health catastrophe in the country.[1].
As part of the Federal Ministry of Health, the NPHCDA is responsible for primary health care policy, planning, and implementation and provides oversight to primary care clinics where most essential health services are provided. The agency had the urgent task to swiftly develop and implement strategies that would rapidly inform, educate, and build the capacity of frontline health care workers to maintain essential health services.
Ensuring that essential health services were effectively maintained during the pandemic was an enormous challenge. In addition to a tightened federal budget, lockdowns, travel restrictions, and social distancing created unprecedented challenges to service delivery. The government knew it needed a solution to ensure that workers could be trained to both handle the new health threat from COVID-19, while at the same time maintaining essential health services.
The government turned to Electronic Learning, or e-learning.
E-learning for training and capacity building
With prevailing global health trends and widening health inequities in low- and middle-income countries (LMICs), e-learning provides a platform for flexible, user-centered, and easily updatable information for health worker training.
E-learning is often less expensive than traditional training, which usually requires travel costs and stipends. As technology and internet access continues to grow, e-learning platforms have the opportunity to bridge the gaps in capacity building for health workers in LMICs and improve service delivery.
E-learning is not a new approach in Nigeria. It has been used in education[2]and health[3] albeit at small scale across different programs and levels of care. In addition, several e-learning courses to improve health worker capacity via WHO and Immunization Academy have gained popularity among health providers in Nigeria in recent years. Even so, there have been barriers[4] to the widespread use of e-learning approaches for health-sector capacity building, including the limited and inequitable access to technology, devices, and the internet, interruptions in power supply, inadequate instructional materials, amongst others.
Training Nigeria’s health workers
The COVID-19 pandemic prompted the NPHCDA to conduct an unprecedented capacity building exercise using e-learning methods to equip over 7,000 national and state-level program managers across the country with the knowledge to cascade training to health workers at the local government level on pandemic response and maintaining essential services.
Learn more about CHAI’s work in Nigeria
CHAI supported the NPHCDA to coordinate and facilitate trainings for these primary health care workers to increase capacity, reduce the spread of disease and save costs for the government. These intensive, multi-day trainings focused on infection prevention and control for COVID-19, provision of services during the outbreak, as well as education about the equipment and commodities required, and effective communication, waste management and cleaning practices to reduce the risk of spread and protect health workers.
These e-learning trainings had three specific goals:
Build capacity
- The trainings used adult learning approaches such as video and role-playing. Tests conducted before and after the trainings showed an increase in both national and state participant knowledge. Trained workers will now be able to pass their knowledge to workers at lower levels of care.
Lower costs
- The trainings provided an 83 percent cost reduction for the government. CHAI calculated that on average, traditional in-class learning costs approximately $83 per heath worker for per diems while the e-learning approach cost $14 per worker for the use of data.
Protect health workers
- By providing an alternative to in-person learning, the e-learning trainings helped prevent the spread of COVID-19. While training was face-to-face at health facilities, program managers put stringent measures in place to ensure the reduced spread of infection.
Lessons learned
Considering the many limitations the country faces with technology, there were several challenges with e-learning training. However, these challenges present as opportunities for future e-learning approaches.
Influencing Environment
- Given that majority of subnational level participants, particularly at the local government and facility levels, have limited exposure to e-learning, training requires prior sensitization on e-learning tools
- With poor internet access and connectivity, the government will need to improve equitable internet access and ensure there are adequate supporting infrastructures such as interconnectivity and electricity for learning
Financing
- Although e-learning implementation costs significantly less than traditional learning styles, Nigeria will need to invest in the overhaul of its capacity-building approaches to include equitable distribution of internet, computers, and necessary technology needed for sustainable and conducive e-learning.
Coordination and Planning
- Program managers at the national and state levels will need to design training in intervals of no more than five hours to improve retention of participants for the entire session.
What this means for the future of health worker training in Nigeria
With increasingly scarce resources, e-learning provides the opportunity to save money and reach more health workers in a wider area with high-quality training. With some investment to expand access to internet and technology, this experience has opened the door to new opportunities to build Nigeria’s health workforce throughout the health system.
CHAI is looking for dynamic and self-motivated individuals who are committed to our mission to strengthen the government and private sector to create and sustain high-quality health systems in the countries where we work. View open positions in Nigeria.
