Primary health workforce learning in an era of COVID-19: is digital delivery here to stay?

By Jack Barton, Zahra Shah and Dr Niti Pall, Primary Care International (PCI)

COVID-19 has forced us all to shift our ways of working, to rapidly innovate and adjust; and we have seen the extent to which this applies to primary healthcare workers. Not only the way in which they deliver care but also how these frontline workers are themselves supported and able to learn.

Continuous professional development (CPD) is essential for clinicians and health managers responding to rapidly changing epidemiology: from the rise of NCDs to the onset of new diseases like COVID-19. The strengthening of primary health workforce capacity is a key pillar of health systems strengthening and Universal Health Coverage, and is particularly needed in resource-poor and humanitarian settings. Some of this learning has been able to continue since COVID-19, thanks to the increasing availability and acceptability of digital delivery. But are we now seeing a long-term fundamental shift in how primary health workforce strengthening and development will be done?

To consider this question we are joined ‘in conversation’ with several of Primary Care International’s (PCI) Project Managers – Jack Barton and Zahra Shah – as well as their International Advisor Dr Niti Pall.

What was your experience regarding the use of technology for learning pre-COVID-19?

At PCI we have always seen the use of technology – in particular digital learning – as an enabler, and looked at the best ways to use this as part of our overall offer, in particular how to deploy technology to adapt and scale-up our existing model.

In general, training approaches involving face-to-face contact have a lot of advantages but also can be very time intensive and costly. Added to this were: the desire to reduce our carbon footprint; the awareness that healthcare workers were already increasingly prepared to access learning digitally including via smartphones; and the fact that the world’s most vulnerable countries are on track to achieve universal Internet access.

We had therefore already begun to work on a programme of digital transformation before COVID-19. We had prototyped a clinical decision support tool and had a dedicated online resource hub accessed by 438 clinicians from 14 countries. We’d also worked with MSF to pilot a ‘blended learning’ approach.

What happened to all this when COVID-19 emerged?

We were unable to carry out any face-to-face training. This led to a fast-track scale-up of our digital offer. Following requests from partners and frontline healthcare workers we developed an open access COVID-19 online module. In parallel we put together a learning management system to host this, and future digital learning.

One of our key considerations in this scale-up was ensuring accessibility. Internet access is improving but is not yet available universally. So ensuring that online modules could be downloaded and completed offline via an app was essential.

In addition, we made sure the courses could be accessed on smartphones as well as laptops.

We are also offering ‘live’ learning alongside our core e-learning where possible, through virtual classrooms and distance mentoring.

How have primary healthcare workers reacted to this shift?

We have found willingness and interest from healthcare workers to engage with digital learning. This builds on an existing trend, but there is no doubt that the COVID-19 pandemic has accelerated the need for, and acceptability of, online learning. We have had almost 2500 doctors and nurses access our COVID-19 online course since March 2020 which demonstrates the interest and ability to learn this way.

Challenges remain. As well as issues such as poor internet access, digital literacy of many primary healthcare workers is often low and we therefore need to build in learning and time around this.

What do we need to focus on moving forward?

The risk of the learning experience not being as deep as a face-to face programme is always a challenge with e-learning, especially when it is being done at scale and in places and cultures where there has traditionally been so much value attached to face-to-face interaction. To mitigate this risk, we have invested in tools and multimedia to ensure the learning is varied, interactive and engaging. We are also working on data collection tools to assess the impact of learning on the ground.

More broadly, moving forward we see e-learning as part of a package of blended learning. Face to face learning still has a place. When we are seeing digital learning done as a follow up, after face-to-face training then we see that existing human connections support this digital learning and make it easier to generate real engagement.

At PCI the next phase of our journey is to learn from the experience of trialling the PCI Academy during 2020 and continue its build ready for its full launch next year. Part of this phase of work will be developing our learner engagement strategy to improve connections and support the transfer of knowledge and skills into practice.

Challenges remain, but we can say for certain that digital delivery is here to stay. And that an increasing acceptability to test new approaches to learning has the potential to open-up – and scale-up – training and learning opportunities for primary healthcare workers in resource poor settings.

This article is part of Primary Care International’s co-authored Op-Ed series, exploring resilient systems and healthy populations in the context of Covid-19 and beyond. The perspectives of the authors are not necessarily the views of any of their institutions or affiliations. 

Authors: Jack Barton. Jack is Digital Project Manager, PCI , Dr Niti Pall. Niti is one of PCI’s International Advisors, Jane Lennon. Jane is Communications Manager, PCI.  Zahra Shah. Zahra is a Project Manager, PCI.

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