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

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 (which would itself merit a separate article) 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? Or will things be ‘back to normal’ in a year’s time?

To consider this question we are joined ‘in conversation’ with several of Primary Care International Project Managers – Jack Barton and Zahra Shah – as well as our 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 leaning – 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 labour, 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 based on our Clinical Guides, 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 with clinicians working in the Middle East and in East Africa.

What happened to all this when COVID-19 emerged?

COVID-19 had a massive impact on our work. Many of PCI’s projects came to a halt and 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 primary 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. It was a steep learning curve in terms of the technology! Although the content remained our usual peer-to-peer, pragmatic style.

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

In addition, we made sure when designing the courses that they could be accessed on any device. Not just laptops but also smartphones.

We are also offering ‘live’ learning alongside our core e-learning where possible, through virtual classrooms and distance mentoring. In fact, Zoom is integrated into the learning management system to ensure a smooth user journey.

How have primary healthcare workers reacted to this shift?

We have found willingness and interest from primary 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, outlined earlier, it is often the first time many primary care healthcare workers have undertaken e-learning. Digital literacy is often low and we therefore need to build in learning round this – as well as additional time during the online courses and remote live training. For example, our project developing online e-learning for clinicians in Mexico includes development of a specific digital literacy module.

What do we need to focus on moving forward?

The digital front door is open. E-learning is here to stay – but we need to focus both on accessibility issues and also learner engagement and experience.

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 – as with clinicians we are working with in Libya – then we see that existing human connections support this digital learning and make it easier to generate real engagement.

However, increasing access to e-learning, especially in resource-poor settings, facilitates scaled up opportunities for primary workforce strengthening. 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. We very much look forward to being a part of this testing and scale-up!

Authors

  • Jack Barton. Jack is Digital Project Manager at PCI responsible for management of the PCI Academy. In addition to his project management work across the PCI project portfolio, Jack has been instrumental in driving forward PCI’s technology development work and launching our open-access COVID-19 resources.
  • Jane Lennon. Jane is Communications Manager at PCI. She has a range of experience working for international NGOs on health and women’s rights, with a particular focus on communications and knowledge management work.
  • Dr Niti Pall. Niti is one of PCI’s International Advisors. She is a family medicine doctor who is currently medical Director at KPMG Global healthcare practice and Board chair at Harbr, an accelerator-incubator for international healthcare. She is also a senior consultant at AXA where she advises the emerging customer and innovation team to replicate mobile healthcare across the world. Prior to this Niti was Medical and Innovation Director of international development markets for BUPA.
  • Zahra Shah. Zahra is a Project Manager at PCI. She has been working in start-ups and emerging markets for over 7 years, with a focus on growing tech ecosystems in conflict-affected regions. Merging her passion for technology and development Zahra has worked in digital skills training and entrepreneurship in Gaza and Iraq.

This article is part of Primary Care International’s co-authored Op-Ed series Primary Care Perspectives, 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.