Global Health Institute

Through the Global Health Initiative student fellowship program, I’ve had the opportunity this semester to work with Dr. Indira Narayanan on a project to improve the quality of neonatal care in Ghanaian hospitals and to assess the effectiveness of distance learning methods in quality improvement. The project involves a series of webinars, each focused on a different topic of concern in the neonatal units including birth asphyxia, hypothermia/temperature maintenance, and jaundice. 

Each session involves a case presentation by a Ghanaian hospital related to the topic of focus, which asks the presenting hospital to share examples of past cases. From this, a neonatal physician from the GUMC tailors a follow-on presentation to address the relevant issues faced in Ghanaian hospitals. Our team collaborates with each participating hospital to determine their primary area of concern, identify the shortcomings within the hospital that limit their effectiveness of treating the condition, and develop quality improvement activities accordingly. 

Following preliminary surveys it was determined a common issue in Ghanaian hospitals that impedes effective neonatal was lack of sufficient education of all personnel involved in care of the newborn. This was assessed to stem from infrequent training of hospital staff accompanied by high staff turnover rate. A potential accessible solution for this issue may be found through a distance learning program. 

Previously conducted distance learning programs in LMICs show successful models in course deployment and participation, as well as in resulting knowledge gains. In Zambia, a program organized by Johns Hopkins University in collaboration with Zambian experts on HIV received good feedback from participants, with significant increase in number of participants in each subsequent session. By the third session, more than 500 students had registered for the distance learning course. Another course focused on diagnosis, treatment, and prevention of tuberculosis involving the US, South Africa, India, and Pakistan resulted in an increase in the median test score from 66% to 86%, while a program in India on biostatistics and research ethics showed similar knowledge gains between on-site and online learning platforms immediately following course completion and in knowledge retention three months afterwards. 

These programs reflect good prospects for distance education in LMICs, however, more research is needed to examine the effectiveness of distance learning programs on clinical practice as well as in comparison to more standard methods of clinical training. Distance education also has the potential to contribute to more equitable healthcare in resource-poor settings by expanding access to training to community health workers who are the main providers of healthcare in more remote communities. If distance learning programs are found to be successful with effective clinical results, they can be a more accessible and flexible training method as they limit the need for travel, are more financially sustainable, and have lower opportunity costs for learners who must balance training with active patient care.