1. E-Learning and E-Library as educational imperative for rapid scale up: The case of MEPI Ethiopia Miliard Derbew MD.FRCS.FSC-ECSA Associate professor of Surgery MEPI Ethiopia PI. milliardderbew@gmail.com August 06 – 09, 2013 Kampala, Uganda

2. Outline Background HRH strategy in Ethiopia The Scale-up eLearning implementation strategy Implementation barriers MEPI areas of intervention Lessons learned Way forward

3. MEPI-E: background  Grant awarded on September 20, 2010  5 Year grant  Program implementation started in May 2011  Year 1 was mainly a startup phase  Active implementation of major project activities was initiated in the 2 nd year  Currently in 3rd year- forth quarter of program implementation

4. MEPI Ethiopia Consortium  MEPI Ethiopia is a consortium project involving four local and five US- based universities.  Local/ Ethiopia  Addis Ababa University  Hawassa University  Haramaya University  Defense College of Health Science  US based parthners  JHU  UW  Emory University  UCSD  University of Alabama

5. MEPI Ethiopia: long term goals  Improvement of the quality and the quantity of medical graduates  Human capacity building and retention  Enhancement of research and bio-ethics capacity

6. Strategic objective I: Support to the Ethiopian Ministry of Health’s rapid expansion of medical schools and graduates Expansion of IT infrastructure and E-learning facilities for medical education Enhance availability of learning resources Strengthening existing and establishment of new community based training sites

7. Strategic objectives II: Partnerships of AAU with newer medical schools including sharing of AAU faculty and curriculum Enhancement of pedagogical, mentorship, and research training programs for medical faculty Development of a clinical educator track and mentorship in career development Promotion of advanced training in specialties/ Sub- specialties program relevant to PEPFAR goals ( chest specialist, ID,FM, endocrinology, pediatrics surgery, radiology etc

8. Strategic objective III: Provision of modular and computer-based courses in research methodology Establishment of clinical epidemiology and bio- ethics units at the participating institutions Establish Research Grants Management Office Strengthening and training of local IRBs

9. Ethiopian facts → High burden of disease; high rates of infant / maternal mortality → Critical shortage of trained health personnel Health Indicators ETHIOPIA 2010 CANADA 2010 Life Expectancy at Birth (years)5481 Under-5 Mortality Rate (per 1000 live births)1066 Maternal Mortality Rate (per 100,000 live births) 35012 Health Workforce 20072008 Physicians (per 100,000 population)2.2198 Nurses & Midwives (per 100,000 population)241043 Births Attended by Skilled Personnel6 %6 %99 % World Health Organization, Global Health Observatory Data

10. HRH Strategic Plan for Ethiopia HRH Requirement Projection for Selected HRH categories HRH Category200920152020 General Practitioner1,01710,84614,792 IESO(New)9961611 Nurses20,10941,00949,362 Midwives1,3798,6359,886 Anesthesia Professional1882,8103,271 Pharmacy Professional26619,42010,049 Laboratory professionals282315,33016,403 10

11. The Scale Up Number of medical schools in Ethiopia increased from 5 to 23 in the last five years Student enrollment has also increased from 336 in the 2004/05 academic year to over 2560 in the last academic year The target is to scale up the yearly intake to 9000 in the coming 5 years.

12. Medical School enrollment No Universiti es 2010/11 2009/1 0 2008/92008/72007/62005/62004/5Total 1 Addis Ababa 356 250380209111101861137 2Gonder 205 1562211771228265823 3Adama 89 150110260 4Jimma 221 20721814711815183924 5Hawassa 100 125258110805537665 6Mekele 180 146252150278165721 7Bahir Dar 107 10610872286 8 St Paul M/M school 120 1274233202 9Haromaya 170 18810866362 10 Arbaminch 60 6251113 13 Total NIME 1608 151717489644584703367101 1500 Rapid Assessment of public universities, 2010

13. Enrollment to medical Schools

14. Challenges Shortage of Classrooms, access to laboratory and library seats, and dormitories Shortage of faculty and increased workload on existing faculty ----- Burn out !! Shortage of core textbooks and reference materials Compromise quality of medical education and graduates

15. Possible Solutions Continue with the traditional learning:- Efficiency? Effectiveness? Quality? Fully online and distance learning:- is it a feasible option? given the e-infrastructure?, computing literacy rate?, and the nature of medical education? Hybrid learning :- a combination of both face to face and eLearning MEPI-E selected approach for eLeaning

17. MEPI eLearning strategy to support the scale up MEPI-Ethiopia supports the use of information and communication technologies to accelerate expansion of medical education in all Consortium Medical Schools. It also recognizes that the planned MEPI goals and objectives can hardly be met without extensive use of ICTs to support the teaching/learning and research endeavors. An eLearning strategy that aims to be the essential information resource to guide informed planning and implementation of eLearning tools developed

18. Aims of the eLearning Strategy Support the ongoing scale-up in medical education in Ethiopia (particularly in the MEPI Consortium Medical Schools) Promote and enable sharing through common standards Provide for continuity and mobility of learning Encourage and promote good practice among medical schools Enable virtual communities Knowledge management in eLearning for health Overcome wasteful duplication of resources

19. Implementation strategy: phased approach Phase I (Year 1 and 2) Establish enabling infrastructure Raise awareness of eLearning service Implement Faculty Development program for eLearning course design Implement pilot program Phase II (Year 3) Develop blended prototype programs Complete evaluation of pilot Review evaluation results from Phase I to decide on how to scale up from Phase I on number of courses and types of interactions being done within eLearning Phase III (Year 4+) The Scale up phase Complete Phase II evaluation Review Phase II evaluation results and decide how to enhance well established eLearning practices from external benchmarks and from own experience gathered in Phases I and II

20. Barriers for Implementation of eLearning in MEPI-E Consortium Medical Schools Patchy access to infrastructure Fragmentation of resources and materials Limited IT and instructional design skills (both faculty and students) Lack of common standards for eLearning

21. MEPI areas for Intervention Building the eLearning infrastructure Accelerating and embedding eLearning Supporting faculty and students Leadership for eLearning culture

22. Building the eLearning infrastructure LAN Infrastructure and Internet Connectivity upgrade Wired and Wireless LAN infrastructure development at a cost of over 3 million birr Internet connectivity upgraded from 6 mbps to 50 mbps

23. Learning infrastructure Hardware: servers, computers, laptops, tablets and other learning devices – 7 high capacity servers purchased – 50 laptops purchased for laptop loan service (additional 20 under procurement) – 1000 tablets purchased (to be distributed for students)

24. Wi-Fi hotspots on campus

25. Tablets for students Provided to undergraduate medical students (1000 in Year 3 and additional 1000 will be provided in year 4) Medical textbooks are loaded in memory card and provided to students along with the tablet Wi-fi capability to access electronic resources on campus or over the Internet Revolving fund to ensure sustainability

26. Learning infrastructure Learning facilities and venues – Two computer labs with a capacity of 120 and 30 computers established – A project to interconnect three classrooms with multi-directional video- conferencing link and smart classroom underway Computer Lab Smart-Classroom

27. THE NEW CHS MEDICAL LIBRARY

28. Accelerating and embedding eLearning eGranary and Moodle learning management system installed and configured An eLearning studio with multimedia recording, digitizing, and editing facilities is under establishment eLearning pilot program started with some of the training programs with Emory University on Bio-ethics, Data Management, and Grants Writing

29. What is the eGranary Digital Library? An off-line digital library that is fully indexed and searchable using built-in search engines Provides lightening fast access to educational materials including video, audio, books, journals and websites even where no Internet access exists Tools that allow users to add local content, e.g. publications and courses External 4 terabyte eGranary USB unit

30. What’s Inside the eGranary? The information stored inside the eGranary covers dozens of topics ranging from health sciences to education Types of resources available: 1,200+ complete Web sites 800+ partial Web sites 250+ academic and medical journals 50,000+ books 55+ educational software programs 80+ computer software applications

31. Support for faculty and students 14 faculty members attended an online Moodle training program provided by JHU >800 Undergraduate medical students received training on eGranary Instructional design skills training given for faculty

32. Leadership and eLearning culture eLearning strategy developed to enable leaders of the CHS understand, plan and sustain the context for eLearning in the medical education system Further training and benchmarking programs are planned

33. Lessons Learned Cooperation and Collaboration (North-South and South-South) are essential Understand readiness for eLearning and learn the needs and expectations of your users (faculty, students, and administrators) Development of eLearning strategy before any intervention

34. Way Forward LAN Expansion and Upgrade Full networking of the new medical library LAN upgrade of the old buildings Outdoor wireless connectivity in selected areas Internet connection upgrade Upgrade from 50 mbps to 100 mbps

35. Way Forward Learning facilities Include additional four smart classrooms (to make it 7 interconnected classrooms) Expand the laptop loan service Purchase additional 1000 tablets Moodle and eGranary Scale-up training of faculty on instructional design and content development Scale-up training of students on how to use the two systems

36. Way Forward Content development Finalize the establishment of the eLearning studio Select suitable courses for eLearning (blended) and start development of e-courses Add local content (teaching materials, lecture notes, locally developed textbooks, etc… )into the digital library platform Institutional repository Develop a system in which published and unpublished research by faculty and students of AAU College of Health Sciences will be stored and made available to the global health community

37. Thank You “It is not the strongest of the species that survives nor the most intelligent, it is the one that is most adaptable to Change” Darwin

38. Thank you!