Use of Web conferencing to deliver Continuing Medical Education(CME), in resource constrained settings. Peter Mwaura- Health informatics fellow
Goal of the project The goal of the proposed project in Kenya is to ensure coverage, equity, and quality of care. Coverage gap is defined as difference between current coverage and universal coverage. Equity gap is defined as differences in access to coverage of the CMEs between the urban and rural health workers Quality gap is defined as difference between providing the standardized CME package and provision of effective client friendly services
Past experiences Continuing medical education (CME) refers to a specific form of education that helps those in the medical field maintain competence and learn about new and developing areas of their field e.g. HIV guidelines have typically evolved rapidly hence need for continued update. These activities may take place as live events, written publications, online programs, audio, video, or other electronic media. In Kenya, CME activities are falling behind and cannot keep up with the demand. Moreover, current paper and workshop based approaches are quite inefficient and costly, CME in Kenya are supported by big pharmaceutical companies which is not a sustainable approach
The CME are poorly coordinated, supply driven, and that the content of the information and learning provided is frequently not relevant to the diverse needs of todays rural health care workers. The motivations and incentives of the health workers to participate in CME efforts have been queried Classroom learning reached many health workers rapidly but training became diluted as it cascaded down the system.
Classroom teaching assumes a deficit in knowledge and not skills. In practice there deficiencies in basic skills that are further aggravated by task shifting. Eg. WHO staging assumes skills in clinical examination and diagnosis. This is not a core skills in nursing training. Re-deployment of staff results in loss of skills in the institution
Web conferencing bridges the gap Web conferencing is one of the most revolutionary development in communications technology, and has greatly influenced the way businesses work. Web conferencing facilitates effective communication while reducing infrastructure costs. Web conferencing cuts down on travel expenses and time. Since the health workers who are deployed at the rural areas do not move from their health facilities hence, can save considerable amounts of money. It also saves precious time, which can be utilized for other works and increase productivity. Its is easy to standardized and coordinating CMEs With the advent of high-speed broadband and wireless networks, Web conferencing has become more efficient.
Challenges in implementing web based CMEs Based on the some peer reviewed publication web conference has been used in developed countries, to deliver CMEs, but there are challenges Connectivity problems Health worker not willing to take up change Infrastructure issues
literature review Web conference has been proved to has successful been used in developed countries (Markova T, Roth LM), Curran V, Lockyer J, Sargeant J, Fleet L) to deliver CMEs.Markova TRoth LM In a baseline not yet published, on the acceptability of e- learning in Central province in Kenya, the following were noted, 73.2% of the health workers interviewed had access to the computer. The confidence level on using the computer was noted as 25%-High, 38.5% moderate and 14.6% lower. The health workers interviewed confirmed that 43.5% of them had the access to computers for between 2-4hrs per day. 78.5% of the client were willing to use e-based learning.
The strategy That CME itself should be recognized as a high priority at all levels, including by government and health workers. The political commitment is critical; the health workers also need to be motivated, this will only be achieved through the listing of CMEs in the annual operation plan for delivery of the services at the district level as well as provincial level Develop / strengthen web based CMEs through DHMT/DPHN and within the institutions Support the MOH to develop the web based system Train the DHMT on how to train the health workers on how to use the systems.
Broad areas to be covered using web conferencing PITC PMCT MNCH (Reproductive health, emergency obstetrics newborn care, and child health) Chronic HIV care, chronic diseases management Tb and other OIs Nutrition Commodity management (drugs and others) Laboratory Documentation Monitoring and evaluation Referral systems and linkages Clinical mentorship skills
Expected outcomes Sustainable web based CME conferencing health system At least 10% More health workers in the rural areas are reached with CMEs. Improved quality of services, coverage, and equity – Chart review – Observation of care sessions – Documentation of services
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