Presented by : Gilbert MUNYEMANA National University of Rwanda Harmonizing capacity building and work responsibilities of Rwandan nurses through E-learning Presented by : Gilbert MUNYEMANA National University of Rwanda E-merge 2012

CONTENT BACKGROUND AND RATIONALE IMPLEMENTATION PROCESS ACHIEVEMENT TO DATE CHALLENGES AND REMEDIALS ACTIONS CONCLUSION

I. BACKGROUND AND RATIONALE A. RWANDA Landlocked country situated in central Africa Land Area: 26,338 square Kilometers. Population: Approx. 12 million Borders: Uganda to the north, Tanzania to the east, Burundi to the south and Democratic Republic of Congo to the west. Source : http://www.gov.rw/, http://en.wikipedia.org/wiki/Rwanda

I. BACKGROUND AND RATIONALE B. INDICATORS : POPULATION & MEDICAL PERSONNEL Total population: 10,412,820 millions Doctors: 1/18,000 inhabitants Nurses: 1/1,476 inhabitants 62.8% of Nurses in rural areas(2008)and 78% (2010) 38.2% of Nurses in Urban areas(2008)and 22% 2010 Source : Ministry of Health : http://moh.gov.rw

I. BACKGROUND AND RATIONALE C. EDUCATION OF NURSES Before 2005, education of nurses in Rwanda was organized within general secondary education awarding an A2 certificate. Graduates were subsequently employed as associate nurses. In order to improve the quality of the education and services in the health sector, the Government of Rwanda ruled in 2007 to stop A2 nursing students (associate nurse level) and instead start training A1 nurses (diploma level) and midwives in 2007.

I. BACKGROUND AND RATIONALE EDUCATION OF NURSES / CAPACITY BUILDING NEEDS There are 5 government schools of nursing and midwifery: Nyagatare, Kibungo, Byumba, Rwamagana and Kabgayi . These existing fulltime programmes in the 5 Schools of Nursing and Midwifery only admit about 100 A2 nurses per year According to the National Council for Nurses and Midwives of Rwanda (2009), about 5000 nurses and midwives were working in Rwandan health sector.

I. BACKGROUND AND RATIONALE C. EDUCATION OF NURSES / CAPACITY BUILDING NEEDS Those were challenged to go back to school for upgrading their level but they did not want to quit their jobs, and The Ministry of Health could not afford to replace them without paralyzing the functioning of hospitals and health centers. These raised two fundamental Questions How can we mitigate two conflicting obligations, namely capacity building and work responsibilities ? How to train the existing nurses and new ones to meet the MDGs with limited capacity of existing nursing schools ?

I. BACKGROUND AND RATIONALE In collaboration with the National University of Rwanda, through its Centre for Instructional Technology, The Ministry of Health embarked on E-learning for education of nurses which started with 320 students on board in 2012 academic year

II. IMPLEMENTATION PROCESS A. DEFINING OBJECTIVES Broad objective : To promote the quality of nursing and midwifery health services in Rwanda Specific objectives To improve nurses’ and midwives’ knowledge and skills using the modern methods of teaching and learning To equip different health settings with well trained & qualified nurses and midwives To contribute to the reduction of infant and maternal mortality rate (refer to MDG # 4 & 5) To have upgraded & qualified about 1500 nurses and midwives by the year 2020.

II. IMPLEMENTATION PROCESS B. Verification of requirement Focus on : Infrastructure and facilities Curricula ( Content organization , Approach to teaching and learning with Moodle and Assessment ICT skills ( Computer skills, E-resources, Online databases) Report , recommendations were made and have been considered to facilitate the start of the program

II. IMPLEMENTATION PROCESS C. E-learning platform in place After a pedagogical and technical evaluation , Moodle Learning management system was selected ( The Lauriallard’s Conversational Framework was the main evolutional tool ) Moodle is Web application developed as a set of tools which can serve the world community to achieve educational objectives in completely online or blended learning environment. Also known as Learning Management system or Virtual Learning Environment

II. IMPLEMENTATION PROCESS The E-learning for Nursing education is now accessible on : http://www.elearning.moh.gov.rw/

With the platfom , Teacher can ... create online courses Students assessment Initiate online collaboration upload files In different format Create learning activities Class administration

With the platform, Students can ... Access learning Material at anytime and from any where upload the accomplished works for assessment Online discussion with other students and teachers Share interesting material with others

II. IMPLEMENTATION PROCESS D. Training The teaching staff : The existing teachers of the 5 Schools of Nursing and Midwifery have been trained in e-Learning . IT officers of the 5 Schools have been trained to empower them with skills to help students and teachers on the use of moodle e-learning platform IT officers in collaboration with the NUR team trained Students enrolled in e-learning program on how to effectively use the system.

II. IMPLEMENTATION PROCESS E. STUDENTS ADMISSION In the first in-take 140 head of health centers country wide were enrolled in the e-Learning program. In addition , 175 nurses were selected basing on the criteria of passing the entry examination organized by the Ministry of Health in 2010 Being registered in the national council of nurses and midwives is another requirement for the to be enrolled in the e-learning program It was a requirement for each of the e-learning student to have his/her personal computer and if possible a modem to facilitate in accessing internet in their place of work.

II. IMPLEMENTATION PROCESS F. PROGRAM STRUCTURE AND ORGANISATION OF THE CONTENT The programme shall run for a period of 3 years divided into 6 semesters. The programme is conducted in a modular system, using a blended type of learning. The full time program lasts 2 years The programme is structured in such a way that 80% part of it is delivered online via e-learning platform while students are at their respective workplaces, whereas the rest of the programme include face-to face contact sessions at the Schools of Nursing and midwifery The Ministry of Health arranged that Nurses be facilitated to attend their face to face session

II. IMPLEMENTATION PROCESS F. PROGRAM STRUCTURE AND ORGANISATION OF THE CONTENT During face-to-face contact sessions with lecturers at the teaching institutions, students benefit from the available resources at the Schools of Nursing and Midwifery, including lecturers, libraries, and internet facilities. Students are provided with learning aids developed at the Schools, including course hand-outs During the phase of face-to face learning sessions, students will also have practical sessions in skills laboratory at school and undergo a session of integration of clinical competences. This is a form of continuous assessment of clinical learning, and knowledge construction through the integration of the acquired clinical skills and competences with theory.

III. ACHIEVEMENT TO DATE The e-learning program for Rwandan nurses’ education commenced on 2nd –January – 2012 The first intake of 320 in the 5 schools of nursing and midwifery ,currently the total number is 315 , 5 dropped out due different reasons. Improved teaching skills for the teachers of schools of nursing and midwifery where at 10 teachers in each school of nursing and midwifery have been trained All e-learning students have been trained and at They have so far completed 5 courses. An evaluation of their learning process is planned before the end of 2012

IV. CHALLENGES AND REMEDIALS ACTIONS Language barrier , since English is now the medium of instruction while some nurses had their previous education in French. Some of the E-learning students encounter barriers in communication. Teachers of the nursing schools are putting more emphasis on English language during face to face sessions. NUR is developing computer based self teaching materials to ease English learning The Nursing and midwifery school teaching staff are now overloaded . Their work load has now doubled. The Ministry of Health is finding a way to mitigate this problem .

IV. CHALLENGES AND REMEDIALS ACTIONS Internet connectivity is still slow in some parts of the country as well as nursing and midwifery schools. The Ministry of Health in collaboration with the National service providers is working on this issue Students travel long distances from their place of work to the training sites for face- to- face sessions, this is due to the fact that the training centers are few compared to the number of students from all over the country. There is a plan to increased e-learning training centres, In the next intake two more centres will be added to the 5 existing ones

Conclusion Upgrading A2 nurses to A1 level through e-learning is of utmost importance in strengthening the Health sector in Rwanda. Through the e-learning system, students learn at their own pace ,with more flexibility . This will benefit individual students because they will continue to work and earn salaries, at the same time studying and stay closer to their families. It will also benefit healthcare facilities in terms of continuity of care . All stakeholders currently involved in the project deserve a considerable recognition for their tireless efforts being invested. The journey is still long and any contribution to support this initiative is welcomed With the commitment of all stakeholders, the project will achieve its objectives and help Rwanda to develop through a healthier population

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