A public health e-learning master’s programme with a focus on health workforce development targeting francophone Africa: the University of Geneva experience

A shortage of competent clinical and public health professionals, with knowledge and skills in health workforce development, has been a long-standing issue in most of sub-Saharan Africa, bearing 25 % of the global burden of disease and having only 3 % of the health workforce [1].This was the driving factor behind the development of an e-learning master’s programme with focus on health workforce development coordinated by the University of Geneva with technical and financial support of the World Health Organization and the Global Health Workforce Alliance [8].

An initial assessment of needed public health competencies was completed through a survey of 106 representatives of health authorities of the participating countries (Table 1) [14]. The initial survey was complemented by an assessment of expressed training needs among the candidates during the selection process. This allowed defining more precisely learning objectives relevant to the students’ training expectations/needs (Table 2), as recommended in the literature [16, 24]; it proved useful in our case because it appeared to be very motivating.

The chosen distance-learning approach, while part of the call for proposals, was also an opportunity to test Ruiz’s statement, “the integration of e-learning into medical education can catalyze the shift toward applying adult learning theory, where educators will no longer serve mainly as the distributors of content, but will become more involved as facilitators of learning and assessors of competency” [25]: indeed, the reality of connectivity problems in many of the partner countries kept us from seriously considering real-time synchronous lectures as a viable teaching model. Therefore, asynchronous case studies with online readings, exercises, chats and wikis around priority health issues appeared as the only realistic teaching modality, which in turn allowed interactivity among students, course facilitators, collaborative work and exchange of experiences, thus being in tune with modern adult learning strategy recommendations [16, 17].

The e-learning approach also made the programme available to candidates that could not have taken the residential course at the University of Geneva [10]: this is certainly one of the advantages of distance-learning programmes among a long list of possible benefits if principles of effective learning are integrated [26], which was done as mentioned above. Furthermore, the priority-health-issue approach with case studies relating to realities of the working and community environments of students contributed to the motivation of students and was certainly an asset of the programme design, though motivation might also have been influenced by the perspective of a free-of-charge diploma. The local tutoring, which seemed initially as an important feature of the programme, also advocated by many authors [25, 27], neither responded to the students’ nor to the coordination team’s expectations, though a specific workshop had been organized for the local tutors [22]: close-distance tutoring from the Geneva-based coordination team became therefore a major activity. A lack of availability of local tutors was put forward by the students, mainly related to professional obligations of tutors who were senior academics/professionals with international mandates. Midlevel professionals more readily accessible to students yet competent in the field of public health might have been a better choice, as experienced in another distance-learning programme of the University of Geneva [28]. Yet, more drastic measures might be necessary to improve the commitment of local tutors, such as a clear decision of the University authorities putting tutorship high on the academic agenda, which at present is not the most frequent situation [29].

The selection of students was a complex procedure. It was greatly facilitated through the close collaboration of the WHO HQ, regional and country offices. Being a competitive, multiple-step procedure, it eventually allowed selecting of students as a self-assessment process and a personal essay showing their knowledge of public health problems and challenges their respective country of origin were facing, thus insuring a certain degree of “knowledge homogeneity”, as recommended by some authors [30]. It further allowed reducing the risk of favouritism and nepotism which make a rather common problem in such contexts [31], as the final decision of acceptance was the sole responsibility of the Geneva-based coordination team. The dropout rate was low (<10 %): similar dropout rates have been reported in the literature for degree-granting distance-learning courses in sub-Saharan Africa, while dropout rates up to 70 % are mentioned for MOOCs [32].

The electronic platform Moodle was easy handling for the teaching staff, benefited from the IT back office of the University of Geneva, and did not represent a major difficulty for most of the students. The difficulty for students was to connect from their office, and several had to connect via the local Internet Cafés at their expense. The Moodle platform also allowed many different educational approaches as mentioned above, which is also reported as one of its strengths in the literature [33].

The systematic monitoring of the programme allowed measuring student participation and satisfaction as mentioned in the “Results” section. The participation estimated via log-ins and messages posted varied from one module to another, with maximal interest shown for modules “Trauma post Accidents”, “HIV/AIDS” and “Mother and Child health” followed by “Infectious Diseases” and “Food/Malnutrition”, issues that rank high among health priorities in sub-Saharan Africa as reported in the Kaiser/Pew Global Health Survey [34]. The globally high participation rate of most students despite sometimes difficult local situations might also be related to the observed team spirit that emerged over the months among “building sense of community at distance” as some authors have stated [35]. Satisfaction of students as measured on a 10-point scale (10: very satisfied) lies in the mean between 7 and 8 for all the modules and all the disciplines: this can be considered as a high approval rate, which in turn might have some impact on the motivation and performance of students [36]. Yet, one might consider that students’ satisfaction evaluation is of limited relevance when done at the end of the teaching sessions: it could be more informative after the students had the opportunity to put their learning into practice as suggested in a study among alumni of a MPH programme [37].

For each module, one or two certifying examinations had to be taken by each student before they could move to the next module: these examinations tested the knowledge and competencies meant to be acquired during the module (Table 6). Furthermore, a final exam tested in an integrative way, as recommended by some authors [16], the newly acquired knowledge and competencies. Eventually, 78 % of the students succeeded and qualified for the master degree.

The global evaluation (Table 3) of the programme highlighted strengths such as “exchange of experiences among students”, “quality of the feedback on assignments” and “commitment of students despite difficult local situations”. It also highlighted weaknesses, such as little support from local tutors, difficulties in access to Internet and little material support. Development of collaborations and strengthening of networks were considered as opportunities, while lack of long-lasting financial support of the master’s programme and local political instability were considered as principal threats to the programme, and indeed, we experienced three dropouts because of local insecurity/war, a phenomenon reported by others [38]. These observations, not very different from evaluation results of online, distance-learning programmes reported in the literature [39, 40], gave valuable information in order to adapt the curriculum and improve the programme: integrating monitoring and evaluation mechanisms early on the planning of any training programme, as recommended [41, 42], should be a priority to any curriculum designer.

Observed outcomes such as the use of newly acquired skills in professional life, career development and initiated collaborative projects suggest that the master’s programme had some impact “beyond the classroom”, which should ultimately be the aim of any training programme in public health [43].