1. MRC Company Profile
The Medical Research Council’s research unit in The Gambia (MRCG) is the MRC’s single largest investment in medical research in a low and middle-income country. MRCG represents a unique concentration of scientific expertise and high-quality research platforms in the West African region. Our research portfolio spans basic research to the evaluation of interventions for the control of diseases of public health importance in sub-Saharan Africa. MRCG’s scientific vision is to contribute to the post‐2015 sustainable development agenda by producing the evidence base to improve health in West Africa and beyond.
Health and demographic research in sub-Saharan Africa relies on local fieldworkers, with secondary-level education, who are recruited by research organisations and given classroom training which is costly and time-consuming, and can vary by team, project and organisation. These fieldworkers gain the consent of local communities to gather samples and data, provide health promotion and education, and are the public “face” of health research in sub-Saharan Africa. MRCG employs 1200 staff of which 300 are fieldworkers. These fieldworkers, recruited with a secondary school education standard, work with communities, and rarely have the requirement to use computers in their work. Through receiving their basic training via ICT rather than in a classroom setting, fieldworkers are now trained in a standardised manner, gaining professional knowledge and ICT skills enabling further technology use in their work, such as the use of tablets for live data capture.
Through the training programme, fieldworkers gained technical and transferrable skills, from epidemiology and demography to team leadership and project management skills. Workers also gained ICT skills, with some workers using computers for the first time through this project. Both the content and the delivery method have resulted in a more skilled frontline workforce, which improves the quality of data collected from communities, less discarded data, and fewer participant withdrawals.
3. Project drivers and outline
Prior to 2012, fieldworkers at MRCG were recruited from local communities with a secondary-school level of education and trained in fieldwork skills by attending a 12-week classroom-based training course. Running these training courses were not only costly in terms of time and money, but also were difficult to run in a timely manner following recruitment, and difficult to refresh. In addition, classroom training depended on a cadre of 15 trainers who, over time, had dwindled in number, making classroom methods difficult to sustain.
MRC decided to address sustainability of the local training provision through a three-phase funded project. The first project phase was to test the possibility of running e-learning as a means of making the training process more timely and reliable. The reason for testing was that in 2012, the infrastructure in The Gambia was not setup for e-learning: in remote areas, it was difficult to access power, internet and devices. In 2013, once the capability of the local environment to run e-learning had been tested, the second phase of the project was to develop and implement an eight-module basic-training technology enhanced curriculum. The reason for the second phase was to test the local capacity in terms of staff, skills and support for e-learning for staff who did not work with computers as part of their vocation. This phase was successfully completed in 2014, yielding lessons that could be addressed before the third phase of the project. The third phase was to develop and deliver a three-tier curriculum using e-learning, to include basic, intermediate and advanced training as a professional development curriculum. This curriculum had never before been accomplished in sub-Saharan Africa, despite most health and demographic research being conducted using similar fieldwork operations.
4. Technology options
Numerous technologies were available with MRC UK, and were evaluated for use in MRCG, from SMS to augmented and virtual reality, but web-based e-learning was selected because it was possible to deliver the scope and breadth of information required within the infrastructural constraints of the context without excessive cost in device purchase. It was also possibly to use the virtual learning environment used at MRC UK to deliver the Gambian project, so this was the pragmatic option.
5. Implementation and Strategy
The initial module on community engagement in The Gambia was piloted with 20 fieldworkers (2012), demonstrating that sequential implementation of a flipped classroom method worked in context. 20 workers completed e-learning, flexibly (in their own time) over a four-week period, before attending a practical session with a community where their performance in engagement was assessed. The pilot revealed that the process worked, and that with some basic ICT support, fieldworkers could access low-bandwidth instructional content without issue. During the following six months, a further seven modules were developed alongside an online exam, which formed the basic fieldwork training course (Mehta et al., 2013).
The second implementation phase of the project accompanied an MBA dissertation on blended learning economics. For the second phase of this project this course was tested over a period of three months, following the same flipped classroom method, with 300 fieldworkers. Fieldworkers indicated positive satisfaction and intention based on their enjoyment of the course, and that they found e-learning useful in achieving their work goals (Mehta, 2014). With a course authored and successfully implemented in context, lessons had been learned and they were addressed before refresher training was provided. There had been issues with broadband, power and device availability which were addressed through infrastructure upgrades alongside the e-learning project. Issues with access for remote workers: line managers planned for workers to travel to nearby field-stations to access ICT equipment on weekends. To boost trainer support, a team of trainers were appointed and trained in delivering technology-enhanced learning courses. While these measures were implemented, planning for the third phase of the project began: modules were developed on scientific and technical content as well as transferable skills; instructional design work was planned in the UK.
The implementation of the third phase of the project accompanied a PhD research project on technology adoption. The combination of academic and operational interests in this project, within a research organisation meant that senior managers and stakeholders who managed scientific projects that depended on fieldwork were engaged at the outset, were aware of the potential for e-learning to increase the skill-base of their workers, and that they were aware of the timing of e-learning interventions to avoid peak work in scientific data collection. Aligning with operational strategy in the safety and resilience departments also allowed parts of the project to overlap with seasonal flooding to measure the availability of learning technology, and to avoid election campaigning in 2016. The third phase of the project began in late 2015, basic refresher training was repeated, this time as e-learning only, to ensure that any issues uncovered in the previous phase had been resolved.
During 2015 to 2017, the basic, intermediate and advanced courses were sequentially launched, each for three months learner contact time, followed by a three-month break. During the contact time fieldworkers could access the course at any time, and line managers made full provision for access where needed. None of the launch periods conflicted with peak project times, and most fieldworkers could complete their training during the assigned periods. Some were unable to complete because of expired contracts or moving to different jobs. During the third phase, the basic course was also piloted in Uganda and Kenya to demonstrate the broad applicability in context (2016). Taking this approach ensured a bottom-up approach that helped to build critical mass in the worker population. This approach also ensured that course modules could be tailored to different contexts to ensure the course was culturally and technically appropriate for each environment.
6. Outcomes and deliverables
Initial outcomes from the 20-person pilot were simply to ensure that e-learning worked in context. Evidence of outcomes can be seen at:
The second phase delivered a course that was 73% of the cost based on travel, time, facilities and consumables, with break-even including instructional design costs of year three (assuming annual refresh), and real savings of £20k per year. Modules were completed in a mean time of 40 minutes, with a mean repeat of 2.4 attempts per learner, yielding a 60% saving in learner time compared with classroom training. No quantitative metrics were used to benchmark data collection performance of fieldworkers, but managers qualitatively reported less discarded data and better community engagement. Therefore, the project delivered a learning solution that was better, faster and cheaper than the previous method. Costs in terms of learner time, travel costs, facilities costs and were lower, learner time was shorter due to lack of scheduling delay, the knowledge outcomes were standardised and learner comprehension was increased. Flexible learning allowed work priorities to be balanced by learners, and embedded a flipped classroom method at MRCG. This phase also demonstrated that e-learning could be used where there were bandwidth or infrastructure difficulties, provided organisational strategy included scope for building capacity for e-learning.
The third phase of the project focussed on individual technology adoption with e-learning, and the PhD thesis, although in the final stages, collected data that demonstrated that learners in The Gambia had formed a positive intention to voluntarily use e-learning. 300 workers completed basic (266 completions), intermediate (220 completions), and advanced (173 completions) training. The third phase of the project created a career path for fieldworkers, field-supervisors and project managers for fieldwork projects (Mehta, 2017).
At the end of 2016 this project finished, having developed three stages of professional training for Gambian fieldworkers, from basic training, to supervisor and team management training, to project management and leadership training. At this point MRCG had proven that, despite infrastructure difficulties in remote areas, all staff, had been able to use e-learning for their vocational training. Through of five years of e-learning projects, frontline staff had increased their confidence and skill with computers, had increased their knowledge of their work, and were prepared for further innovation in data collection.
The remainder of the project during 2017 consolidated local capacity, including transfer of assets, trainer and ICT support in The Gambia. During 2017, the project widened scope, working as part of the International Fieldwork Group, a forum of up to 35 health and demographic research centres in sub-Saharan Africa seeking to harmonise fieldwork curriculum standards across the region, culminating in a workshop in Dodowa, Ghana in December 2017, where fieldworker e-learning was agreed as a desirable standardised option for best practice in fieldworker development in sub-Saharan Africa.
There have been measurable impacts in the workforce, developing fieldworkers where no previous method of structured technology-enhanced training existed, providing ICT skills, and a career pathway. There have also been improvements in the data collection process as a result of increased workforce skill, resulting in a lower proportion of data and samples discarded or recollected. However, there is also a wider societal impact: fieldworkers provide referrals and health education to the local populations in The Gambia, Uganda and in Kenya, and increasing the knowledge, skill and confidence of this worker group will have wider societal benefits in these communities.
Over five years MRC has sequentially and successfully introduced e-learning and supporting capacity for fieldworkers in The Gambia, proving the concept in Uganda and Kenya, and contributing to a best-practice network across sub-Saharan Africa. The successful conclusion of the project in 2017 provided the timing for this award submission.
Mehta, A. 2017. E-learning for medical research fieldworkers in sub-Saharan Africa In: eLearning Africa: 12th International Conference on ICT for Development, Education & Skills.
Mehta, A. 2014. Technology Acceptance Of E-Learning Within A Blended Vocational Course In West Africa In: Multi Conference On Computer Science And Information Systems 2014 [Online]., pp. 324–328. Available from: http://files.eric.ed.gov/fulltext/ED557293.pdf.
Mehta, A., Murray, K. and Dibba, Mafuji, S. 2013. Exploring a Blended Approach fo Fieldworker Development in Medical Research: Teaching with Technology In: eLearning Africa: 8th International Conference on ICT for Development, Education and Training., pp. 43–44.
10.Appendix: Fieldwork Syllabus
- Community Approaches & Basic Ethics/ Research Ethics
- Quality Data Collection/Anthropometry
- Mathematics & Statistics
- Illnesses & Disease Models
- Health & Hygiene Promotion
- Sample Handling & Phlebotomy
- Health & Safety
- Sharps Safety
- Emergency First Aid
- Community Approaches, Advanced Ethics (Ethical principles), Social Science Methodology- Village mapping
- Introduction to Demography and Epidemiology/Statistics
- Managing and working within a field team (Team Development, Communications & Motivation, On-The-Job Training)
- Further Health Promotion and Education (Health Promotion, Concepts, Health Economics)
- Anatomy and Physiology (Human Life Cycle, Physiology and Systems)
- Introduction to Laboratory Work
Advanced Syllabus included 4 modules on Field Project Management