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J Med Internet Res. 2019 Jan 9;21(1):e12449. doi: 10.2196/12449.

E-Learning for Medical Education in Sub-Saharan Africa and Low-Resource Settings: Viewpoint.

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Heidelberg Institute of Global Health, Heidelberg, Germany.
Ministry of Health, Lusaka, Zambia.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.
Chainama College of Health Sciences, Lusaka, Zambia.
SolidarMed, Lusaka, Zambia.


E-learning has been heralded as a revolutionary force for medical education, especially for low-resource countries still suffering from a dire lack of health care workers. However, despite over two decades of e-learning endeavors and interventions across sub-Saharan Africa and other low- and middle-income countries, e-learning for medical education has not gained momentum and continues to fall short of the anticipated revolution. Many e-learning interventions have been cul-de-sac pilots that have not been scaled up but rather terminated after the pilot phase. This is usually a result of not adopting a system-wide approach, which leads to insufficient scope of training, insufficient technological maintenance and user support, unattainably high expectations, and unrealistic financial planning. Thus, a multitude of e-learning evaluations have failed to provide scientifically sound evidence of the effectiveness of e-learning for medical education in low-resource countries. Instead, it appears that technological development has overwhelmed rather than revolutionized medical education. The question of how to push e-learning into a higher gear in low-resource countries persists. Provision of e-learning as a technology is insufficient. E-learning needs to be vigorously and sustainably integrated into the local educational setting and aligned with national strategies and other national endeavors and interventions. Adhering to a standardized framework for the implementation and evaluation of e-learning endeavors is key, especially to bridge the gap in robust evidence that should also guide e-learning implementations. The primary objective of e-learning for medical education is to strengthen the health system in order to serve the population's health care needs and expectations. Currently, medical e-learning does not measure up to its potential or do justice to medical students in low-resource countries. Technology may help unfold the potential of e-learning, but an all-encompassing change is needed. This can only be achieved through a joint effort that follows a systematic and standardized framework, especially for implementation and evaluation.


blended learning; developing countries; eHealth; health system strengthening; health workers; low-resource countries; mHealth; medical e-learning; medical education; sub-Saharan Africa; technology-enhanced learning; universal health coverage

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