Outsourcing

AMREF and AccentureWorking together to launch an unprecedented e-learning initiative to address a critical nursingshortage in Kenya

The African Medical and Research Foundation (AMREF) is

an independent, non-profit organization whose mission is

to improve health and health care in Africa. AMREF aims

to ensure that every African can enjoy the right to good

health by helping to create vibrant networks of informed

communities that work with empowered health care providers

in strong health systems. AMREF's work strengthens Africa's

health systems and health human resources and uses six

entry points that include HIV/AIDS; malaria; safe water and

basic sanitation; family health; disaster management and

emergency response; and health care-related training.

AMREF is headquartered in Nairobi, Kenya and is the

continent's leading health development organization.

In 2005, AMREF won the prestigious Gates Award for

Global Health for making a major and lasting contribution

to the field of health in Africa. To learn more about AMREF,

visit www.amref.org.

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Although there are nearly 20,000"enrolled" nurses waiting to upgrade to "registered" status, Kenya has theresources and classrooms to train only100 registered nurses a year usingtraditional classroom methods. At thatrate, it would take literally hundreds ofyears to certify these 20,000 enrollednurses. To address Kenya's shortage ofqualified health care workers, AMREFwas asked by the Kenyan Ministry ofHealth to find a rapid and sustainablehealth care training process to upgradeKenya's 20,000 "enrolled" nurses to"registered" status.

AMREF is internationally known for its pioneering initiatives, including aleading-edge telemedicine programthat enables remotely located healthworkers in sub-Saharan Africa to consultlive on difficult cases with doctors atAMREF's central laboratory in Nairobi.To address the nursing crisis, AMREFinitially designed a paper-based distancelearning course, but soon realized that

this approach would not quickly andefficiently address the problem. AMREFthen approached Accenture1 andtogether the two organizations agreedthat a new and ground-breakingapproach to health care training inKenya was needed—e-learning.

However, transforming the vision of e-learning into reality meant overcominghurdles that have hampered past effortsto implement technological solutions in Africa. Drawing on past experiences,AMREF recognized that the success ofan e-learning initiative hinged onforming partnerships and obtainingadvanced technical skills. In 2005,AMREF teamed with Accenture and theKenya Nursing Council to develop arevolutionary e-learning program thatwould enable Kenya to train and certifythese 20,000 nurses in just five years.

1 References to Accenture include Accenture Ltd andits subsidiaries as well as independent charitableorganizations that bear the Accenture name.

Every day in Africa, more than 3,000 children under the age of five die from malaria—a devastating statistic thatillustrates why the continent urgently needs to increase thenumber of frontline health care workers who are qualified to treat such diseases as malaria, the leading cause of childmorbidity and mortality in Africa. More than 85 percent ofKenya's nurses are "enrolled nurses," unable to obtain theadvanced training needed for a "registered nurse" diploma.With that diploma, registered nurses have the skills tocombat the spread of diseases such as malaria, AIDS/HIV and tuberculosis that have such a devastating impact on the country.

Business challenge

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Under the five-year program, Accentureis donating $2.9 million to AMREF todevelop and implement an innovativee-learning program to address Kenya'scritical nursing shortage. The donationconsists of a $1.7 million contribution bythe Accenture Foundations along with$1.2 million of in-kind services includingprogram management expertise and14,500 hours of donated time fromprofessionals in Accenture Learning, an Accenture business that provideslearning outsourcing services.

The e-learning program has threeprimary objectives:

• Design and implement an e-learningsolution to enable the rapid skillsupgrade of nearly 20,000 Kenyannurses to "registered" level.

• Build the capacity of AMREF personnelto develop, implement and monitoreffective e-learning.

• Leverage the results from the programto influence policy and replicate thee-learning program in other Africancountries (i.e. create some reusableassets to monitor, document anddisseminate an alternative model forupgrading health professionals in aresource constrained environment).

The funding from the AccentureFoundations is providing for the programmanagement, staffing and administrativeneeds of the program; PC infrastructurefor the training centers; as well asorientation and training for the mentorswho would support the nurses duringtraining. The contribution from AccentureLearning is being used to develop thee-learning content and infrastructure,specifically:

• Registration, testing and trainingservices for Kenya's regional trainingcenters (including implementation ofa learning management system.)

• Conversion of print-based curriculuminto 143 hours of e-learning content,including assessments.

• Help desk support for nurses andadministrators.

• Training for AMREF representatives todevelop, implement and monitor thee-learning program.

The e-learning program is designed torun over five years and has three distinctphases: design and program planning,to last three months; followed by athree-month pilot serving 143 nurses in four regional training centers withassistance of Accenture DevelopmentPartnerships; and then a six-monthrollout of the full solution to all regionaltraining centers. Following rollout willbe four years of ongoing support of the e-learning program by Accenture.Today, the program is entering into itsfull "run mode" having successfullycompleted all pilot programs.

How Accenture helped

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of e-learning centers to be establishedacross Kenya to deliver the e-learningsolution was substantially increased,with the objective of making the trainingmore accessible to Kenya's remotenursing population.

One of the primary goals of the e-learning initiative is self-sufficiency.The project was designed to graduallytransfer skills and knowledge fromAccenture Learning, giving AMREF anincreasing ability to manage thetechnological elements of the program,as well as to lead efforts to providelocal Kenyan support and coordination.By educating AMREF to administer andexpand the project on its own, theorganization will not be as dependenton outside help after the initial five-year ramp-up period and will betterenable it to develop similar programs in Kenya and other African nations.

The program is designed to leverageAccenture Learning's Web-based LearningManagement System that tracks studentregistration, enrollment and completionof each e-learning module. The scalabletechnology will grow with AMREF'schanging needs, and allow Kenyanhealth officials to compile up-to-dateinformation about graduates' specializedskills. The program also employsAccenture Learning's proprietarylearning content development approachthat enables the efficient conversion ofpaper-based material to the e-learningformat, including instructional topics,imbedded photographs and graphics,and online assessments to evaluate astudent's proficiency.

As the program progressed, AMREFdetermined that in order to effectivelyaddress the nursing shortage, it neededto reach nurses in the more remoteareas of Kenya that have limited publictransportation. Therefore the number

Under the five-year program, Accenture isdonating $2.9 million to AMREF to develop andimplement an innovative e-learning programto address Kenya's critical nursing shortage.The donation consists of a $1.7 millioncontribution by the Accenture Foundations alongwith $1.2 million of in-kind services includingprogram management expertise and 14,500hours of donated time from professionals inAccenture Learning.

“This program is not only going to drasticallyimprove the health system in Kenya, it is alsogoing to be replicated by other countries—and the positive impact on Africa’s healthsystem will be enormous.”

Peter NgatiaDirector of Learning Systems for AMREF

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AMREF is on schedule to achieve its goalof certifying nearly 20,000 registerednurses by 2011. Four modules consistingof 143 hours of training have beendeveloped and deployed. The help deskand learning management system have been rolled out. More than 100 e-learning centers—many in the remotestareas of Kenya—have been establishedto deliver the e-learning training, and 27 nursing schools have alsoimplemented the program. To date,more than 2,000 nurses have enrolledin the e-learning program withenrollment expected to peak in 2008.The first graduation of nurses isscheduled for September 2007.

Additionally, knowledge transfer toAMREF personnel—including contentdevelopment, technology and programmanagement skills—is complete. In thewords of Jo Ensor, Chief Executive ofAMREF UK, "The skill transfer that hastaken place between Accenture andAMREF has added huge value to thisinnovative project. From the start,Accenture placed great emphasis ontransferring knowledge and capacity to AMREF's team in Kenya. They havehelped develop one of AMREF'sstrongest project teams. I've seen manyAMREF employees transformed by theexperience of working with Accenture,both in terms of their projectmanagement skills and their confidence.This has had a positive and sustainableimpact on AMREF, our people and theproject."

The 20,000 newly trained registerednurses the initiative will create over the next five years will be dispersedthroughout Kenya—a completedeparture from what could be doneemploying traditional classroom methods.These nurses represent a staggeringincrease in the number and skills of

frontline health care workers. They willbe skilled at treating Kenya's mostdebilitating diseases, such as HIV/AIDSand malaria, as well as at administeringpreventative treatment—vaccinations,pre- and post-natal care—in the nation'sremote and most impoverished areas.The e-learning courseware also trainsnurses in disaster management andhow to respond to man-made andnatural catastrophes familiar to Kenya,such as famine.

This visionary e-learning program isgroundbreaking on many fronts. Itrepresents one of the first uses of e-learning to train health professionalsin Africa, improving the quality oftraining while drastically reducing thetime it takes to certify registered nurses.Additionally, the learning managementsystem provides an invaluable tool as itenables Kenyan health officials to matchskilled resources with specific needs.

AMREF and Accenture have reinventedthe education process by harnessing thepotential of computer-based learningto dramatically advance Kenya's medicaltraining capabilities. Already, AMREF ispreparing to replicate Kenya's e-learningmodel in other African nations.According to Peter Ngatia, Director ofLearning Systems for AMREF, "Thisprogram is not only going to drasticallyimprove the health system in Kenya, itis also going to be replicated by othercountries—and the positive impact onAfrica’s health system will be enormous."

"Accenture has helped AMREF introducea training model that is truly sustainable.This is just the beginning of what wehope will be an e-learning revolutionthat will enable Kenya as well as theworld's poorest nations to usetechnology to curb disease and improvethe quality of lives", says Matthew

Edwards, the Accenture senior executivesponsor overseeing the relationshipwith AMREF.

According to Ellen Balaguer, managingdirector of Accenture Learning, "Thisprogram has provided a specialopportunity to leverage our technology,resources and the expertise of ourpeople to help solve a serious healthcare crisis in Africa. It has been a veryrewarding experience for our people towork with the AMREF staff, and welook forward to seeing how this programis replicated throughout Africa."

AMREF and Accenture have beenrecognized for their contributions andglobal efforts on this program, including2006 Gold Medal Laureate for theComputerWorld Honors Program and aprofile in the 2006 Global CorporateCitizenship Report (US Chamber ofCommerce). The AMREF e-learningprogram has also been featured in the Financial Times and the CNNdocumentary "Inside Africa."

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