Massive open online courses: a resource for health education in developing countries

Developing countries are undergoing rapid demographic and epidemiological transitions as a result of the increasing burdens presented by both non-communicable diseases and emerging infectious diseases such as Ebola (1). Health education is of paramount importance in the fight against these diseases, as most of them are preventable. However, health education in developing countries is suffering from several challenges such as: inadequate infrastructure; outdated curricula and teaching methods; paucity of well-trained healthcare personnel; and the cultural barriers that prevent open discussions about, and education in, topics such as contraception and sexually transmitted diseases.

E-learning has been shown to address some of the training challenges experienced in developing countries by supporting efficient content delivery, decreasing costs and increasing access (2). One of e-learning’s foremost tools is massive open online courses (MOOCs), which are online courses offering open access via the Internet. Despite being a recent phenomenon, MOOCs have attracted millions of learners from all over the world. For example, Coursera (www.coursera.org), one of the leading providers of MOOCs, has more than 16.1 million learners and offers 1474 free courses (as of 6 November 2015) in various languages. The ‘Understanding IELTS: Techniques for English Language Tests’ course offered by the British Council on the FutureLearn platform (www.futurelearn.com) attracted more than 380,000 participants from 153 countries (3). These statistics show the potential of MOOCs to reach large audiences worldwide. Thus, in public health campaigns, where outreach is a necessity, MOOCs could become a new channel for supplying information.

MOOCs offer a tremendous opportunity to fulfil the unmet training needs of the health sector in developing countries in two complementary ways: as a resource for training healthcare professionals; and as a resource for the general public.

A recent review of MOOCs related to health and medicine provides details of 98 relevant courses offered by 12 MOOC providers (4). These courses encompass a wide variety of topics, including public health (e.g. ‘Principles of Public Health’ and ‘PH201x: Health and Society’), mental health (‘The social context of mental health and illness’), sexual health (‘Contraception: Choices, culture and consequences’) and chronic conditions (‘Diabetes: Diagnosis, treatment, and opportunities’). Many of these courses were offered by renowned universities, such as Harvard University and Johns Hopkins University. Fourteen of the 98 courses offered verified certificates, while another three provided other professional recognition (such as the Continuing Medical Education credit).

The major MOOC platforms have each introduced a series of interlocking online courses to provide mastery of the subject, such as the edX ‘XSeries’ and Coursera’s ‘Specializations’ (5). Currently, about 80 specializations are provided through Coursera (as of 6 November 2015). Of these, around three at any one time are related to medical subjects: for example, ‘Neuroscience: Perception, action and the brain specialization’ and ‘Bioinformatics’. Specializations in topics such as infectious diseases, which are critical problems in developing countries, may help combat the lack of knowledge about these diseases among healthcare professionals and therefore control their spread. However, it may be necessary to develop courses that offer customized specializations according to each country’s needs, and which are tailored to cater for linguistic and cultural diversity.

Certification fees can be an important determinant of the success of these courses as continued medical education for physicians in developing countries. Currently, the fees charged for verified certificates and specializations are generally lower than fees for other similar professional development courses, and scholarship schemes are often available for participants with financial difficulties. For example, Coursera’s ‘Signature track’ (verified certificate) costs USD30–100 and a ‘Financial Aid’ scheme is available to participants in need (6). Maintaining lower course certification fees is important to attract a large number of participants from developing countries as the disposable incomes of people (and governments) in these parts of the world are substantially lower than in the developed world.

MOOCs played an important role in the recent Ebola epidemic in educating healthcare workers and volunteers working in affected areas as well as the general public around the world. The ‘Understanding the Ebola Virus and How You Can Avoid It’ course offered on the ALISON platform (www.alison.com) was one of the first free online courses offered on the subject. This course was taken by over 10,000 West Africans and had been translated into several other languages as of October 2014 (7). This MOOC was created as a rapid response to the need to educate large numbers of people about the Ebola epidemic, demonstrating that MOOCs can deliver high-quality essential knowledge about major health problems to the masses using multimedia and interactive content.

In many non-Western cultures, there are greater barriers to public health education because of a lack of openness around discussing topics such as sexual health, addiction and other transmitted diseases such as tuberculosis or leprosy. A course on contraception, for example, could help people educate themselves without having to talk to a health professional about family planning, which in some cultures is taboo or discouraged by faith. Furthermore, being able to access accurate and trustworthy information through a MOOC could empower people who may otherwise not know what options are available to them (4). MOOCs on health and medicine can help patients and their carers to understand the treatment options available to them, and to discuss these options with their healthcare team without being burdened by medical jargon (8).

Despite the many benefits attributed to MOOCs, the number of learners from developing countries on these courses remains low. Linguistic and cultural barriers represent challenges for the spreading of these courses (9,10). In addition, limited access to digital technology, computer illiteracy and low-bandwidth Internet connectivity are some of the major barriers to participation. However, statistics from the International Telecommunication Union (ITU) show there has been a large increase in the number of households with Internet access and the number of individuals accessing the Internet. In 2015, it was estimated that 10.7 per 100 inhabitants in Africa, 39 per 100 inhabitants in Asia and the Pacific, and 40.3 per 100 inhabitants in the Arab world have Internet access at home (11).

Despite these obstacles, there are strategies that can be employed to help combat these challenges. These include developing access hubs at strategic central locations to provide the required technology and internet access; developing offline content delivery platforms to overcome slow internet connectivity issues; and forming a national MOOC-coordination secretariat. Customized course development with accreditation from governmental authorities can further address local needs (12).

In many developing countries such as Sri Lanka, Nigeria and Egypt, medical education is conducted only in English. This means MOOCs created in English could be used as ongoing medical education tools since the language barrier would not hinder their use. Some projects have successfully translated or adapted courses to fit different contexts. For example, the Edraak platform (www.edraak.org), with more than 498,000 learners (as of 30 March 2016), offers courses from edX that have been translated, along with new courses created in Arabic.

However, there is still a wide gap between access levels in developing and developed countries. Therefore, developing access hubs in strategic locations is an important step towards making MOOCs more accessible.

In summary, we encourage collaboration between the World Health Organization, elite educational institutions, international funding agencies, MOOC providers and local health authorities in developing countries to create customized health education courses to meet the needs of their populations. MOOCs could be used as tools for continuous medical education as health professionals are likely to face fewer barriers in accessing these courses than the general population in developing countries (because they are likely to have a better command of English and/or they can access courses via the workplace). Furthermore, developing/translating courses into native languages and creating local meeting centres where people can discuss course content with trained local instructors can help to disseminate information to the masses and address gaps in health education. Course providers and platforms can increase their appeal to participants in developing countries by allowing downloadable and low-bandwidth content (e.g. low-resolution videos), thereby unlocking the potential of MOOCs to be used as a worldwide health education tool.