Leveraging open-source technology and adapting open eLearning content to improve the knowledge and motivation of Ghana’s rural nurses

Community Health Nurses (CHNs) play a vital role in extending maternal and child health care to rural communities, but they face challenges with isolation, limited resources, and limited opportunities for career advancement. CHNs are the lowest credentialed nurses in the Ghana Health Service (GHS) hierarchy, which further exacerbates their challenges. The Government of Ghana has made significant efforts to reduce maternal and infant mortality rates, with a decline from 410 maternal deaths per 100,000 live births in 2010 to 380 maternal deaths per 100,000 live births in 2013. However, maternal and infant mortality rates remain alarmingly high and concentrated in rural areas. Ghana has established community-level facilities to bring basic maternal, newborn, and child health (MNCH) care closer to both urban and rural-dwelling families, but the country is still far from meeting the Millennium Development Goals (MDGs) for maternal and child mortality. Human resources for health (HRH) are essential in the attainment of these health objectives. The central role that health workers play in improving people's health has been long known and is now explicitly stated and emphasized in the new Sustainable Development Goals (SDGs). Unless urgent action is taken to address the shortage and uneven distribution of health workers, none of the health goals can be met. It is predicted that by 2030, an additional 10 million health workers is needed. Studies on developing services to meet the MDGs emphasized the importance of having health workers with the appropriate skills available and motivating them. The problems noted by many studies include lack of technical skills, low motivation, and poor support networks. Health workers face unimaginable challenges in addressing the ever-changing health care needs of their communities, and a continuum of learning from pre-service to in-service training is needed. The open education movement provides an enabling environment for addressing the need for continuing professional development. The exponential growth in Internet access and information and communication technologies (ICTs) has led to more people having access to open education resources via their mobile phones. mLearning is especially meaningful in rural areas where infrastructure is poor and access to resources needed to face the rising demand for continuing education materials can seem insurmountable. In Ghana, the Care Community Hub (CCH) project sought to address the barriers in CHN motivation by developing and deploying a mobile application (app), CHN on the Go, to CHNs in five rural districts. The app supports CHNs through tools for continuous learning, diagnostic decision-making, and improved nurse-supervisor interactions. The project aimed to leverage open-source technology and adapt open eLearning content to improve the knowledge and motivation of Ghana's rural nurses. The CCH project focused on adapting and using open eLearning content to address CHNs' motivation challenges and ultimately improve their knowledge and job performance. The project's approach involved developing a repository of adapted open learning resources to meet the needs of CHNs in rural Ghana. The project's findings and recommendations are expected to contribute to the development of effective strategies for improving the knowledge and motivation of CHNs in Ghana and other low- and middle-income countries.