Cape Town, South Africa — Relying only on face-to-face training for primary healthcare workers in low- and middle-income countries is becoming unsustainable.
Research from the Knowledge Translation Foundation (KTF) examines what happened when the Practical Approach to Care Kit (PACK) programme shifted from in-person training to online and blended learning, and sets out what is needed for digital training to support health systems rather than simply replace classrooms.
The study, From face-to-face to e-learning: transitioning to new training models to strengthen the health system by supporting primary healthcare workers in low- and middle-income countries, analysed 29 courses delivered in South Africa between 2020 and 2023. The COVID-19 pandemic forced the move away from the programme’s established facility-based, in-person model. Using the Health System Process Goals framework, the researchers assessed the barriers and enablers of e-learning, treating it as part of the wider health system rather than as a standalone technical fix.
The analysis suggests that e-learning expanded access and standardised course content, but success depended on addressing systemic barriers rather than relying on technology alone.
Key findings include:
- Blended learning works best. Courses had the strongest uptake and completion when online content was combined with in-person technical support for registration and start-up, protected time for group learning around online cases, and consistent follow-up toward completion. Many primary care workers continued to prefer learning in groups.
- Subsidised data is essential for fair access. “Reverse-billed” data, where the cost of access is covered for learners, was necessary to avoid excluding those who could not afford connectivity.
- Automated systems aid management. The ability to standardise content, reach workers in remote settings, track learner progress, auto-generate certificates, and produce training reports supported workforce planning.
The research also identifies barriers that limit the approach. Learners often lacked protected time to complete training, which risks shifting an unfair burden onto an already stretched workforce. Other challenges included gaps in digital literacy, limited internet access, limited evaluation of outcomes, and reliance on donor funding, which makes long-term continuation difficult.
The authors conclude that e-learning can only strengthen health systems if it is built into administrative workflows and budgets, rather than run as a temporary, externally funded project. They offer recommendations for Ministries of Health, funders, and implementers: move toward government-owned training platforms, adopt accredited blended learning models, and introduce policy that guarantees protected time for staff to develop their skills.
The work reframes digital training as a tool for health system strengthening, and provides practical guidance for governments and partners weighing how to keep their health workforce current and skilled in delivering evidence-informed care.
ENDS
About the Knowledge Translation Foundation
The Knowledge Translation Foundation (KTF) closes the gap between medical evidence and frontline care. We turn complex, fast-changing clinical evidence into practical tools, training, and digital systems that primary healthcare workers can actually use. Our work spans South Africa and the wider Global South, combining knowledge translation with in-house digital innovation. The goal is a health system where the best evidence reaches the point of care, and keeps pace as it changes.
Media contact:
Joey Latief
Yusuf.latief@uct.ac.za | +27 82 671 8734
