BRAC University sets an example of successful online education for midwifery students

Like most other countries, Bangladesh is facing the onslaught of Covid19.The educational institutions have remained closed since March 16 and might remain close for an indefinite period.  Students in all level are worried about the academic year. Several educational institutions across Bangladesh are trying to resort online classes, following its closure. Midwifery education programme of JPGSPH, BRACU also moved forward with virtual learning arrangements.

Bangladesh started Midwifery as a new profession since 2012 and currently functions in 41 public nursing colleges and institutes and also private midwifery institutes has  been increased from 17 to 41.Over the years Government of Bangladesh has taken a number of steps to bring them into the mainstream of health service delivery in the country. Till now a total 4,396  midwives ( from GOB and private institute) received license from Bangladesh Nursing and Midwifery Council (BNMC). In 2018, 1,149 registered midwives have been deployed to 342 Upazila Health Complexes around the country.  Currently,  3247 licensed midwives are  waiting for recruitment in the Public Service Commission (PSC) in the government health setting.

BRAC University is a pioneer in establishing diploma in midwifery course. This is a residential 3 years  course, focus is  practical 60% & 40 % theory. The students are from different corners of Bangladesh. Such as Ramu, Parbatipur, Halwaghat etc. Most of them are from low socio economic status; 41% are from farmers family,14%  day laborers, 15% small business owners and rest 30% are private job  holder. taxi driver, van driver etc.  So far 602 midwives have graduated from its seven academic sites, situated in the remote areas of six divisions across the country. Furthermore 628 students are currently studying in different semesters. Unfortunately, Following government notice all students had to leave the hostel suddenly. Before leaving, the students participated in a quick training on COVID 19 with emphasis on handwashing technique. They   left with key information and awareness materials (leaflets and posters) on COVID 19.

In Bangladesh, according to BTRC, till the end of March, 2020 total number of mobile phone subscribers has reached 165.337 Million  and the internet subscribers has reached 103.253 Million. This information encouraged BRACU Midwifery Program to start offering effective remote learning education  using mobile phone and Internet platforms..

Equity of education is at the heart of our thinking. To address this issue, we conducted a quick survey to understand the situation of cell phone and internet access among the students, so that we may adapt a strategy to reach all the students specially less privileged students. We found that 58% students were using personal smart phone, 28%  students had access through  family member’s (father, mother, sister, brother)  smart phone, 9% had access through  other than family member’s (uncle, aunty, cousin, neighborurs etc. ) smart phone. Only 5 % students had button phone.

BRACU immediately convened a remote learning team and provided appropriate guidance to the teachers, who would be engaged in remote learning. 628 students were divided into several small groups led by a responsible teacher for each group. Monthly study and assessment plans were shared with all students well ahead of time to establish routines that allowed everyone to get organised and be engaged. Regular online live classes were initiated and now  continuing using  zoom platform and Face book live. The day before a scheduled class, the responsible teacher posts a reminder message in the group  mentioning the time and topic of the class and also one  hour before the class starts. Follow up sessions are also there to gather feedback and assess understanding.

At the end of the class, the live video and other study materials are uploaded on the same page so that those failing to  attend the schedule class , have the opportunity to watch the uploaded videos. Student’s attendance are also maintained with different category information. Such as how many present at schedule class,  how many visit the uploaded class etc.

Following schedule class, teachers are continuously interacting with the individual student over the phone, what's app & messenger to monitor their progress and respond to their questions. Students are also connecting with the teachers and their peers.. A student of 3^rd year residing in srimangal tea garden does not have a smart phone of her own. She walks more than one kilometer every alternate day to a friend’s place and watches the videos of last two days from her friend’s smart phone. She makes her own notes from the video and later she gets clarifications from her teacher over her own button phone, if she needs any. In addition, teachers keep the parents updated and encourage them to monitor study progress. Since May 2020, We  found that live streaming attendance reached 84% ,whereas 99% students have attended classes through the recorded versions.  Furthermore, around 95% students have passed the exams and the remaining 5% were unsuccessful and have attended retake exams . No dropout case has been reported . The Covid-19 pandemic has also compelled our students  to enhance their digital expertise. 

We should acknowledge the innovativeness and creativity of our teachers and management responding to the students who do not have a smart phone. Extra time and efforts are spending on those students over phone with repeated follow up and extensive question and answer session. All students are assigned with module specific assignments that must be submitted after returning back . Even teachers are holding MCQ and SAQ based online exams to prepare the students for semester final exam.

As mentioned before, our students came from diverse socioeconomic backgrounds, and many have lost their income source with the declaration of the nationwide general holiday. Students are struggling to buy internet data package to continue online classes and smart phone was not accessible to all students. Developing midwives project has  mobilized fund and provided smart phones and mobile data to poor students to avoid learning interruption.

Similar many developing countries, uninterrupted internet connection is also a challenge in Bangladesh. Sometimes even for dedicated students, remote learning is a challenge because there is less scope for interaction.

Faculty drop out is a constant challenge in midwifery education and most of the trained faculty get recruited by the government almost every year.  There are hardly any potential candidates that can fill the vacuum. Online learning platform also created opportunity to address faculty drop out issue. Good results were also observed using small number of faculty teaching more students at a time online. Online education has created space for motivation and hope to the students. It gave an opportunity to stay connected among the students and has created huge opportunities for effective learning and collaboration outside the classroom. Students are encouraged to continue their studies, thus  preventing dropouts and other social issues, like early marriage. This is the high time to move forward with a variety of alternative technological arrangements and long-term planning, leaving no students behind.

(Dr. Selina Amin is Head, Midwifery Education Programme & Project Director, Developing Midwives Project, James P Grant School of Public Health, BRAC University while Dr Sharmina Rahman is Strategy Advisor, Developing Midwives Project, BRAC James P Grant School of Public Health, BRAC University.)

-rmc//