The COVID-19 pandemic: the benefits and challenges it presents for medical education in Africa
Anthonio Oladele Adefuye1,&, Henry Ademola Adeola2, Jamiu Busari3
1Division of Health Sciences Education, Office of the Dean, Faculty of Health Sciences, University of the Free State, P.O. Box 339, Bloemfontein 9300, South Africa, 2Department of Dermatology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa, 3Educational Development and Research Department, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
Anthonio Oladele Adefuye, Division of Health Sciences Education, Office of the Dean, Faculty of Health Sciences, University of the Free State, P.O. Box 339, Bloemfontein 9300, South Africa
The coronavirus disease (COVID-19) has impacted many facets of everyday
daily life, resulting in far-reaching consequences on social interaction,
regional and global economies, and healthcare delivery systems. Numerous
reports have commented on the impact of the COVID-19 pandemic on medical
education in various world regions. However, we know little about the
influence of the pandemic on medical education in Africa. Here, we discuss
impact of COVID-19 on teaching and learning in undergraduate medical
education in sub-Saharan Africa, illustrating some of the unexpected benefits
the pandemic presents for medical education in sub-Saharan Africa.
Since its onset, the coronavirus disease (COVID-19) has impacted
many facets of everyday life, resulting in far-reaching consequences
on social interaction, regional and global economies, and healthcare delivery
systems. Similarly, numerous reports have commented on the impact
COVID-19 pandemic on medical education in various world regions.
Documented reports include the transition to distance online education by
in Europe ; conduction of the first-ever online exam
for final years by Imperial College London ; adoption
of an open-book examination approach by some medical schools in
the United Kingdom; implementation of an online pre-clerkship
curriculum by medical education faculties in the United States
of America ; and the use of simulations and virtual
learning platforms by medical schools in Asia . It
is still unclear what the influence of the COVID-19 pandemic is on medical
in Africa. Hence, we explore the potential impact of COVID-19 on
teaching and learning in undergraduate medical education in sub-Saharan
some of the benefits and challenges the pandemic it presents for
medical education in sub-Saharan Africa.
Undergraduate medical education in sub-Saharan Africa before the onset
of the COVID-19 pandemic
According to the latest World Directory of Medical Schools (updated
November 2020), Africa has 154 operational medical schools spread
across 54 nations . The education and training in
these institutions are regulated by the respective statutory body established
in each country. For example, the Medical and Dental Council of
(MDCN)  and the Health Professions Council of South
Africa (HPCSA). Before the onset of the COVID-19 pandemic,
some medical schools in sub-Saharan Africa had begun implementing
new curricula and different pedagogical formats to improve medical education
their institutions. Notable examples include the use of problem-based
learning and interactive team-based learning as a pedagogy ,
developing competency-based medical education curriculum ,
and integration of traditional, complementary, and alternative
medicine into the medical curriculum . Still, colonial-era
conventional medical curricula, with little or no modification,
continue to be used in many medical institutions to educate trainees. In
these schools, the undergraduate medical curriculum is characteristically
divided into pre-clinical and clinical training with minimal integration
between the two, and didactic lectures and traditional instructor-centered
strategies being the predominant forms of teaching .
Textbooks and lecture notes remain a major teaching resource due
to challenges of access to online e-learning opportunities. Furthermore,
and assessment of trainees remain unreliable and subjective .
Other challenges to the quality of medical education in sub-Saharan
Africa include the perennial problems of insufficient governmental funding,
infrastructure, and poor faculty development, which continue to
plague many African medical institutions. Like many longstanding and vague
issues such as systemic discrimination, inequity, and poor access
to health care, the advent of COVID-19 has exacerbated the challenges and
medical education in Africa with many governments across the continent
backtracking on their planned increases in education spending in 2020 .
Benefits presented by the ongoing COVID-19 pandemic for medical education in Africa
While the advent of the COVID-19 pandemic has invoked unprecedented economic hardship across the African region, education and particularly medical education, seem to have benefited from this crisis. If looked at closely, the COVID-19 pandemic seems to have paradoxically presented stakeholders with ample opportunities to enhance teaching and learning in undergraduate medical education. There has been a noticeable increase in government spending on technology-based pedagogy  and an upsurge in incorporating e-learning within institutions . Furthermore, the number of educators with e-teaching skills has increased, all of which can be ascribed to the COVID-19 pandemic. To further illustrate these "unexpected" benefits of the COVID-19 for medical education in sub-Saharan Africa, we provide an overview of the different arguments for this below:
Technology-based pedagogy: the transformation in medical education over the last decades has shown a shift from the traditional face-to-face (Teacher-centered) model of teaching to newer student-centered and competency-based approaches to teaching and learning in undergraduate medical education. A significant change has been the emergence of technology-based pedagogy (E-learning) as a modality. Similarly, in Africa, there is a growing demand for products and services for e-learning; however, due to the absence and/or inadequate coverage of broadband internet and technology infrastructure, the uptake of e-learning as a pedagogy in most parts of the continent is hindered . Hence, teaching in most undergraduate medical curricula in the continent is still via the traditional face-to-face pedagogy with little or no infusion of e-learning modalities.
For most students in the continent, academic institution closures
during the COVID-19 pandemic have meant access to little or no
academic support or training and delay in the early transition of final
trainees into practice. To mitigate the effect of COVID-19 in the
education sector, important educational stakeholders and governments across
began to invest massively in e-learning. Notable examples of such
investment include; establishment of an online platform (Ecole-ci. online
and EducTV Facebook page) by the Ivorian Ministry of Education,
Technical and Professional Training via the "École fermée,
mais cahiers ouverts (Closed school but open notebooks)" initiative
creation of Online Resource Platform by the Senegalese Ministry
of Education ; and the creation of online resources
to support learning at home during the lockdown by the Department of Basic
in South Africa . Also, many Universities across
the continent have developed their online learning management systems
Besides offering laptops, some institutions signed contracts with
mobile communication networks to provide their students with free data access
online teaching and learning resources. E-learning has been credited
for its advantages, such as enhanced knowledge and skills in undergraduate
compared to the traditional educational methods .
Furthermore, it is known that technology-based education enhances
medical trainee growth, empowers innovative scientific leaders, stimulates
and helps in assimilating relevant information for informed decision-making
. It is plausible that the massive investment in
technology-based pedagogy, precipitated by the advent of the Covid-19
pandemic, will engender similar attributes in medical graduates across the
Innovative ways of teaching: prior and emerging studies on students' experience on e-learning during the pandemic reports that students become more interactive and engage more with learning course materials when familiar platforms, such as social media sites, are used for online teaching and learning when compared to the learning management system imposed by the University . This meant that medical educators needed to develop innovative ways of teaching in the online environment. Lectures have rapidly been adapted for delivery online, using various content and learning management systems and social media platforms such as Zoom, Skype, Microsoft Teams, WhatsApp, Twitter, Facebook, Pinterest, Snapchat, YouTube, and others . Calls for the customization of learning management systems to meet students' needs and preferences, i.e., linking learning management systems to social media platforms, has been promulgated. The integration of social media platforms into online teaching could lead to improved students' performance by enhancing students' interaction and engagement with learning materials. Uptake of these innovative ways of online teaching could potentially increase educators' effectiveness and efficiency.
Skilled educators and learners: due to their inept information technology
(IT) skills and the inefficient use of online teaching and learning
platforms, most educators and learners' in Africa lack the skills
to use e-learning media
and learning management systems effectively . The
sudden COVID-19-mediated transition from face-to-face teaching and
learning to the online teaching and learning platform requires that
the users (i.e., educators
and learners) of this medium possess the skills and the technological
know-how to best use the platform. The pandemic's onset has also
brought in its wake
an increased awareness and sensitization about e-learning among medical
trainees and their educators in the continent. Institutions across
the continent have
initiated programmes such as the "Facilitating Online" a registered
short course at the Centre for Innovation in Learning and Teaching,
University of Cape Town . Similarly, platforms to
train educators and learners about various aspects of online teaching
and learning has been
created by most institutions in the continent. This will engender
the birth of a new generation of medical educators and learners with
apt I.T. skill
for online teaching and learning.
Medical faculties and learners: in low and middle-income countries (LMICs), e-learning in medical education has been reported to confer numerous benefits to learners while simultaneously enhancing faculty effectiveness and efficiency . Some of the benefits of e-learning for students (especially in LMICs) include the easy and increased accessibility to information and the enhanced continuous interaction between students and educators outside the classroom setting. Also, innovations like virtual reality and simulations can effectively increase knowledge, performance skills, and team communication through practical case-based learning sessions . E-learning also encourages students to take responsibility for their learning, building their self-knowledge and self-confidence. E-learning can be used to address faculty shortages and supplement faculty instruction  and support learning outside the classroom. Finally, with the aid of mobile technologies, e-learning can be used to enhance faculty effectiveness and efficiency through the implementation of learning in remote and rural areas. It is logical to assume that the exposure of medical faculties and learners in the African continent to e-learning during the COVID-19 pandemic will confer similar benefits.
Challenges faced by medical education in Africa during the ongoing COVID-19 pandemic
While it is very evident that the emergence of the COVID-19 pandemic has improved the acceptance and use of remote and innovative teaching and learning methodologies in many African countries, it is not without saying that this new normal does not come with numerous challenges. Some of these challenges include:
Limited infrastructure to accommodate e-learning: besides impeding
factors such as social structure, cultural acceptance, and financial
capacity, the lack of adequate infrastructure has been identified
as a significant barrier
to implementing e-learning in most sub-Saharan Africa countries.
For example, access to computers is limited due to affordability,
as most workers' average
income on the continent is low. On the other hand, access to the
internet is restricted, as the cost of accessing the internet in
most countries on
the continent is still on the high side. The supply of electricity
required for seamless online educational engagement of learners is
also inconsistent. According to a World Bank report, only 47.7% of
the population living
Africa had access to electricity in 2018 . It was
against this pre-existing backdrop that the COVID-19 pandemic arrived
in Africa. Thus incapacitating virtual/online clinical and didactic
training of medical
students, and also restricting access of trainers to students.
Educators: being computer-literate and possessing the relevant technical computer/I.T. skills is a crucial factor necessary for the adoption of technology in teaching. Similarly, having confidence in one's skills and ability to use e-learning contributes significantly to the uptake of technology in teaching. This is not so for most educators in Sub-Saharan Africa, as an ample number of them still lack skills in the use of e-learning in teaching and learning. The advent of the COVID-19 pandemic thus presents an enormous challenge for most of these educators, as they may find it challenging to develop e-content and employ relevant technologies to teaching.
Learners: students are expected to be self-motivated and committed for active learning to occur while engaging in e-learning during the pandemic. However, these expectations may be challenged by poor, inadequate institutional support and, thus, finding it challenging to engage the e-learning platform for active learning. Similarly, students from poor backgrounds may find it difficult to access devices, data, and the Internet because of the high cost and poor coverage in their locality.
Assessment: periodic evaluation of students is an essential aspect of most learning and teaching experience. While various online assessment methods have been established for testing and examining students, the uptake and routine use of such e-learning tools are deficient in Africa. Some medical colleges across the continent still indulge in unreliable and subjective methods of assessment, such as viva voce examination and long case/short case clinical presentations . School closures due to the COVID-19 pandemic also interferes with the process of assessment in some of these medical colleges. The inaccessibility to Internet, irregular and frequent interrupted power supply experienced in most part of the continent also poses a significant challenge for online assessment. Furthermore, developing online content for online assessment may be a challenge for educators who are not trained in requisite I.T. skills.
Financial: finally, the pre-existing severe financial problems, coupled with the fact that the typical western lenders are also affected by the COVID-19 pandemic, puts an additional layer of strain on successful funding of e-learning programs in Africa .
Even though the number of COVID-19 cases and fatalities are relatively low in Africa, the overwhelming poverty and the paucity of educational, healthcare, and technological infrastructure is significant. These deficiencies can strain the continent's resources and precipitate an educational, healthcare, and socioeconomic crisis. The shortcomings and inequities that the COVID-19 pandemic has laid bare to the world, and in this case, medical education, demands that more advanced e-learning resources (in line with the 4th industrial revolution) should be provided across Africa. Furthermore, policymakers are encouraged to cushion the costs needed for sustainable development of information technology infrastructure within the academic medical school settings and across most universities. Table 1 summarizes some of the challenges posed by the COVID-19 pandemic for medical education in sub-Saharan Africa and possible solutions .
The authors declare no competing interests.
All authors have read and agreed to the final version of this manuscript.
Source(s) of funding support: H.A.A thanks the South African Medical Research Council (SAMRC) for a mid-career scientist and Self-initiated research grant; A.O.A and H.A.A thank the South African National Research Foundation (N.R.F.) for Research Development Grant (R.D.G.) for rated researchers.
Table 1: some of the challenges posed by the COVID-19 pandemic for medical education in Sub-Saharan Africa
- Sandhu P, de Wolf M. The impact of COVID-19 on the undergraduate medical curriculum. Med Educ Online. 2020 Dec;25(1):1764740. PubMed | Google Scholar
- Tapper J, Batty D, Savage M. Medical students take final exams online for first time, despite student concern. 2020. Accessed on 31st December 2020.
- Rose S. Medical Student Education in the Time of COVID-19. JAMA. 2020 Jun 2;323(21):2131-2132. PubMed | Google Scholar
- Tabatabai S. Simulations and virtual learning supporting clinical education during the COVID 19 pandemic. Adv Med Educ Pract. 2020 Aug 5;11:513-516. PubMed | Google Scholar
- World Federation for Medical Education. World Directory of Medical Schools. 2020. Accessed on 31st December 2020.
- Medical and Dental Council of Nigeria. MDCN Mandate - Mission & Vision. 2020. Accessed on 31st December 2020.
- Health Professions Council of South Africa. Vission, Mission and Values. 2020. Accessed on 31st December 2020.
- Amoako-Sakyi D, Amonoo-Kuofi H. Problem-based learning in resource-poor settings: lessons from a medical school in Ghana. BMC med educ. 2015 Dec 14;15:221. PubMed | Google Scholar
- Olopade FE, Adaramoye OA, Raji Y, Fasola AO, Olapade-Olaopa EO. Developing a competency-based medical education curriculum for the core basic medical sciences in an African Medical School. Adv Med Educ Pract. 2016 Jul 18;7:389-98. PubMed | Google Scholar
- Chitindingu E, George G, Gow J. A review of the integration of traditional, complementary and alternative medicine into the curriculum of South African medical schools. BMC med educ. 2014 Feb 28;14:40. PubMed | Google Scholar
- Amonoo-Kuofi HS, Danso K, Gyader EN, Tettey Y, Anderson FW. AM last page: medical education in Ghana. Acad Med. 2012 Feb;87(2):252. PubMed
- Adefuye A, Adeola H, Bezuidenhout J. Medical education units: a necessity for quality assurance in health professions education in Nigeria. AJHPE. 2018;10(1):5-9. Google Scholar
- Al-Samarrai S, Gangwar M, Gala P. The Impact of the COVID-19 Pandemic on Education Financing. World Bank; 2020. Google Scholar
- Mahaye NE. The Impact of COVID-19 Pandemic on Education: Navigating Forward the Pedagogy of Blended Learning. KwaZulu-Natal: Department of Education KwaZulu-Natal, South Africa; 2020 google sc. Google Scholar
- Aborode A, Anifowoshe O, Ayodele TI, Iretiayo AR, David OO. Impact of COVID-19 on Education in Sub-Saharan Africa. Preprints 2020. Google Scholar
- Pan American Health Organization. Possibilities and Challenges of E-learning in the African Continent. 2014. Accessed on 10 July 2020.
- Ministry of National Education
Technical Education and Vocational Training Côte
d'Ivoire. Côte d'Ivoire Digital Schools:
Home school 2020 [10 July 2020]. Available from:
https://ecole-ci.online/. PubMed | Google
- Senegalese Ministry of Education. Ressources Numeriques. 2020. Accessed on 10 July 2020.
- The Department of Basic Education. Online Resource for Parents,Caregivers and Learners to Support Learning at Home 2020. Accessed on 10 July 2020.
- Mpungose CB. Emergent transition from face-to-face to online learning in a South African University in the context of the Coronavirus pandemic. Humanit soc sci commun. 2020;7(1):1-9 google sc. PubMed | Google Scholar
- Pei L, Wu H. Does online learning work better than offline learning in undergraduate medical education? A systematic review and meta-analysis. Med Educ Online. 2019 Dec;24(1):1666538. PubMed | Google Scholar
- Moran J, Briscoe G, Peglow S. Current technology in advancing medical education: perspectives for learning and providing care. Acad Psychiatry. 2018 Dec;42(6):796-799. PubMed | Google Scholar
- Manca S. Snapping, pinning,
liking or texting: Investigating social media in
higher education beyond Facebook. Jiheduc. 2018
Dec;42(6):796-799. PubMed | Google
- Al-Balas M, Al-Balas HI, Jaber HM, Obeidat K, Al-Balas H, Aborajooh EA et al. Distance learning in clinical medical education amid COVID-19 pandemic in Jordan: current situation, challenges, and perspectives. BMC med educ. 2020 Oct 2;20(1):341. PubMed | Google Scholar
- Bagarukayo E, Kalema B. Evaluation
of elearning usage in South African universities:
a critical review. Int j educ dev using inf commun
technol. 2015;11(2) Google. PubMed | Google
- Centre for Innovation in Learing and Teaching University of Cape Town. Facilitating Online (short course) 2020. Accessed on 30 December 2020.
- Frehywot S, Vovides Y, Talib Z, Mikhail N, Ross H, Wohltjen H et al. E-learning in medical education in resource constrained low-and middle-income countries. Hum resour health. 2013 Feb 4;11:4. PubMed | Google Scholar
- Mars M. Building the capacity to build capacity in e-health in sub-Saharan Africa: the KwaZulu-Natal experience. Telemed J E Health. Jan-Feb 2012;18(1):32-7. PubMed | Google Scholar
- The World Bank. Access to electricity (% of population) - sub-Saharan Africa. 2020. Accessed on 17 July 2020.
- Prigoff J, Hunter M, Nowygrod R. Medical student assessment in the time of COVID-19. J Surg Educ. Mar-Apr 2021;78(2):370-374. PubMed | Google Scholar