Barriers and Enablers of Open Distance Learning for Working Nurses in Sub-Saharan Africa
Dr. Bekele Alemu · Department of EpidemiologyORCID: 0000-0001-5109-3700
Published 22 August 2026·Citation style: apa·587 views · 91 downloads
Abstract
Sub-Saharan Africa faces a critical shortage of skilled nurses, yet working nurses rarely access career-progression education. We surveyed 1,860 nurses across 11 countries studying through ODEL programmes to identify the barriers that stall completion and the platform features that most predict success.
Introduction
The WHO estimates Sub-Saharan Africa carries 24% of the global disease burden with only 3% of its health workers. Upgrading practising nurses to degree and postgraduate qualifications is a recognised lever for health-system strengthening, yet the nurses who most need upskilling are the least able to leave employment for full-time study. ODEL promises to close this gap, but completion rates in health-professional distance programmes remain poorly documented.
Literature Review
Research on ODEL completion identifies technology access, employer support, family obligations and assessment anxiety as recurring themes, but studies focusing specifically on shift-working nurses in low-bandwidth settings are sparse. Self-determination theory predicts that autonomy-supportive course design — flexible pacing, clear progress feedback and community belonging — should improve persistence, though empirical tests with health workers are limited.
Methodology
We conducted a mixed-methods study: a survey of 1,860 nurses enrolled in ODEL programmes across 11 Sub-Saharan countries (58% response), platform learning-analytics for 12,000 learners, and semi-structured interviews with 42 nurses who either completed or withdrew. Logistic regression identified completion predictors; interview data were analysed thematically.
Results
Completion at 36 months was 71%. The strongest enablers were: drip-released content (OR 2.1), evening live tutorials (OR 1.8), class WhatsApp communities (OR 1.7) and employer study leave (OR 1.6). Dominant barriers were shift conflicts with fixed deadlines (cited by 44% of withdrawals), data costs (31%) and family care obligations (28%). Nurses receiving zero-rated platform access completed 19 percentage points faster than those without.
Discussion
Findings align with self-determination theory: autonomy-supportive pacing and belonging predict persistence. Practical implications are direct — flexible assessment windows, zero-rated learning platforms and employer partnerships materially change outcomes. Limitations include self-report bias and single-institution platform analytics.
Conclusion
ODEL can upgrade the nursing workforce at scale when pacing, community and connectivity barriers are engineered out. We provide a checklist for programme designers and employers.
Acknowledgments
We thank the nursing councils of the 11 participating countries and all nurse respondents.
Funding & Conflicts
No external funding. Platform analytics provided by EIU institutional research office.
Data Availability
Survey instruments and anonymised data available from the corresponding author under a data-use agreement.
References
- [1] Alemu, B. (2026). Barriers and Enablers of Open Distance Learning for Working Nurses. EIU Journal of Public Health, 9(1), 3–21.
- [2] WHO (2023). Health workforce requirements for universal health coverage. Geneva: World Health Organization.
- [3] Deci, E., & Ryan, R. (2020). Self-determination theory and the facilitation of intrinsic motivation. Psychological Inquiry, 11(4), 227–268.