Perception and Challenges of Health Science Students toward E-learning in a Sub-Saharan African Country: A Multi-institutional Study

Gloria Kabare (1), Nikita Muthuuri (1), Krishan Sarna (1,2), Fidel Gwala (1,2), Thomas Amuti (1,2), Beda Olabu (1,2), Moses Obimbo (1,2) and Julius Ogeng’o (1,2)

1Research in Medicine, School of Medicine, University of Nairobi, P.O. Box 30197-00200, Nairobi, Kenya

2Department of Human Anatomy, School of Medicine, University of Nairobi, P.O. Box 30197-00200, Nairobi, Kenya

Correspondences to: Gloria Kabare; email:

Received: 14 May 2021; Revised: 02 Oct 2021; Accepted: 20 Oct 2021; Available online: 6 Dec 2021



Background: E-learning is important in improving access to quality health sciences education. This study aimed to determine the perspectives of Kenyan health science students toward e-learning in a bid to enhance effective learning during the COVID-19 pandemic and beyond. Methods: This descriptive cross-sectional study targeted 294 Kenyan health science students. Approval was obtained from the Kenyatta National Hospital–University of Nairobi Ethics Research Committee, and informed consent was obtained from participants. Data were collected using Google Forms and analyzed using SPSS version 27.0. A p value ≤0.05 was considered significant at 95% confidence interval. Results: Most students had good knowledge of online learning; 74.9% reported having received training on the same by their universities and 74.5% further reported to have taken tests on the same. Almost half (45.5%) were knowledgeable of the use of the internet to access materials. Most (79.6%) portrayed a positive attitude toward online learning, agreeing to its use as an integral part of learning. However, 70.2% noted a decrease in concentration and changes in reading habits (44.7%). Regarding challenges faced, unreliable internet connection (56.9%) and lack of motivation (73.7%) were common. Conclusion: The majority of the Kenyan health science students portrayed good knowledge, attitude, and practice toward e-learning amidst challenges.



Keywords: Online learning, Health science students, COVID-19; Sub-Saharan Africa

 Ann Afr Surg. 2022; 19(1): 16-22 


 Conflict of interest: None

 Funding: None.


© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.


Online learning has been a revolutionary educational tool that has propagated the advancement of healthcare training worldwide for a long time. However, its use in low-resource countries such those in sub-Saharan Africa remains under-exploited (1). Unlike developed countries where it was integrated into health training institutions as early as the start of the 2000s, developing countries have been lagging behind (2) despite advancements in technological development and internet access (3).Low- and middle-income countries face many challenges in healthcare, among which is low doctor-to-patient ratio due to constrained healthcare workforce (3). As such, online learning has been identified as a feasible tool to increase the capacity of healthcare workers and expand the healthcare workforce to cover underserved areas (4). With improved access to primary healthcare, this is a key strategy in implementing universal health coverage in sub-Saharan Africa. Successful online learning has been noted to promote e-health readiness and reception of telemedicine in resource-constrained countries (5). Online learning is also a reliable and realistic option for continuity of healthcare training during disruptions caused by phenomena such as the ongoing COVID-19 pandemic. Despite its notable benefits in the medical field, training in medical schools has remained largely traditional over the years, mostly employing physical lectures (6). With the onset of COVID-19 pandemic, World Health Organization guidelines and government restrictions, including lockdowns and closure of schools, have hampered the traditional physical face-to-face learning in medical institutions to a great extent. Following the official reporting of the COVID-19 pandemic, learning and assessment in Kenyan universities were halted. With strict measures from the Ministry of Health, online learning resumed at different times, depending on the individual universities’ administration organization. At the time of this study, no physical learning had resumed, and each university had to choose the teaching platform and make arrangements for internet infrastructure for their students. Online learning has therefore become a major enabler of learning, even in low-resource areas (7). Kenyan health sciences’ learning institutions have been faced with the task of scaling up online learning platforms to meet educational demands during the pandemic. For institutions to be successful in the implementation of online learning, key elements of online learning need to be considered carefully (3). These elements include institutional support, infrastructure, information and communications technology technical expertise, and faculty and student engagement (2, 3).


Despite the importance of students’ engagement and perspectives toward the success of institutional online learning (8), there is paucity of data on the same in low-and middle-income countries, particularly in sub-Saharan Africa (3). As such, there is a need for comprehensive evaluation of health science students’ perception toward online learning in sub-Saharan Africa through assessment of their knowledge, attitude, practice, and challenges. These findings will not only improve the quality of healthcare