Pandemic Invention: Expanding Learning in Africa’s Health Labs

Wednesday, September 8, 2021

Global Health

Photo: From a data and management training session WDI conducted in Kenya in 2019. Pictured is the in-person training session of the data and management training. The man in the pink shirt is doing a role playing activity with the lab manager.

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the CDC recognized in early 2000s  that “fragile and fragmented” labs across Africa were undermining the development and use of effective treatments, they knew something had to be done. Shortly thereafter in 2007, the Labs for Life  public-private partnership with the U.S. Centers for Disease Control (CDC), PEPFAR, and various Ministries of Health to strengthen laboratory systems—was born. For 14 years, as part of this partnership,  global medical technology  company Becton, Dickinson and Company (BD) has been training clinical laboratory staff in low and middle income countries—and for the last three, the William Davidson Institute (WDI) at the University of Michigan has served as the monitoring and evaluation arm of this important work.

From the start, the goal has been “to improve the quality management systems within labs across Africa,” explained Erika Beidelman, Senior Research Associate at WDI and the Institute’s lead on the project. To achieve that objective, BD began training and mentoring lab personnel to encourage quality improvements and instill best practices. WDI joined a decade later to gather data and demonstrate the program’s impact. It was a program that was steadily moving toward its aim. That is, until COVID-19 struck.

In March 2020, just about everything paused around the globe, including this laboratory mentorship and training program. “Our regular on-site training and mentorship came to an abrupt halt,” said Nuphar Rozen-Adler, Director of Global Health at BD. Travel ceased and BD trainers could no longer reach the laboratory staff they were meant to guide. Upcoming training sessions were stalled, and with them went the data continuity WDI needed to convey the program’s effectiveness—a process they were in the middle of completing. BD knew that a virtual solution would be required to continue supporting the labs participating in Labs for Life partnership

Luckily, there was a solution waiting at WDI. “We knew our own resources, so we recognized an opportunity to engage our Education team to help solve this problem,” said Pascale Leroueil, Vice President of Healthcare at WDI. The team proposed the solution to BD, offering to harness the experience and tools at the Institute to develop a program capable of continuing both the training sessions and the monitoring requirements.


WDI’s learning management system, ExtendEd, was designed to make training a seamless, effective and lasting experience. Developed to support digital education opportunities, the tool proved a perfect fit for the program’s new needs. It also opened up doors to rethinking how the model could work in the future. “This approach was a fortuitous opportunity to test something that is more sustainable and scalable,” Leroueil said.

BD had long shared a desire to incorporate leadership training into the programming. They wanted to give managers the tools they needed to more effectively guide their staff. “This became an opportunity to bring in that management and leadership aspect and provide the skills really needed to ensure that the technical training and its results persist in the lab,” said Beidelman.

With practical comprehension and application in mind, WDI’s Healthcare and Education teams went to work designing a course that would successfully train laboratory leaders on effective management and communications skills. In May of 2020, BD reached out to the Association of Public Health Laboratories (APHL) for the technical assistance needed to develop this training program. Since 2008, APHL has delivered a highly successful leadership training program called Foundations of Laboratory Leadership and Management, to laboratorians across Africa and Asia. APHL sent the FLLM training package to the Institute, where the teams worked together to modify the two-week, eight-module, course into an online format tailored to the program.  

The new model was built to provide both the technical and soft skills these managers needed to succeed. It also allowed the cohort to consider how to apply the knowledge to the workplace. “We did a lot of rewriting and re-conceptualizing instructional materials that were designed for in-person learning,” said Amy Gillett, WDI’s Vice President of Education. They reworked  the material within the management curriculum in order to shift it to an online program, mixing self-directed content and assignments with weekly “office hour” group meetings led by APHL staff members, Clement Phiri and Edwin Ochieng.

The course, called Laboratory Leadership and Management Essentials, contained eight modules, was delivered over eight weeks to 20 participants across Kenya, Uganda, and Rwanda. The group covered key managerial topics, from organizational structure to conflict resolution to financial management. The goal of the course was to transform the management capabilities of these laboratory leaders — and it delivered. “This online platform allowed us to assure continued engagement and training to labs that we have been supporting for years,” said Rozen-Adler.

There were other significant technical adjustments that needed to be made. The ExtendEd portal was built with the expectation that users would be on a desktop or laptop computer, but the team found that many managers in the African laboratories were using their mobile phones to access the materials. As a result, they redesigned the ExtendEd portal to be mobile-first, creating a more user-friendly environment for learners relying on those devices.

With these changes, the framework could provide a lasting educational solution for this partnership and others. “The structure we’ve developed for this course, the length and the format, the weekly asynchronous content and end-of-week synchronous activity, worked very well, and we are looking at replicating it for other programs,” Gillett said. “We’ve got this down.”

Learn more about WDI’s virtual learning capabilities.

The big gain from having this training solution, along with continuing the essential monitoring component, is seeing that online education is not just a solution for pandemic times.


These changes may be here to stay, at least in part. Not only did this new program model allow the partnership to reach its essential participants, but it also provided an opportunity for WDI to compile data showing the positive effect of these training sessions. With the additional time and engagement, WDI was able to run significant impact assessments, including a knowledge test that showed a 20% improvement in skills, a survey on the performance of key management tasks before and after the course, and a three-month follow-up assessment on the use of the materials and tools shared. Through the course, participants increased their staff coaching, improved their ability to delegate, and more appropriately addressed conflicts. The expanded timeline and modified teaching model “gave them enough time to both learn the content and administer it in their labs,” said Beidelman. “It ended up being extremely effective.”

BD was also encouraged by the results. “The cat is out of the bag,” said Rozen-Adler. “Learning can be very effective online. While there is value in in-person training and education, there are tremendous benefits to offering either complementary or replacement training via virtual platforms that allow for greater flexibility and broader access, among other benefits.”

The potential of this new program is clear to the teams. As Beidelman noted, “The big gain from having this training solution, along with continuing the essential monitoring component, is seeing that online education is not just a solution for pandemic times.”

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