This paper discusses, using a case study of Peoples-uni, the potential role that online education can play in achieving SDG 4. One remarkable aspect of Peoples-uni was its ability to reach individuals within a wide variety of countries. This in itself speaks to the potential of an online environment as a tool for achieving SDG 4.
This evaluation has demonstrated that an online platform focused on public health, like Peoples-uni, can result in multiple types of impacts. This evaluation helps generate learning about the impact pathways by which an online educational institution might work. Potential pathways included developing knowledge to enhance practice and appreciation of context; enhanced research capacity through knowledge of public health and evidence-based programming; empowering individuals about the potential of education as a means of improving their lives; developing a vision of the critical mass needed of individual capacities for national level impacts; building confidence, skills and capacities of students to enrol in doctoral programmes, in part through providing mentoring opportunities; and enhancing career prospects by obtaining an accredited degree. Although the goal of this evaluation was to help the Peoples-uni planners and implementers to rethink and refine their theory of change, the major message has been to confirm the theory of change, as set out in Fig. 1. The main reflection is to emphasise the importance placed by the students on the ‘input’ section of the theory on the need for university partnerships to provide a credible academic award for career development.
Despite this evaluation focusing on the graduates of Peoples-uni, we feel that some of the lessons will be of broader relevance to the field of health and beyond. A volunteer-led organisation outside the traditional higher education system has been able to create an international volunteer tutor workforce and use the benefits of OER and an open educational platform to create an educational programme valued by its graduates in LMICs. The products of this and similar programmes are likely to be of value to global interventions such as SDGs. Evaluations like this will be of use in guiding future refinements within programmes such as this one.
This evaluation has also generated ‘learnings’ on how an online education platform like Peoples-uni can be enhanced to better address the constraints and barriers of students working and living in settings that can, at times, be both resource poor and poor in internet connectivity. Key process learnings from the evaluation included the need for Peoples-uni to partner with local universities in order to obtain accreditation; the need for providing additional support for students after their dissertation; having more stringent criteria for admissions; Peoples-uni providing better follow-up support, including providing transcripts (online transcripts are currently available to download, but are not paper based); and, if possible, having more of a physical presence, including providing opportunities for students to attend local workshops and conferences, most likely in African countries. Most of the above points would require more capacity than Peoples-uni presently has available. In order to address the capacity gap, we think an organisation like Peoples-uni needs to develop strong partnerships, both globally and regionally.
The impact pathways identified by the graduates are not dissimilar to those that may be expected from any successful educational programme. A further impact that might have been identified by the graduates from our online programme would be the commitment to volunteerism, since the tutors are all volunteers. This is actually demonstrated by the finding that a number of graduates have themselves joined Peoples-uni as volunteer tutors and are passing their skills to others in this and other ways. In a separate but related theme, the use of OER as the main source of the resources used in the programme encourages the sharing of educational materials for the common good. The theme continues into the demonstrated importance of collaboration – the online format has discussion forums that encourage collaboration among students and among the tutors (each module having at least five tutors to spread the load). The whole programme is a demonstration of international collaboration, with tutors from more than 50 countries and students from nearly 100 countries. Further, its impact is demonstrated by the number of published papers resulting from collaboration among alumni [5, 18, 19]. Other strengths of the online format in general are the ability to combine study with work and family life, and for those geographically remote from a university campus. More than half of the graduates said they would not have been able to gain an MPH in any other way.
Were the objectives of Peoples-uni met?
It is too early to say if the first part of the mission of Peoples-uni, namely “[t]o contribute to improvements in the health of populations in low- to middle-income countries”, has been met, but the programme has clearly met the remainder “by building public health capacity via e-learning at very low cost” (http://www.peoples-uni.org/content/overall-objectives).
The programme has provided public health education, with the majority of graduates coming from Africa or the Indian sub-continent, and including a wide range of types of health professionals. Many said that they would not have been able to get an MPH without Peoples-uni. Further, it was encouraging to see that such a high proportion of the graduates were already passing their training on to others, and the ‘train the trainers’ objective was being met.
Although career development of the students was not specified as an objective of the programme, many of the questions in both parts of the evaluation cover this aspect. Career advancement, such as promotion, new positions or responsibilities, appreciation by the employer, as well as accessing the next educational step of a PhD, appear to have been welcome and frequent outcomes of the programme. Critical thinking was one of the interview themes that emerged, and is found as an underlying theme of much of the educational programme. It was also encouraging that such a high proportion of the respondents felt that the programme fits them to deal with local public health problems. The high proportion of respondents who had already published papers or started research is also a positive outcome of relevance to improving the health of their populations.
The existence of a growing cohort of well-trained public health professionals, who are already maintaining collaboration in education and research , is a resource to be nurtured and expanded. It is to be hoped that, in a next phase of the activities of Peoples-uni, a way to utilise this resource to further meet the objective of improving the health of populations will be found.
Building capacities for global health action: the salience of Peoples-uni at a time of SDGs
The evaluation also provided former students the opportunity to offer input to enhance future versions of Peoples-uni. Clearly, the leading challenge raised by most students was the need for accreditation. Getting accreditation from universities that are based in countries like the United Kingdom, Australia or New Zealand has proved to be a serious challenge. Consistent feedback from a number of students was to seek out accreditation from local universities. While we think that this is an attractive way forward, it also raises a number of challenging questions, such as (1) What are the incentives for local universities to collaborate with an online platform like Peoples-uni? (2) What are the mechanisms by which such partnerships can both help the quality of public health training in local universities without having negative economic impacts for the university? (3) What role should international organisations and funders like the UN or WHO or global foundations play in promoting such partnerships between an online platform and local universities? (4) Can action-focused partnerships be created between international organisations, online platforms and local Universities not only for accreditation but also to build capacities on the ground for action?
The tropEd Network for International Health in Higher Education is a good example of networked partnerships between universities, and has emphasised the importance of quality assurance in transnational higher education . Other than partnering to provide an educational programme, forms of partnership to capitalise on the ‘products’ of educational programmes in collaborative research, evaluation and policy will require a different set of partners and models. Local, national and international health service providers now become possible partners. As described below, these will have the potential to help meet the SDG targets. It is important to remember that benefits for each member of a partnership is an essential component for success and sustainability (of note, since the paper was submitted for publication, Peoples-uni has established a partnership with Euclid University (www.euclid.int), which will offer an MPH to Peoples-uni graduates).
We believe that answering the above questions will be critical, not just for Peoples-uni but also to move towards more thoughtful models of capacity-building that pay attention to the inequities in access to education that exist between different countries. As we work towards achieving the SDGs, what role should accessible education through a platform such as Peoples-uni play in building capacities in settings where existing training in public health is weak? Could an online platform like Peoples-uni have a role to play in disrupting existing inequities in educational systems?
The feedback from multiple students clearly generated data that provided evidence that an online platform can help enhance individual-level access. Yet, Peoples-uni or online platforms are unlikely to be disruptors of existing orders without active partnership either at the local or national levels or partnerships with organisations like the UN, WHO or international foundations. One of the great strengths of Peoples-uni is that established networks of alumni are already working in settings that may have an important role in reducing inequalities in health and education.
Towards global health action
Key actions that emerge from the discussion are as follows:
There needs to be dialogue around how an educational organisation like Peoples-uni can get help in accreditation. Given SDG 4’s focus on reducing inequities in education, such a dialogue becomes critical.
There need to be efforts to build such accreditation through partnerships with local universities based in country settings. We think organisations like the UN or foundations with global reach have a role to play in building such partnerships.
Both of the above dialogues around accreditation and local partnerships need to be accompanied by a focus on the types of quality, with an eye on the excellence or quality needed to achieve the multiple SDG goals.
It is also worthwhile to have a broader discussion around the public health capacities that are needed globally, nationally and locally to address the SDGs. An important question that emerges from our work here is the important role that online institutions can play in enhancing access. Going forward, one way to conceptualise the needs of building capacities for addressing SDGs is to think about a distributed network of capacities that are available globally, and especially locally, based on need (by distributed network we imagine one centralised quality assurance and implementation group that also includes a number of national and regional partners that are also leading in implementation and incorporating contextual knowledge). Low-cost platforms with a far reach have a role to play in further developing such a distributed network. The distributed network will need to be sensitive of the heterogeneities of problems/needs across and within different countries/regions and also the varieties of capacities that already exist.
Based on the feedback, such a distributed network would include courses that pay attention to the varieties of local contexts that public health practitioners work in. We believe knowledge of such local contexts will be increasingly important in addressing the SDGs. We also think that a critical mass of trained public health professionals within a nation or a region who understand the basics of public health as well as evidence-based programming provides opportunities to conceptualise capacity-building at the country or perhaps even the regional level.
Although the evaluation was conducted externally in the hope that this would reduce any tendency to want to post only positive responses, we are not able to discount the possibility of response bias. Non-respondents might well have been less positive about the stated value of the programme. The response to the questionnaire part of the study was greater among those who said had gained their award from Peoples-uni than those whose award came from MMU, and this may have been because they were keen to reflect their views of the importance of the need for future university partnerships to improve the credibility of the award – a key and consistent finding of the study. In addition, we did not validate or triangulate the answers from other sources, such as by interviewing employers. Further, those interviewed were not representative of all graduates in terms of gender due to the selection criteria being restricted to geography and the body giving the master’s award. This was not an intended consequence, and may have biased the interview responses in an unknown direction.
The first of our study questions of whether Peoples-uni met its objectives, which include improvements to the health of populations, can only partly be answered by a survey of graduate experience and opinions. It is possible that the positive career developments described by the graduates might have occurred without their enrolment in Peoples-uni. It was also probably too early in the life history of the graduates to explore the wider impacts on society or the workplace. As part of the dissertation assessment, students are asked to reflect on the impact that the course has had on their work, and there are many anecdotal reports of such impact.
Finally, by focusing on the graduates of the programme, we appreciate that these represent the success stories. We are not able to capture the reasons why these people actually managed to enrol and then succeed while others who might have benefited missed out. A future evaluation might tackle this issue and help identify ways to open up education further via the Peoples-uni approach, especially for women.