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Connecting People-Changing Lives in Asia

Chapter 6

Distance education and health services: helping communities realize their dreams

"In a country as large as Mongolia, the Internet helps to close distances and helps people communicate and realize their dreams."
- President Ts. Lkhagvasuren, MD, Health Sciences University of Mongolia
(project leader, ICTs for Health Services in Rural Mongolia)

Distance technologies using ICTs have long been an important method for reaching remote populations with educational and other services that would otherwise be inaccessible and unaffordable. This is true of both developed countries like Canada and developing countries in Asia. Distance education reaches people who cannot attend conventional educational institutions owing to their distance from the institution, poverty, family obligations, job, gender discrimination, farming requirements, and other reasons. The advent of the Internet and other ICTs has so changed the paradigm for delivering distance education and health services, that PAN has been focusing on providing support to institutions across Asia to re-examine new ICT-based ways to deliver these services. PAN's innovative projects are reaching disadvantaged populations, influencing policy, and building a base for progressing from development to research in this critical sector.

This chapter describes PAN's recent projects to deliver distance education and health services in Bhutan, Indonesia, Mongolia, the Philippines, and Viet Nam. We also discuss the network's current approach to funding distance-education projects via a unique, collaborative approach known as PANdora.


Distance education in the Kingdom of Bhutan

The mountainous country of Bhutan is one of Asia's remotest nations. Enclosed by the Himalayan foothills, Bhutan faces a double challenge in the field of education: a rapidly growing student population and a shortage of trained teachers. The current ratio of teachers to students - 1 to 150 - is unacceptable if a high-quality education system is to be achieved. ICTs could be used to train more teachers through distance education in a cost-effective way.

In 2003, PAN teamed up with Bhutan's National Institute of Education (NIE) in a project on ICT-supported distance teacher education. The project, currently in its early stages, will develop and test an appropriate ICT-based learning support system and assess whether ICTs improve the quality of, and access, to learning support. Other components will examine student satisfaction and access to ICT-supported teacher education from gender perspectives, and make recommendations for a national teacher education policy based on the research findings. By the end of the project, the aim is to have developed and implemented up to 16 distance-education courses, along with online tutorials, support and counselling services, and other multimedia materials.

In addition to online materials, the project is planning to broadcast a wide range of radio and TV segments. Broadcast media may prove to be more viable for distance delivery than web-based materials in many parts of Asia - at least until speedier Internet connections become available throughout the region. The development of educational broadcasting skills in Bhutan may become a distinctive contribution to PAN's future distance-education work. The NIE project is also emphasizing the development of key performance indicators for distance educators, another speciality that may prove valuable to distance-education researchers across the PAN region.


Distance education in the world's largest archipelago

Another country with an urgent need for distance education is Indonesia. Stretching across the Malay Archipelago, the world's largest, its 6 000 inhabited islands are home to some 238 million people. The distance from Aceh in the west to Irian Jaya (on the island of New Guinea) in the east is over 5000 kilometres, equivalent to the distance between Vancouver and Quebec City.

PAN's partner in distance-education research and applications in Indonesia is the Universitas Terbuka (UT), the Open University of Indonesia. UT is the only university in Indonesia to deliver education entirely at a distance. UT has about 250 000 students in 30 provinces, and provides a selection of 900 courses. It has a headquarters in Jakarta and 36 regional offices. UT's clientele are students who cannot attend traditional institutions of higher education owing to lack of financial resources, isolation in rural areas, or full-time employment.

UT's history of using ICTs for distance education shows that it was an evolutionary process, as education professionals compared notes and realized the potential of various technologies to deliver course materials and teaching assistance and as the technologies themselves became more powerful. It also demonstrates the role that outside agencies such as IDRC's PAN can play in supporting this evolution.

Until the early 1990s, UT had been providing course materials to students in printed form via postal services, as well as offering some tutorials through radio and television. With the arrival of the Internet in the mid-1990s, course delivery methods were about to change, recalls Tian Belawati, academic vice-rector of UT and PAN project leader. At that time, Belawati had just returned home to Indonesia from doctoral studies at the University of British Columbia and was heading UT's Centre for Indonesian Studies. With her Media Research Centre colleague, A.P. Hardhono, who had also returned from doctoral studies - at the University of Victoria - she began exploring how to use other media in ways that would suit the Indonesian situation. The Media Research Centre was already developing the university's website and mailing-list based tutorials for some courses. "I then enriched the website by developing an online database for research abstracts and an online journal. The response as shown by the 'hits' visiting the website was very encouraging," says Belawati.

Based on this initial positive experience, Belawati and her colleagues wanted to improve the online-based learning support service, but were hindered by limited resources. She proposed a PAN study of the availability of the Internet to potential students and of its acceptability for educational purposes. The results of the survey were encouraging to the UT team, whose next goal was to improve their mailing-list based tutorials using more recent web-based technology. Their research showed that about 60% of UT students (mainly male) were accessing the online materials from their workplace and about 40% from Internet cafes. The major challenges addressed by the project were the difficulty students had in finding qualified tutors in rural areas and students' inability to meet with tutors when they had full-time jobs. Therefore, the project's main objective was to determine how Internet-based training materials, tutorials, counseling, and academic information would affect student satisfaction and course completion rates. At the same time, the project would examine gender differences in access to the Internet and acceptance of ICTs as an educational tool.

In 2001, PAN granted CA$ 250 000 to Belawati and her colleagues, Hardhono and M. Toha Anggoro, to assist in developing more comprehensive online services for the UT system, and in examining its ICT-based delivery policy. The project involved 200 other academic staff, who were trained as online tutors and web-based materials developers. The team found that student participation rate in the online tutorials was relatively low - only about 3.5% of registered students - although it was in line with Indonesia's national Internet access rate. Further analysis showed that those who did participate had higher achievement and course completion rates than those who did not. This modestly positive feedback was enough for UT to continue providing online tutorials in combination with other methods (in-person tutorials, radio and television tutorials).

The project contributed greatly to UT's capacity building in faculty resource development, communication infrastructure and facilities, networking and partnerships, making UT an ICT-smart institution in a short period. Overall, the project has influenced a change in UT's institutional policy, enabling advancement in the university's online services.

PAN is also helping UT to rebuild and recover resources and Internet access points that were destroyed in Aceh during the December 2004 tsunami.


Ambitious goals for distance education in Mongolia

Mongolia is a large country with a relatively small population. Its 2.8 million people are spread out over 1.56 million square kilometres, giving it a population density of about 1.8 people per square kilometre. (By comparison, Canada looks crowded with its population density of 3 people per square kilometre.) Mongolia has a comparatively well-developed Internet infrastructure and more and more Internet users. It has also been able to achieve one of the highest literacy rates in the world, with almost 98% of the adult population literate.

Nonetheless, there is need for far greater access to technology and educational services in the underprivileged rural areas of the country. To address this need, PAN supports the Government of Mongolia in its mission to deliver distance education to 75% of the population by 2010. In 2001, PAN supported a project led by the English for Special Purposes Foundation (ESPF) to introduce Internet-based education to the country. The project required setting up four interdisciplinary teams composed of IT personnel, educational planners, subject matter specialists, and teachers. The project teams created instructional materials in the Mongolian language on subjects including mathematics, English, information technology, gender issues, and legal rights.

The project succeeded in generating awareness of distance education and online methods in a wide range of Mongolian organizations, including the following project stakeholder groups:

ESPF has implemented IDRC's Enhanced Vocalization Engine (EVE) software for language modeling - a unique, interactive web-based product that teaches correct English pronunciation. The project's achievements have the potential to be sustained through curriculum development with the National University of Mongolia (NUM), which is interested in developing online courses that may include British and American studies, Mongolian studies, computing, and gender issues. These pioneer researchers in Mongolia are currently continuing work at a new level as collaborating partners in PAN's regional distance-education research network (PANdora), described below.


Health services in rural Mongolia

With a per capita GDP of only US$ 1 918, Mongolia struggles to bring essential services such as health care to a scattered population over its vast territory. However, the country has good potential to apply ICTs in making health care more accessible, especially in rural areas. Mongolia has already proved itself willing and capable of embracing ICTs and undertaking experiments for ICT-supported service delivery. The PAN-supported project, "ICTs for Health Services in Rural Mongolia," addresses distance diagnosis of illness in rural areas and continuous distance education for rural doctors.

The project has set up distance diagnosis centres at the Health Sciences University of Mongolia in the capital, Ulaanbaatar, and at medical centres in Arkhangai, Sain-shand (Dornogobi), and Erdenet. It experiments with delivering Internet-based diagnosis and consultation for patients in certain areas of health care and has set up a research and practitioner network that links specialists, family doctors, and front-line health care workers. Distance diagnosis technologies that use the Internet are being assessed and adapted taking into account the country's low bandwidth capacity. This project component also includes training doctors in distance diagnosis. The project collaborator, InfoCon Ltd, has developed a diagnostic database, "Doctor," designed to reflect national medical priorities, including breast cancer and other women's issues. Under its former director, Nara Baljin, InfoCon has become a major force in the development of Mongolia's ICT infrastructure. Tragically, Ms Baljin died in 2004 at an early age, and is sorely missed in her own country and in the international distance-education community.

In the broader area of distance education, the PAN project has trained educational personnel to use web-based teaching technologies and methods, including design of course materials and conversion of existing materials for delivery over the Internet. Initial results show that the telemedicine application can save time and money. The distance diagnosis system is up and running and physicians have consulted over 80 patients by Internet. The project team has conducted training sessions for physicians, lecturers, other medical professional, and students.

An evaluation team looking at the project found that the software developed for Internet-based diagnosis had been tailored to Mongolia's difficult phone-line conditions and is effective in minimizing the burden on traffic flow. It uses text-based information, rather than graphics-based material, and is designed to "resume" if there is a phone-line disconnect - not an uncommon occurrence. The evaluators observed that the application could be adapted to provide similar services in other countries with poor telephone infrastructure and unmet diagnostic needs in remote areas, such as the mountain regions of Pakistan.


Delivering informal training in water and sanitation in the Philippines

In the Philippines, PAN supports efforts to use ICTs in distance delivery of non-formal education. This project is directed at increasing awareness and knowledge of poor rural and urban Filipinos about water, sanitation and hygiene issues. It assists the Molave Development Foundation (MDF), a small NGO in Makati City, to build on its national research and development work in public hygiene education. The Water, Sanitation and Hygiene project (WASH) is a public information project for urban Filipino communities, using creative communication media such as magazines, comic books, and posters. The project examines the effectiveness and sustainability of using digital and electronic media for teaching and learning WASH issues. The studies are taking place in one rural and one urban area, both of which have existing community-based organizations and ICT infrastructure. MDF has succeeded in establishing partnerships with government and private agencies and has created links with other groups interested in distance education.

Through focus-group discussion, the research team has discovered that women tend to be more uncomfortable with computers than men. On the other hand, women recognize the potential of computers in communication and in helping to improve the lives of their families and communities. Men tend to perceive computers as a device for business, education, and entertainment.

Although the project is not yet complete, there have been encouraging developments. Public response to the WASH online modules is generally positive, especially among youth. Participants report that the learning process is more enjoyable because the modules incorporate sight, hearing, and touch. The community regards the use of computers for distance education on WASH and other topics as promising. They see computers as tools for empowerment and advocacy that can bring employment opportunities. According to project leader, Dr Angelo Juan Ramos, "They see the potential of distance learning technologies in non-formal education, in livelihood generation, health education and in uplifting the status of their communities as a whole."

The response from the Department of Education, other government officials, and project partners has also been positive, says Dr Ramos. "The results have made them eager to look more closely at ICTs as tools for distance learning and sustainable development, despite apprehensions regarding infrastructure and access. The WASH modules are being well received by educators in the non-formal education sector, and communities appreciate that they are intimately involved in the content development and design process in coming up with the modules."


Reaching Viet Nam's aquaculture workers

In Viet Nam, the fisheries sector employs millions of people and contributes 4-5% of GDP annually and 9-10% of national exports. Aquaculture is a rural economic activity, in which women make up 45% of the workforce. The government regards the sector as one that could help improve the role of women in rural and mountainous areas. Its goal is to increase the number of fishery technicians by 20% by 2010, creating two million aquaculture jobs. By 2003, only 30% of the required graduates had been trained.

The Fishery College No. 4 (FC4) at Bac Ninh (near Hanoi) has been running since 1994, with start-up funding from the Canadian International Development Agency. It addresses the need for college-level and continuing education courses of students and workers in the country's northern provinces. Initially, the college relied on a system of face-to-face course delivery, whereby college instructors helped local staff deliver a 1-week aquaculture course to farmers. But college instructors had to travel to rural areas and be away from the college for up to a month at a time. PAN began to support FC4 in 2003, in collaboration with Newfoundland's College of the North Atlantic, an institution that specializes in the development and delivery of distance education in rural and remote areas. The project has been pilot-testing the use of ICT-supported distance education for delivering courses to farmers in a rural area of Viet Nam. The approach blends traditional classroom instruction with online distance education. The theory and certain other course components are delivered by distance methods using ICTs, taking into account the local low-bandwidth conditions. The practical course components are taught in face-to-face classes. Vietnamese IT consultants are working with Canadian team members in distance-education capacity building for FC4 staff and farmer students. By mid-2005, a core group of instructors had been trained in network administration, Internet and web design, and in how to deliver online courses. Course materials have been developed, and open-source software, Moodle, has been translated into Vietnamese and tested in an aquaculture course. The project team is hoping to obtain funding to develop and sustain its work in remote rural areas across northern Viet Nam, and may multiply its impact through collaboration with rural colleges, which would use the project's online materials.


Combining Asian project resources via PANdora

In 2004, PAN decided to build on its previous distance-education projects by developing a unique research and development network: PANdora (PAN Asia Networking Distance and Open Resource Access). The strengths and interests of the various PAN project teams were assessed, as well as those of other leading distance-education teams across South and Southeast Asia. A process of interviews and meetings was conducted in 12 countries (Bhutan, Cambodia, Hong Kong, India, Indonesia, Laos, Mongolia, Pakistan, the Philippines, Sri Lanka, Thailand, and Viet Nam). This overview tour led to a major conference in Siem Reap, Cambodia, attended by 40 researchers, government, and NGO pioneers from across the region. The conference generated proposals for nine new distance-education projects, each involving collaboration between institutions in three or more nations. By early 2005, the nine proposals had been refined and funded from 2005 to 2008 as the next round of PAN's contribution to Asian distance education.

The nine projects cover a comprehensive range of current distance learning technology (DLT) issues:

Running simultaneously, the nine projects are designed to complement each other in building a comprehensive approach to distance education, specifically suited to Asia's urban and rural needs. The projects are monitored to prevent overlaps and duplication of effort. An interactive web site has been developed (www.pandora-asia.org), through which the project teams can collaborate in audio and text conferences and in testing new online applications, including messaging techniques and open-source learning management systems.

In Greek legend, PANdora's Box was a "mixed bag" of surprises representing the cares and problems of the world. Distance education is one of the ways in which the problems of Asian society, social and economic, are being addressed. However, many of the techniques currently being offered for distance education purposes are being found through evaluation studies to be ineffective, even counter-productive, in the Asian context. As in the myth of Pandora's Box, caution is required in their adoption. At the bottom of Pandora's casket, however, lay hope - the overall objective of PAN's educational work.



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Teachers accessing distance education at the NIE in Samtse, Bhutan
© S. Nanda, IDRC

Digital pioneer
Tian Belawati, vice-rector, Universitas Terbuka (Indonesia)



Dr. Tian Belawati



Students at UT Jakarta use the online system to check their grades
© S. Nanda, IDRC


Doctors in Mongolia use ICT equipment to provide distance medical diagnosis to rural areas. In addition, the equipment is used to deliver distance learning via Internet applications to rural medical doctors
© S. Nanda, IDRC

"I am just a farmer. I used to be shy and afraid of talking to people. Regardless of my limited education, Molave trained me and now I lead the Maguinda MCT volunteers in teaching our community members how to use and learn from the WASH ICT Module. I also learned how to use the computer and I can even teach others how to use it."
- Danny Majait, Multipurpose Community Telecentre volunteer, Barangay Maguinda, Butuan City


A satellite connection provides ICT-based health information to rural community members in the Philippines
© A. Ramos






A fisherman along the Mekong Delta region
© R. Ramlochand, IDRC


© S. Nanda, IDRC