EXPANDING REPRODUCTIVE HEALTH LEARNING OPPORTUNITIES IN LOW-RESOURCE SETTINGS: TECHNOLOGY-ASSISTED LEARNING CENTERS

Theresa C. Norton, MBA
Senior Information Resource Developer
JHPIEGO

Richard L. Sullivan, Ph.D
Director, Learning and Performance Support Office
JHPIEGO

Susan J. Griffey, Ph.D
Vice-President, Technical Operations
JHPIEGO

Correspondence:
JHPIEGO
1615 Thames Street, Suite 200
Baltimore, Maryland 21231 USA
Phone: (410) 537-1800
Fax: (410) 537-1477
E-mail: info@jhpiego.net 
Websites: http://www.reproline.jhu.edu , http://www.jhpiego.org 

Abstract

Given preservice education and inservice training institutions with limited resources, many students and healthcare professionals in low-resource settings have few options for staying up-to-date in their health fields. To achieve sustainable development of updated healthcare professionals, international donor organizations are turning to information and communication technology (ICT). Since 1999, JHPIEGO Corporation, an affiliate of Johns Hopkins University, under a cooperative agreement with the U.S. Agency for International Development (USAID) has been establishing Technology-Assisted Learning Centers (TALCs) at key health sciences schools and inservice training centers in countries such as Bolivia, Malawi, Haiti, Nepal, and Uganda. As JHPIEGO works to integrate TALCs with other efforts to strengthen curriculum and training systems, it has seen disparate outcomes of the TALCs, depending largely on variables of the host institutions and telecommunications infrastructures. This paper discusses the lessons learned and development outcomes of expanding health education opportunities through TALCs.

Keywords:

Reproductive Health, Training, Computer Center, Information Technology, Education, Learning, Evaluation, Developing Countries

Internet Health 2004;3(1):e5

Introduction

Although the reproductive health status of families in most developing countries is improving, governments continue to search for new ways to achieve further reductions in maternal and infant mortality. A persistent problem is the lack of providers qualified to meet the increased demand for reproductive health services. This often is due to the limited ability of education and training systems to generate and maintain sufficient numbers of qualified service providers and trainers. An additional problem is that as the need to train large numbers of providers has increased, inservice training costs have skyrocketed. As a consequence, in many countries there is a need to strengthen the capability of preservice institutions (medical, nursing and midwifery schools) to provide clinical training. 

As the focus of preservice education has begun to shift, valuable insight has been gained as to how educational systems in many countries must be reconfigured to address existing constraints. For example: 

· At present, information transfer at all levels of the higher education system often is ineffective and costly. 
· To support the shift to competency-based training (in which hands-on practice with models is used to build skills) requires that policymakers, faculty and trainers have easily accessible and up-to-date information in order to: 
o revise national service delivery policies and guidelines, 
o learn about new research findings in educational methods and training technologies, and 
o develop training materials that are standardized and consistent with international reproductive health guidelines. 
· Current training methodologies, whether or not they are competency-based, often are too expensive to maintain, especially in countries with large populations. This is primarily due to the high cost of keeping faculty and trainers up-to-date-a knowledge transfer problem. 

The lack of up-to-date information, as well as lack of an inexpensive way to obtain new information, is a major problem currently facing many countries as they work to improve the quality of training. [4] For example, books, journals and other publications are expensive and need to be replaced regularly. Consequently, for the past 8 years JHPIEGO staff have actively pursued new educational and learning approaches designed to take advantage of advances in information technology. These new approaches are integrated with JHPIEGO's framework for strengthening reproductive health training systems.

Strengthening Reproductive Health Training Systems

JHPIEGO works to improve the health of women and families throughout the world. Through advocacy, education and performance improvement, JHPIEGO helps host-country policymakers, educators and trainers increase access and reduce barriers to quality health services, especially family planning and maternal and neonatal care, for all members of their society. Key in the delivery of quality services is a competent healthcare provider. The framework shown in Figure 1 guides the establishment of national training systems capable of developing competent providers. The framework consists of a number of components.

Figure 1. Framework for Integrated Reproductive Health Training

Needs assessments are conducted with key stakeholders to compare desired and actual performance of healthcare providers. The root causes of performance problems are the starting point for the design and implementation of interventions within JHPIEGO's area of expertise. Concurrent with the needs assessment is the sharing of up-to-date resource materials with stakeholders helping to ensure that the subsequent strengthening and dissemination of national policy and service delivery guidelines will meet the needs of the healthcare system. 

Inservice training results in the immediate development of competent healthcare providers. Inservice training encompasses a number of performance improvement interventions and ensures that health professionals already providing services have the opportunity to update their knowledge and skills according to the latest scientific information and standardized practices. For reasons of sustainability, JHPIEGO advocates for the concurrent strengthening of preservice education. Preservice education involves those institutions concerned with initial or basic education of healthcare providers at all levels (e.g., schools of medicine, nursing, midwifery). 

Key to effective inservice training and preservice education are trainers and faculty with up-to-date clinical knowledge and skills. Trainers and faculty attend clinical updates and training skills courses to prepare them to improve the performance of providers. One approach being implemented by JHPIEGO to help trainers and faculty keep up-to-date is the use of technology, delivered through establishment of Technology-Assisted Learning Centers (TALCs). The role of technology and TALCs within the framework are addressed in the next section.

In this framework, clinical training for both the preservice and inservice systems is offered at a single set of service and clinical training sites. These sites are standardized as to essential equipment, supplies, infection prevention practices and contraceptive services. 

The evaluation component of this framework represents the evaluation phase of the performance improvement process. Regular feedback is needed to assess how well the integrated reproductive health system is functioning. 

Technology within the Framework

The structure of the framework provides for a cycle where evaluation leads to continuous improvement to the reproductive health system over time. The use of technology helps make the framework sustainable by efficiently fulfilling functions such as:

· Providing current international resource materials electronically
· Providing sample national service guidelines on the web
· Expanding access to the knowledge component of learning through computer-assisted learning (thereby increasing the faculty-to-student ratio)
· Continuing update of knowledge through access to the Internet and CD-ROM

JHPIEGO began using technology to make the framework sustainable in 1995 with the development of the ReproLine® (Reproductive Health Online) website (www.reproline.jhu.edu), funded initially by the U.S. Agency for International Development (USAID) through the Training in Reproductive Health Project. In subsequent years, additional electronic services were developed to provide a suite of technology-based learning products called Performance Support Services (PSS). PSS addresses a range of information, learning, and communication needs, and technology-access constraints (e.g., Internet access). The PSS products and services, summarized in the table below, have improved access to high quality, up-to-date information in reproductive health and family planning, HIV/AIDS, maternal and neonatal health, cervical cancer prevention, and infection prevention and control for healthcare providers, trainers, faculty, and students in more than 125 countries. 

The last item, establishment of technology-assisted learning centers, was a key step in broadening access for healthcare professionals to the other electronic performance support services listed in the table.

Need for Technology-Assisted Learning Centers 

While many international organizations are moving to providing health materials electronically, just as many low-resource preservice and inservice institutions lack the computers and Internet connectivity to take advantage of this wealth of information. In these situations, the cyclical aspect of the framework for strengthening reproductive health systems can stall because a solution is not built-in for updating the learning interventions over time.

To aid those healthcare professionals affiliated with institutions without adequate access to computers and the Internet, JHPIEGO began to establish TALCs in 1999. TALCs provide healthcare professionals with access to computers and computer user training, reproductive health-related CD-ROM libraries and learning packages, and reliable e-mail and Internet services. As participating partner institutions have seen how quickly their faculty, staff and trainers embrace the use of ICT as an important tool, they have developed their own visions for how the technology can strengthen their preservice education and inservice training. In its best implementation, the TALC becomes a model for what other institutions in a country can achieve using technology.

JHPIEGO TALC Locations

JHPIEGO TALCs are currently operating in Haiti, Bolivia, Ecuador, Ghana, Malawi, Nepal, Kenya, Uganda, and Uzbekistan. Each TALC has its own unique characteristics, related to its setting and target audience. Variables such as cost and availability of Internet access, hardware, software, computer consultants and administrative staff are accounted for in the process of setting up a TALC.

The primary focus of TALCs is on the usage needs of faculty and trainers, and the secondary focus is on the needs of students. The reason for the primary focus is that faculty and trainers form a manageable-sized user group for which to provide computers and training. In addition, faculty members need to update their knowledge before students. In providing for both primary and secondary user groups, the following usage needs are taken into consideration:

Faculty and Trainers · Require ability to revise and customize reproductive health learning materials; · Want to progress in their professional development; · Desire contact with colleagues for problem-solving
Students · Want to take control of their learning· Want to improve chances for academic development through new skills/learning (e.g., win scholarships tied to advanced academic achievements)

In selecting sites for TALCs, JHPIEGO was challenged to determine where it could get the most "bang for the buck;" that is, where expenditure of funds would provide the most value as measured by the satisfaction of target user needs and meeting of its objectives, as follows:

# Increase the number of healthcare faculty and trainers who can provide quality reproductive health (RH) training.

# Increase the number of healthcare faculty and trainers using new technologies to obtain up-to-date RH information.

# Increase the number of healthcare faculty and trainers linked with international RH experts.

The following sections detail the challenges JHPIEGO faced in selecting site locations and evaluating the success of TALCs, as well as the lessons learned from the process and outcomes.

Establishment of TALCs: The Long and Winding Road 

With several TALCs in operation, JHPIEGO began to see that the process for establishing TALCs was far from uniform. Sites that showed programmatic success in the area of strengthening reproductive health curriculum or training systems sometimes were far from ideal for meeting the objectives of a TALC because of environmental and logistical factors. In time, the TALC planners were able to identify key factors contributing to success and those posing barriers to success.

Factors of TALC Site Selection

Contributors to Success · Internet connectivity in country· Favorable political climate regarding telecommunications· Competitive (private) market for Internet Service Providers (ISPs)· Host institution commitment to contribute resources to maintaining TALC· "Captive audience" of users (preservice)· Technology support infrastructure (training and computer/network staff or consultants)
Barriers to success · Weak telecommunications infrastructure· Lack of commitment by host institution (unwilling or unable to contribute resources such as labor)· Sporadic user community (inservice)· User demand insufficient; failure to "embrace" use of technology· Inability to maintain center (staffing, etc.)· Cost-recovery system at cross-purposes with reaching target audience

As JHPIEGO was able to compare and contrast TALC locations, it started to form a profile of a hypothetical ideal TALC site. The ideal site would be located in a country where use of technology had begun, both with standalone computers and connection to the Internet. JHPIEGO found that it could not tackle introducing an entire institution to the concept of technology value. Internet connectivity into the country would consist of fairly good bandwidth. Again, JHPIEGO was not equipped to solve country connectivity problems. The institution in which the TALC would be housed would have space available for the TALC and the capacity to prepare the facility for computer installation. And finally, the institution would have a resident or nearby user base eager for technology access and would be willing to make access to the TALC convenient to the users.

At one location, JHPIEGO found all the contributors of success to be present, which led to the TALC becoming a springboard for academic innovation. That site was in La Paz, Bolivia.

TALC Case Study: La Paz, Bolivia

An Idea Takes Shape

Under a cooperative agreement with the U.S. Agency for International Development, JHPIEGO began working with authorities, faculty, staff and students at the Universidad Mayor de San Andrés (UMSA) medical and nursing schools in 1998. The goal was to strengthen preservice education and training so that UMSA could produce medical and nursing graduates who were better able to meet the primary health care needs of Bolivia's population. As JHPIEGO helped introduce updated reproductive health information into the curriculum, it began to see the need to provide faculty and staff with long-term access to current health resources. Given the extremely limited resources in the Health Sciences library at UMSA, JHPIEGO realized that electronic access in the form of computers, CD-ROMs and the Internet would provide the best solution. At about the same time, JHPIEGO had finished establishing a TALC at an inservice training center in Petionville, Haiti at the Institute of Haitian Health and Community Service, which was enthusiastically received. JHPIEGO decided to build on the experience in Haiti by setting up a similar center at UMSA.

Getting Started

After discussing the process for establishing a TALC, UMSA and JHPIEGO agreed to partner in establishing a TALC in the Health Sciences Library. JHPIEGO would provide the equipment and arrange for Internet access, while the UMSA would make an adequate room available and provide staff to administer the center. As it turned out, the administrator (also a librarian) would be the key proponent for the center and largely responsible for its success.

With the support of Bolivian physicians in the United States, UMSA began the process by renovating and furnishing a room within the Health Sciences Library. In September 1999, JHPIEGO and technical personnel in Bolivia installed eight computer workstations, a network server, Internet access through a cable modem connection, and a CD-ROM library of titles such as HIV/AIDS and STDs. Several sessions of computer user training were conducted and a cost-recovery plan was instituted to enable the university to maintain the center after JHPIEGO/USAID funding ended.

Accomplishments

By the end of the first year, the UMSA and JHPIEGO agreed that the TALC project had been a success. TALC users said they finally were a part of the modern world. One of the first UMSA faculty members trained at the TALC (a woman who had, until then, never used the Internet) said that she enrolled in the training because she worried that having no Internet access had caused the medical school to fall far behind the world's medical community. Access to the Internet now ensured that students and faculty need not fear falling behind for lack of up-to-date information.

JHPIEGO conducted a formal evaluation of the TALC in La Paz, Bolivia in March 2001 by surveying approximately 300 students, faculty, and library staff. The purpose of the evaluation was to determine the effectiveness of the TALC, and to examine to what extent the availability of information and communication technology was ensuring access to updated reproductive health information. The results of the evaluation are documented in JHPIEGO technical report JHP-19, Increasing Access to Reproductive Health Information in Low-Resource Settings: Evaluation of a Technology-Assisted Learning Center in La Paz, Bolivia. [5]

Results showed that students were using the TALC to take charge of their education, find answers to their academic questions, and produce better quality coursework. While JHPIEGO expected a "trickle-down" effect of updated knowledge from faculty to students, for example, the evaluation revealed that the reverse was occurring, with students doing the bulk of the research at the TALC (while faculty seemed to be using departmental computer resources). As students grew more proficient in their use of the TALC as a research tool, they also developed more sophisticated desires for user support, which posed a challenge due to the limited ability of library staff to provide high-tech user support. 

UMSA Health Sciences faculty used the TALC to access numerous reproductive health resources and websites to enhance their teaching and to make improvements to reproductive health course materials. When faculty members were asked how they usually used the TALC, almost all (90%) reported that they searched for updated/current information on the Internet, many citing JHPIEGO's ReproLine website (www.reproline.jhu.edu) as being among their most useful resources. Communication with other universities and colleagues is also providing UMSA faculty an opportunity to learn from, participate in, and contribute to the broader health community. This also has the potential to filter down into improved learning for students from the improved reproductive health teaching materials developed by faculty. 

In its initial stages, the TALC's early success stimulated unexpected benefits. Access to the TALC helped university officials realize that computer skills, access to the Internet and the ability to read English were essential tools for their students and faculty. In the first year of the TALC's operation (and because of the TALC) UMSA staff and faculty initiated three projects exploiting technology and focused on South-to-South collaboration for Bolivia: establishing a regional library network, putting Bolivian medical journals online, and developing distance education strategies. 

Innovative Uses of the TALC

As faculty, staff and trainers at UMSA have seen how quickly technology is embraced as an important tool, they have developed and implemented their own visions for how the technology can strengthen their preservice education and inservice training. [2]

These visions involve using the TALC for more than just academic research. The TALC use has grown to offer opportunities for distance learning, provide its users with access to virtual libraries and help Bolivia's health community collaborate with other countries through e-mail and other information technologies. The TALC also has been used for computer training conducted by consultants from other countries in the LAC region. In an interview, Ms. Marilin Sanchez (senior librarian and TALC administrator) said that she believed that the TALC had helped to influence a variety of decisions and policies at the university level that have helped UMSA and the Bolivian medical community embrace these new technologies and stay current. In 2000, Bolivia was represented for the first time at the International Congress on Medical Librarianship. Ms. Sanchez traveled to the conference in London to discuss the TALC experience and its role in establishing a network of health sciences libraries in Bolivia. 

Within the first year after opening the TALC, the UMSA staff initiated three projects to promote South-to-South collaboration for Bolivia. These are:

Library Network - The UMSA Medical Library is currently the designated coordinating center for a network of health sciences libraries in the LAC region. Since the TALC opened, the Biblioteca Regional de Medicina (BIREME) has worked with UMSA and Ms. Sanchez to create a virtual medical library to be shared among other schools in the Bolivian BIREME network, including Sucre, Santa Cruz and Tarija. 

Online Journals - After a week of training in web development, Ms. Sanchez worked with Proyecto SCIELO (the Scientific Electronic Library Online) and was able to post journals online. Students and faculty now have online access to the Bolivian Medical Journal, the Sucre Medical Journal, the Bolivian Food and Nutrition Journal, and the Journal of the Bolivian Medical College. 

Distance Education - A consultant from the Latin America and Caribbean (LAC) region worked with a group of UMSA faculty (Dean of the Faculty of Medicine, the Vice-Dean, Chief of Nursing, Chief of the Medical School, and Chief of the School of Public Health) to plan a distance education course for Bolivia. 

TALC Raises the Bar of Academic Requirements

In addition to the new projects, access to technology and the Internet have influenced new graduation requirements and provided incentive for faculty to hone their own skills. Weak skills in English and computers had put faculty and students at a distinct disadvantage. Because such skills are often prerequisites for scholarships, for example, faculty and students were often unable to apply. Medical students at UMSA are now required to have computer skills as well as the ability to read English before embarking on their internship year. Ms. Sanchez believes these new requirements are one indication of the TALC's influence. Access to the TALC helped university officials realize that computer skills, access to the Internet and the ability to read English were essential tools for their students and faculty.

TALC Use Becomes Part of Curriculum

Finally, many departments at UMSA have incorporated use of the TALC into their curriculum. For example, the Master's in Public Health (MPH) program uses the TALC for epidemiology and biostatistics classes as well as for the web-based National Health Information System for two weeks each year. The Master's programs for higher education, family medicine, forensic medicine and biochemistry/nutrition are also using the computers. In addition, the medical school has implemented a curriculum change and since 2001, first year medical students complete a public health module on the Internet (to allow for on-line research on anatomy and social medicine).

Lessons Learned

As JHPIEGO has compared its TALC experience in La Paz, Bolivia with that of other locations, it has seen how merely injecting technology in a training system will not always gain the desired effect.

Importance of Push-Pull Marketing

The concept of push-pull marketing has traditionally referred to a manufacturer creating demand for goods and services by enticing both a middleman or channel distributor and the end consumer. With the advent of the Internet, push-pull marketing has taken on a new form. [1] The successful implementation of TALCs can be seen to reflect good practices of push-pull marketing.

Push Marketing: Keeping Your Service in the Mind of the Consumer

Continued attraction of TALC users takes more than just a well-attended launch.
TALC administrators must continue to make users think of the TALC for their information needs. Intellectual "give-aways" are one way to draw users to technology. [3] In a survey of 293 La Paz TALC users, 53 respondents said that they subscribed to JHPIEGO's e-mail discussion list and free e-mail newsletter. Successful promotion of the TALC was evidenced by the fact that survey respondents reported depending more on technology resources for their academic information needs (187) than on traditional print resources (147).

The traditional aspect of push marketing, appealing to a "channel distributor," could also be seen at the La Paz TALC. The commitment of the host institution to making the TALC successful led them to provide resources to hire additional library staff to administer the TALC and extend the operating hours. This show of commitment by the provider of services (the university) to the "channel distributor" (the senior librarian) promoted the value of the TALC to the library staff and led to improved services for the end users.

Pull Marketing: "Build It and They Will Come": Maybe, Maybe Not

A popular American movie contained a memorable line whereby a die-hard baseball fan was advised to build a baseball field to attract the ghosts of great players past. The line, now oft repeated, was, "Build it and they will come."

Similarly, a debate among the international community has entailed discussion of whether users will inevitably be drawn to, and use, technology if it is simply made available. In practice, it is more likely that potential users need to have incentives to change their traditional approaches to learning.

For example, faculty may require incentives to update course materials. The inclination is to minimize effort by preparing a course once and delivering the same lecture many times. At the La Paz TALC, the user surveys revealed that while the focus of the TALC may have been on addressing the needs of faculty, the majority of the users were students. One can envision a "pull" effect on faculty whereby students update their own knowledge and ask difficult questions of faculty. Faculty members are then motivated to perform searches on the Internet and CD-ROM to keep up with their students.

Another aspect of pull marketing of electronic services is making the service accessible and appealing to use. Locating the La Paz TALC within the Health Sciences library was strategic in that users were likely to come to the library for academic reasons and stay to use the TALC (as reported by 158 survey respondents). La Paz TALC administrators also pulled in the secondary audience, students, through a cost-savings promotion: buy 5 hours of computer time and get 1 hour free. In TALCs set up to attract an inservice audience, such as those in Haiti and Kenya, more sporadic use of the computers seem to be linked to the lack of pull: healthcare professionals had to leave their workplace to use the TALC. At other TALCs, such as Uganda, pull marketing was hampered by the high cost of Internet connectivity, thereby making cost-recovery through fees impractical.

TALC Success Affects Market Economy

The experience with the La Paz TALC also demonstrated how the successful introduction of a technology service could have a ripple effect resulting in benefits to other aspects of the community. When JHPIEGO conducted a survey at the La Paz TALC 2 years after its launch, TALC administrators reported that the successful implementation of the cost-recovery scheme (fee for use) had attracted the notice of local entrepreneurs, who in turn opened Internet cafes near the university. The cafes then began undercutting the prices charged at the TALC. Since the TALC still had the advantage of being located in the Health Sciences library, the cafes did not adversely affect the TALC. Instead, their existence resulted in improved Internet access for the TALC audience by offering more access options for users. This was evidenced by the fact that 138 survey respondents reported also using computers at Internet cafes.

Importance of Technology Appreciation in Local Culture

As JHPIEGO began to identify contributors to TALC success, it saw that introduction of technology to strengthen reproductive health training systems would be an uphill battle unless the target audience appreciated the potential benefits. In JHPIEGO's experience, the countries with rapidly advancing Internet connectivity and use tended to have the cultural climates poised to make creative use of the technology when it became available through the TALCs.

Using the "Build it and they will come" analogy again, "they" will come only if they know what a baseball field is used for and have heard that it is worthwhile to use. In other words, prior awareness of the advantages of technology increased the likelihood of TALC success.

Latin America, for example, is embracing technology and the Internet at rapid rate, as is evident in technology coverage in Bolivian newspapers such as Los Tiempos.com. In the survey of La Paz TALC users, 280 of 293 respondents had used a computer prior to coming to the TALC. The success of the TALC may be seen as linked to the users' prior awareness of the advantages of technology.

Challenges in Evaluating Use of Information and Communication Technology

After the launch of the TALCs, JHPIEGO worked with the TALC administrators to collect usage information for the purpose of evaluation--to varying degrees of success. At TALCs such as La Paz that had a solid support infrastructure (administrators, technicians), logging of users was more rigorously performed, thus aiding in data collection. At other institutions with little support staff, user monitoring was sporadic. In addition, JHPIEGO recognized that there was a difference between evaluating a TALC (e.g., reliability of the equipment and Internet connection) and evaluating use of a TALC (e.g., were the results of Internet searches feeding into improved reproductive health curriculum?). This difference led JHPIEGO to try different evaluation methods, from keystroke monitoring software to administrator status reports. Finally, JHPIEGO conducted an evaluation of the La Paz TALC by surveying and interviewing 293 users, only to find out that much of the successes were revealed by anecdotal evidence--difficult to track in a quantitative way. This posed a challenge because, paradoxically, technology interventions are often held to a higher standard of proof of their value than other traditional interventions, perhaps because these solutions are still new. 

Conclusions

Lack of up-to-date reproductive health information hinders the efforts of low-resource countries to improve the health of women and their families in part due to the lack of qualified providers. In recent years, international donor organizations have begun to address this need by integrating the use of information and communication technology into the framework for strengthening reproductive health training systems. JHPIEGO, an affiliate of Johns Hopkins University working under a cooperative agreement with the U.S. Agency for International Development, has established Technology-Assisted Learning Centers (TALCs) around the world in institutions involved in reproductive health learning. The experience of the TALCs reflects successes and challenges due to a variety of factors, ranging from country bandwidth considerations to effective marketing of technology in the institution to the intended users.

REFERENCES

1. Campbell, Chas. Push-Pull Marketing.
http://www.mnrealty.com/magazine/education/webmktg5.htm 

2. Curran K et. al. Realizing the Possibilities: A Technology-Assisted Learning Center At Universidad Mayor De San Andrés, La Paz, Bolivia. TechKnowLogia. April/May 2001.

3. Leonte, Diane. 2000. Push, Pull & Dangle... The 3 Basic Strategies of Internet Marketing. ( http://www.soaringprofits.com/push.shtml) 

4. McIntosh N and Oliveras E. 1995. Using the Internet to Improve Reproductive Health. JHPIEGO Corporation: Baltimore, Maryland. 

5. Schenck-Yglesias C et al. 2002. Increasing Access to Reproductive Health Information in Low-Resource Settings: Evaluation of a Technology-Assisted Learning Center in La Paz, Bolivia. JHPIEGO Technical Report JHP-19.

ACKNOWLEDGEMENT

This website was made possible through support provided by the Service Delivery Improvement Division, Office of Population and Reproductive Health, Bureau for Global Health, U.S. Agency for International Development, under the terms of Award No. HRN-A-00-98-00041-00. The opinions expressed in this newsletter are those of JHPIEGO and do not necessarily reflect the views of the US Agency for International Development.

Cite as: 
Norton T,Sullivan R L, Griffey S J
Expanding Reproductive Health learning opportunities in Low-Resource settings: Technology assiasted Learning Centers 
Internet Health 2004;3(1):e5
URL: www.internet-health.org/ih200431e05.html 

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