Effectiveness of a Blended Learning Approach for Strengthening Capacity in Neglected Tropical Disease Control in India and Nigeria

Background

Persistent gaps in Neglected Tropical Diseases (NTDs) knowledge and skills among frontline health workers in endemic countries remain an important factor limiting progress toward elimination targets. Blended learning approaches offer a potentially scalable solution, but robust evidence from low- and middle-income countries (LMICs) remains scarce. This study evaluated the effectiveness, acceptability, behavioral effects, and cost of a blended learning program for NTD capacity building in India and Nigeria.

Methods

A mixed-methods intervention study was conducted in India and Nigeria. A total of 177 purposively selected health workers across three levels (frontline/community workers [Level 1], clinicians and primary care providers [Level 2], and district supervisors/program managers [Level 3]) participated in a blended training program combining interactive online modules with practical onsite skill sessions. Guided by the integrated frameworks of Implementation Science and Kirkpatrick, outcomes were assessed using pre/post knowledge tests, 3–6 month follow-up observations and interviews, focus group discussions, and comprehensive costing. Quantitative data were analyzed using Stata, and qualitative data underwent thematic analysis.

Results

The program achieved high acceptability across all cadres and settings. Knowledge scores improved significantly after training (average gains 5–42.5%, p<0.001, Cohen’s d 1.1–1.8) across the 3 training courses. At 3–6 months, workplace observations and supervisor feedback observed improved service delivery. Challenges included internet connectivity, language barriers, and lower online completion rates among Level 1 workers.

Conclusions

A contextually adapted blended learning approach is feasible, acceptable, effective, and cost-efficient for strengthening NTD workforce capacity in resource-limited settings. With targeted adaptations (local languages, offline access, and cadre-specific tailoring), this model offers a promising strategy to support the WHO NTD Roadmap 2021–2030 and Zero Leprosy goals.

Author Summary

Neglected tropical diseases (NTDs) continue to cause suffering, disability, and stigma for millions of people, especially in countries like India and Nigeria. A major challenge is that many health workers lack up-to-date knowledge and practical skills to diagnose, treat, and support affected people effectively.

In this study, we developed and tested a blended learning approach that combines online courses with hands-on, in-person training. We trained 177 health workers at different levels, from community volunteers to doctors and program managers, in one state in India and two states in Nigeria.

We found that the training was very well received. Participants’ knowledge improved significantly, especially in difficult areas such as managing leprosy reactions and reducing stigma. Three to six months later, health workers were applying what they learned: they were better at examining patients, detecting cases earlier, counselling people with compassion and providing better care. The entire program was delivered on budget, showing it is affordable and practical.

Our findings show that blended learning can be an effective, acceptable, and be delivered at a reasonable cost to strengthen health workers’ skills in resource-limited settings. With some improvements, such as materials in local languages and better offline access, this approach can help many more countries make real progress toward ending NTDs and achieving the global goal of zero leprosy.