title: A partial economic evaluation of blended learning in teaching health research methods: a three-university collaboration in South Africa, Sweden, and Uganda.
abstract: BACKGROUND
  Novel research training approaches are needed in global health, particularly in sub-Saharan African universities, to support strengthening of health systems and services. Blended learning (BL), combining face-to-face teaching with computer-based technologies, is also an accessible and flexible education method for teaching global health and related topics. When organised as inter-institutional collaboration, BL also has potential for sharing teaching resources. However, there is insufficient data on the costs of BL in higher education.
  
  
  OBJECTIVE
  Our goal was to evaluate the total provider costs of BL in teaching health research methods in a three-university collaboration.
  
  
  METHODS
  A retrospective evaluation was performed on a BL course on randomised controlled trials, which was led by Stellenbosch University (SU) in South Africa and joined by Swedish and Ugandan universities. For all three universities, the costs of the BL course were evaluated using activity-based costing with an ingredients approach. For SU, the costs of the same course delivered with a classroom learning (CL) approach were also estimated. The learning outcomes of both approaches were explored using course grades as an intermediate outcome measure.
  
  
  RESULTS
  In this contextually bound pilot evaluation, BL had substantially higher costs than the traditional CL approach in South Africa, even when average per-site or per-student costs were considered. Staff costs were the major cost driver in both approaches, but total staff costs were three times higher for the BL course at SU. This implies that inter-institutional BL can be more time consuming, for example, due to use of new technologies. Explorative findings indicated that there was little difference in students' learning outcomes.
  
  
  CONCLUSIONS
  The total provider costs of the inter-institutional BL course were higher than the CL course at SU. Long-term economic evaluations of BL with societal perspective are warranted before conclusions on full costs and consequences of BL in teaching global health topics can be made.
authors.affiliation: Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Minna
authors.initials: M
authors.lastname: Kumpu
authors.affiliation: Department of Public Health Sciences, Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
authors.forename: Salla
authors.initials: S
authors.lastname: Atkins
authors.affiliation: Centre for Studies in Family Medicine, Department of Family Medicine, Western University, London, Ontario, Canada.
authors.forename: Merrick
authors.initials: M
authors.lastname: Zwarenstein
authors.affiliation: Centre for Health Systems and Services Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; lnkonki@sun.ac.za.
authors.forename: Lungiswa
authors.initials: L
authors.lastname: Nkonki
keywords: blended learning; cost analysis; education; health systems research; public health; public health professional; students