Blended learning and e-learning in nursing education in Africa: a systematic review of challenges and opportunities

Nursing education worldwide is required to produce highly competent professionals capable of meeting evolving health demands by integrating new technologies into both education and care delivery (Badil, 2024; Torres-López et al., 2025). In an era of rapid digital transformation, it is imperative for nursing institutions to align pedagogical innovations in delivering education (Barbosa et al., 2021). The use of blended learning which integrates face-to-face and online instruction whiles e-learning relies primarily on digital and virtual modalities, both have emerged as promising mechanisms to enhance flexible, access, and continuous professional growth in nursing and healthcare education (Aryee et al., 2024). During the COVID-19 pandemic, nursing and health professions educators rapidly shifted from wholly face-to-face instruction to e-learning and blended approaches, both out of necessity and to maintain continuity of education (Ahmed et al., 2025; Namulondo et al., 2023). These developments have resulted in growing adoption of blended and e-learning models among universities and nursing institutions. In many countries, these models have persisted post-pandemic owing to their benefits in flexibility, access, and learner preference (Ahmed et al., 2025). However, evidence about their overall effectiveness remains inconclusive. Some studies highlight significant gains in learner engagement and knowledge retention (Alsharari et al., 2025), while others reveal limited or inconsistent improvements, especially in low-resource contexts (Mojarad et al., 2023). These paves way for thorough analysis of how these approaches influence nursing education in Africa. Across Africa, efforts to integrate digital learning are often constrained by structural and resource challenges. A systematic review of e-learning in sub-Saharan Africa between 2016 and 2022 revealed persistent barriers such as unreliable internet connectivity, inconsistent power supply, lack of institutional policy frameworks, and limited instructor capacity (van der Merwe et al., 2023). Similarly, Empirical evidence from Ghana, Namibia, and Iran indicates that the effectiveness of online learning in nursing education is hindered by weak technical and institutional support systems (Gracious et al., 2024), limited instructor interaction and inadequate ICT skills among educators and students (Ashipala et al., 2023), and difficulties replicating clinical practice in virtual environments leading to reduced practical competence (Mousavizadeh, 2022). However, When institutions strengthen digital infrastructure, improve educators’ digital skills, and adopt sound instructional design, blended learning can help bridge gaps in nursing education by combining online theory with hands-on practice, as shown in studies from China and Iran (Atashinsadaf et al., 2024; Li et al., 2021). Therefore, the pertinent question is not whether blended or e-learning models are beneficial per se, but rather under what conditions each approach becomes pedagogically sound, contextually relevant, and socially equitable to nursing education in African. This ongoing debate reflects broader global concerns about the quality, equity, and inclusivity of digital learning. Advocates argue that technology-enhanced education enable access to self-paced and lifelong learning and bridge geographic divides, especially in resource-limited and remote areas (Aryee et al., 2024). Conversely, critics warn that premature adoption without adequate infrastructural and pedagogical support risks deepening inequities and undermining clinical competence among nursing graduates (Ndura & Sitati, 2024). Additionally, reviews show that while e-learning and blended learning often match traditional education in delivering theoretical content, their effectiveness is rarely superior in contexts where digital infrastructure, mentorship, and interactivity are weak (Vallee et al., 2020; Yu et al., 2025). In this light, Africa presents a compelling test case for the viability of digital pedagogies, where significant diversity exists in national policies, institutional capacity, and learner readiness. Beyond pedagogical and infrastructural arguments, this issue is deeply intertwined with the United Nations Sustainable Development Goals (SDGs), which position education and health as interconnected pillars of sustainable development. SDG 4 (Quality Education) explicitly seeks to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all, with Target 4.3 calling for equal access to affordable and quality technical, vocational, and tertiary education, and Target 4.4 aiming to substantially increase the number of youth and adults with relevant skills for employment and decent work (United Nations, 2015). also, SDG 3 (Good Health and Well-being) Target 3. emphasizes the need to “substantially increase health financing and the recruitment, development, training, and retention of the health workforce in developing countries. Successful integration of e-learning and blended learning in nursing education may strengthen human resource capacity for health and foster inclusivity, innovation, and equity. Although research on digital learning in African nursing education is growing, existing reviews remain limited in scope and often lack critical appraisal. For example a scoping review on effectiveness of various types of e-Learning pro-grammes, and the facilitators and barriers to its use (Aryee et al., 2024) reveal variations across countries, program levels, and institutional capacities are rarely examined systematically, leaving contextual differences underexplored. Given that nursing education must integrate theoretical knowledge, clinical competence, and ethical practice, these gaps hinder the development of informed policies and effective teaching strategies. A comprehensive synthesis of evidence on the challenges and opportunities of blended and e-learning in African nursing education is therefore necessary to guide sustainable, context-specific implementation. The findings of this review will have practice implications by informing educators on effective pedagogical approaches, inform policies guiding stakeholders in digital education planning, and identify areas for future inquiry. Additionally, the review will advance progress toward the Sustainable Development Goals (SDGs) by promoting equitable, innovative, and high-quality nursing education across Africa.