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Mbarara University of Science and Technology (MUST) Community Based Education Research and Service (COBERS) program issues and experiences (By Gad Ruzaaza Ndaruhutse, Program Coordinator)

  1. Context

The Community Based Education (CBE) approach first emerged during the 1970’s in response to population demand for need based education. At the core of CBE was a paradigm shift away from viewing universities as ivory towers. Contextually, Mbarara University of Science and Technology (MUST) at it inception in 1989 embraced CBE as the philosophy for health professions’ education within the Faculty of Medicine. Progressively, CBE has been adopted across all Medical Schools in Uganda. The purpose was to establish a curriculum which would facilitate the interaction between the local communities, University lecturers and students, to make them more directed towards the prevailing and emerging needs within Uganda and beyond. MUST continues to tailor its curriculum towards the emerging health and health care needs and demands. 

From the 1990s to 2009 the CBE model laid emphasis on service learning, represented in the acronym COBES (Community Based Education and Service). During 2010, there was curriculum review that incorporated aspects of leadership and put more emphasis on research. Coincidentally all the medical schools in Uganda chose to come together under the MEPI-MESAU consortium in order to build synergy in addressing the prevailing health and healthcare bottlenecks in the county using an educational approach. It was agreed that guided by the core MESAU competencies and the demand for evidence-based  practice research becomes mainstreamed into the service learning agendas leading to the emergence of COBERS (Community Based Education Research and Service).

At MUST, COBERS has grown in its depth and scope through providing the Leadership and Community Placement (LCP) course using a multidisciplinary approach. The course is geared towards instilling leadership knowledge and skills and Primary Health Care management essential for confronting the health challenges of the 21st Century. Students are expected to gain the essential skills and tools required for playing a leadership role in their work environment. In addition to the grounding in primary health care, community diagnosis, health systems and family medicine, students are introduced to leadership and management. A cross cutting expected course output will be ‘health managers who lead’ for effective implementation of Primary Health Care and Uganda’s minimum health care package. It is also expected that students will have developed a positive attitude towards working in rural / community placements.

  1. Achievements

At outset, the most prominent achievement of COBERS is a re-orientation of curricula to the population health needs. Students participate in community placements in interdisciplinary teams of five to eight students. COBERS guidelines have been developed for both students and staff.

Students are placed at a rural health facility where they participate in facility-based health care and also undertake a community project with the neighboring community. The number of sites continues to increase: from three sites during 1995 to 23 rural sites during 2010 and 30 sites in 2012. There are 50 different sites where students could be placed in future. A checklist was used to mark out basic essential items required at a site to qualify it to have students placed at that particular site. The sites have been ranked using a criteria developed by MEPI – MESAU. The number of participating students has increased as well from 40 students in 1995 to currently 230 students annually. Every year students implemented a community project that ensures participation of the community for ownership and sustainability.

The participating lecturers have also increased progressively to 33. At every site there is a trained preceptor who participates in supervision, teaching and assessment. In some of the sites two supervisors have been trained. It can be argued that participating lecturers provide a level of technical advice and support to the participating health facilities.

Whereas students have contributed to healthcare improvement, they have also carried out small research projects that have further informed program implementation. Some of the projects have been widely disseminated at the MUST annual research dissemination conference and on grand rounds. Two of such projects featured at the 15th February, 2013 MEPI teleconference. 

  1. Emerging trends and  perspectives

The experience of MUST presents the partnership educational model embraced by COBERS as a realistic strategy for transformative health professions’ education based on need based health care interventions. In spite of resource constraints, MUST recognizes the demand to increase the time spent in community from 6 weeks to at least 10 weeks.

Attempts are being made to strengthen ICT and e-learning to enhance COBERS.  This requires, however, investment into basic IT equipment and maintenance of internet connectivity.

In order to address student accommodation challenges, it is proposed that students’ hostels be constructed at selected health facilities. This requires engaging line ministries - Ministry of Local Government, Ministry of Finance, Ministry of Health and Ministry of Education as well as the host districts.

The sustainability of the program hinges on maintaining the existing partnerships and the commitment of the site – based supervisors (preceptors). The plan is to maintain at least two trained supervisors at each site. 

 

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