Undergraduate students' contributions to health service delivery through community-based education: A qualitative study by the MESAU Consortium in Uganda.
BACKGROUND
It has been realised that there is need to have medical training closer to communities where the majority of the population lives in order to orient the trainees' attitudes towards future practice in such communities. Although community based education (CBE) has increasingly been integrated into health professions curricula since the 1990s, the contribution students make to service delivery during CBE remains largely undocumented. In this study, we examined undergraduate health professions students' contribution to primary health care during their CBE placements.


METHODS
This was a qualitative study involving the Medical Education for Equitable Services to All Ugandans consortium (MESAU). Overall, we conducted 36 Focus Group Discussions (FGDs): one each with youth, men and women at each of 12 CBE sites. Additionally, we interviewed 64 community key-informants. All data were audio-recorded, transcribed and analysed using qualitative data analysis software Atlas.ti Ver7.


RESULTS
Two themes emerged: students' contribution at health facility level and students' contribution at community level. Under theme one, we established that students were not only learning; they also contributed to delivery of health services at the facilities. Their contribution was highly appreciated especially by community members. Students were described as caring and compassionate, available on time and anytime, and as participating in patient care. They were willing to share their knowledge and skills, and stimulated discussion on work ethics. Under the second theme, students were reported to have participated in water, sanitation, and hygiene education in the community. Students contributed to maintenance of safe water sources, educated communities on drinking safe water and on good sanitation practices (hand washing and proper waste disposal). Hygiene promotion was done at household level (food hygiene, hand washing, cleanliness) and to the public. Public health education was extended to institutions. School pupils were sensitised on various health-related issues including sexuality and sexual health.


CONCLUSIONS
Health professions students at the MESAU institutions contribute meaningfully to primary health care delivery. We recommend CBE to all health training programs in sub-Saharan Africa.
Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences, New Mulago Hospital Complex-School of Public Health Building Suite nr 307, P.O. Box 7072, Kampala, Uganda. latuyambe@yahoo.com.
Lynn M
LM
Atuyambe
School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda.
Rhona K
RK
Baingana
Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, College of Health Sciences, New Mulago Hospital Complex-School of Public Health Building Suite nr 307, P.O. Box 7072, Kampala, Uganda.
Simon P S
SPS
Kibira
School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Anne
A
Katahoire
School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Elialilia
E
Okello
School of Social Sciences, Makerere University College of Humanities and Social Sciences, Kampala, Uganda.
David K
DK
Mafigiri
Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda.
Florence
F
Ayebare
Faculty of Medicine, Gulu University, Kampala, Uganda.
Henry
H
Oboke
Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.|School of Health Sciences, Kampala International University Western Campus, Bushenyi, Uganda.
Christine
C
Acio
Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.|School of Health Sciences, Kampala International University Western Campus, Bushenyi, Uganda.
Kintu
K
Muggaga
School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Scovia
S
Mbalinda
Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda.
Ruth
R
Nabaggala
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Gad
G
Ruzaaza
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Wilfred
W
Arubaku
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Samantha
S
Mary
Faculty of Medicine, Gulu University, Kampala, Uganda.
Peter
P
Akera
School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
James K
JK
Tumwine
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
David H
DH
Peters
Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda.
Nelson K
NK
Sewankambo
D000328:Adult; D003153:Community Health Services; D004504:Education, Medical, Undergraduate; D005260:Female; D017144:Focus Groups; D006266:Health Education; D006801:Humans; D008297:Male; D018794:Problem-Based Learning; D036301:Qualitative Research; D014454:Uganda
Community-based education; Contribution; Health service; MESAU; Qualitative; Uganda; Undergraduate students