Influence of Community-based Education on Undergraduate Health Professions Students' Decision to Work in Underserved Areas in Uganda

Overview

Journal BMC Res Notes

Publisher Biomed Central

Specialties Biology
General Medicine

Date 2017 Dec 10

PMID 29221498

Citations 5

Authors

Samuel Kizito

Rhona Baingana

Kintu Mugagga

Peter Akera

Nelson K Sewankambo

Affiliations

Soon will be listed here.

Abstract

Background: Uganda is beset by a shortage of health workers and the few available are mal-distributed. Providing rural exposure through community-based education could positively influence students' perspectives towards work in rural areas. We aimed to assess the impact of Community-Based Education and Research (COBERS) on health professions students' attitudes towards working in rural areas. This was a before-and-after study among 525 students of 4 medical universities in Uganda. Data was collected using self-administered paper-based questionnaires. Logistic regression and Poisson regression respectively were used to assess intention and intended number of years of work in rural areas.

Results: Before COBERS, 228/518 (44.0%) students indicated that they intended to work in rural areas as compared to 245/506 (48.4%) after the COBERS placement. Before the COBERS placement, the factors that were associated with students considering to work in a rural area were: extra allowance (OR = 0.2; 95% CI 0.1-0.6), and availability of social amenities (OR = 0.2; 95% CI 0.1-0.7). After their COBERS placement, the factors were: access to long distance courses (OR = 2.0; 95% CI 1.0-3.7) and being posted to a facility in a rural area (OR = 15.0; 95% CI 6.5-35.5). Before the COBERS placement the factors that influenced how long students thought they would be willing to work in a rural environment were: reliable electricity (IRR = 0.6; 95% CI 0.3-1.0) and Internet (IRR = 1.5; 95% CI 1.0-2.3), high salary (IRR = 0.4; 95% CI 0.3-0.7), and having skills to practice in rural settings (IRR = 2.0; 95% CI 1.3-3.1). Reliable electricity (IRR = 0.5; 95% CI 0.3-0.8) and long distance courses (IRR = 2.1; 95% CI 1.4-3.1) were significant motivators after having undergone the COBERS placement.

Conclusions: The majority of health professions students do not intend to work in rural areas after they graduate. Improving the welfare of health professionals working in rural areas could attract more health professionals to rural areas thus addressing the maldistribution of health workers in Uganda.

Citing Articles

Perceptions and experiences of undergraduate medical students regarding social accountability: a cross-sectional study at a Subsaharan African medical school.

Oriokot L, Munabi I, Kiguli S, Mubuuke A BMC Med Educ. 2024; 24(1):409.

PMID: 38609908 PMC: 11015595. DOI: 10.1186/s12909-024-05412-3.

Increasing the availability of health workers in rural sub-Saharan Africa: a scoping review of rural pipeline programmes.

Kolie D, van de Pas R, Codjia L, Zurn P Hum Resour Health. 2023; 21(1):20.

PMID: 36918864 PMC: 10013286. DOI: 10.1186/s12960-023-00801-z.

Factors affecting job choice among physician anesthesia providers in Uganda: a survey of income composition, discrete choice experiment, and implications for the decision to work rurally.

Law T, Subhedar S, Bulamba F, OHara N, Nabukenya M, Sendagire C Hum Resour Health. 2021; 19(1):93.

PMID: 34321021 PMC: 8320091. DOI: 10.1186/s12960-021-00634-8.

A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries.

OSullivan B, Chater B, Bingham A, Wynn-Jones J, Couper I, Hegazy N Front Med (Lausanne). 2020; 7:594728.

PMID: 33330559 PMC: 7729061. DOI: 10.3389/fmed.2020.594728.

Rural pipeline and willingness to work in rural areas: Mixed method study on students in midwifery and obstetric nursing in Mali.

Sidibe C, Toure O, Broerse J, Dieleman M PLoS One. 2019; 14(9):e0222266.

PMID: 31498819 PMC: 6733462. DOI: 10.1371/journal.pone.0222266.

References

Bailey N, Mandeville K, Rhodes T, Mipando M, Muula A . Postgraduate career intentions of medical students and recent graduates in Malawi: a qualitative interview study. BMC Med Educ. 2012; 12:87. PMC: 3480922. DOI: 10.1186/1472-6920-12-87. View

Silvestri D, Blevins M, Afzal A, Andrews B, Derbew M, Kaur S . Medical and nursing students' intentions to work abroad or in rural areas: a cross-sectional survey in Asia and Africa. Bull World Health Organ. 2014; 92(10):750-9. PMC: 4208487. DOI: 10.2471/BLT.14.136051. View

Omaswa F . The contribution of the Medical Education Partnership Initiative to Africa's renewal. Acad Med. 2014; 89(8 Suppl):S16-8. DOI: 10.1097/ACM.0000000000000341. View

Amalba A, van Mook W, Mogre V, Scherpbier A . The effect of Community Based Education and Service (COBES) on medical graduates' choice of specialty and willingness to work in rural communities in Ghana. BMC Med Educ. 2016; 16:79. PMC: 4774102. DOI: 10.1186/s12909-016-0602-8. View

Bailey R, Baingana R, Couper I, Deery C, Nestel D, Ross H . Evaluating community-based medical education programmes in Africa: A workshop report. Afr J Health Prof Educ. 2015; 7(1 Suppl 1):140-144. PMC: 4625844. View

Kotha S, Johnson J, Galea S, Agyei-Baffour P, Nakua E, Asabir K . Lifecourse factors and likelihood of rural practice and emigration: a survey of Ghanaian medical students. Rural Remote Health. 2012; 12:1898. View

Wakida E, Ruzaaza G, Muggaga K, Akera P, Oria H, Kiguli S . Health-profession students' teaching and learning expectations in Ugandan medical schools: pre- and postcommunity placement comparison. Adv Med Educ Pract. 2015; 6:641-56. PMC: 4677597. DOI: 10.2147/AMEP.S91624. View

Kiguli S, Baingana R, Paina L, Mafigiri D, Groves S, Katende G . Situational analysis of teaching and learning of medicine and nursing students at Makerere University College of Health Sciences. BMC Int Health Hum Rights. 2011; 11 Suppl 1:S3. PMC: 3059475. DOI: 10.1186/1472-698X-11-S1-S3. View

Mubuuke A, Mwesigwa C, Maling S, Rukundo G, Kagawa M, Kitara D . Standardizing assessment practices of undergraduate medical competencies across medical schools: challenges, opportunities and lessons learned from a consortium of medical schools in Uganda. Pan Afr Med J. 2015; 19:382. PMC: 4430042. DOI: 10.11604/pamj.2014.19.382.5283. View

10.

Eyal N, Barnighausen T . Precommitting to serve the underserved. Am J Bioeth. 2012; 12(5):23-34. PMC: 4300339. DOI: 10.1080/15265161.2012.665134. View

11.

Atuyambe L, Baingana R, Kibira S, Katahoire A, Okello E, Mafigiri D . Undergraduate students' contributions to health service delivery through community-based education: A qualitative study by the MESAU Consortium in Uganda. BMC Med Educ. 2016; 16:123. PMC: 4843200. DOI: 10.1186/s12909-016-0626-0. View

12.

Rockers P, Jaskiewicz W, Wurts L, Kruk M, Mgomella G, Ntalazi F . Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment. BMC Health Serv Res. 2012; 12:212. PMC: 3444383. DOI: 10.1186/1472-6963-12-212. View

13.

Klionsky D, Abdelmohsen K, Abe A, Abedin M, Abeliovich H, Arozena A . Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition). Autophagy. 2016; 12(1):1-222. PMC: 4835977. DOI: 10.1080/15548627.2015.1100356. View

14.

George G, Gow J, Bachoo S . Understanding the factors influencing health-worker employment decisions in South Africa. Hum Resour Health. 2013; 11:15. PMC: 3646670. DOI: 10.1186/1478-4491-11-15. View

15.

Talib Z, Baingana R, Sagay A, van Schalkwyk S, Mehtsun S, Kiguli-Malwadde E . Investing in community-based education to improve the quality, quantity, and retention of physicians in three African countries. Educ Health (Abingdon). 2013; 26(2):109-14. PMC: 4156792. DOI: 10.4103/1357-6283.120703. View

16.

Lori J, Rominski S, Gyakobo M, Muriu E, Kweku N, Agyei-Baffour P . Perceived barriers and motivating factors influencing student midwives' acceptance of rural postings in Ghana. Hum Resour Health. 2012; 10:17. PMC: 3438115. DOI: 10.1186/1478-4491-10-17. View

17.

Johnson J, Nakua E, Dzodzomenyo M, Agyei-Baffour P, Gyakobo M, Asabir K . For money or service?: a cross-sectional survey of preference for financial versus non-financial rural practice characteristics among Ghanaian medical students. BMC Health Serv Res. 2011; 11:300. PMC: 3223142. DOI: 10.1186/1472-6963-11-300. View

18.

Mariam D, Sagay A, Arubaku W, Bailey R, Baingana R, Burani A . Community-based education programs in Africa: faculty experience within the Medical Education Partnership Initiative (MEPI) network. Acad Med. 2014; 89(8 Suppl):S50-4. DOI: 10.1097/ACM.0000000000000330. View

19.

Songstad N, Moland K, Massay D, Blystad A . Why do health workers in rural Tanzania prefer public sector employment?. BMC Health Serv Res. 2012; 12:92. PMC: 3364903. DOI: 10.1186/1472-6963-12-92. View

20.

Willcox M, Peersman W, Daou P, Diakite C, Bajunirwe F, Mubangizi V . Human resources for primary health care in sub-Saharan Africa: progress or stagnation?. Hum Resour Health. 2015; 13:76. PMC: 4566492. DOI: 10.1186/s12960-015-0073-8. View