COBES DEFINITION OF: A LEARNING STRATEGY. SERVICE-LEARNING

RATIONALE OF COBES PROGRAMMES IN GENERAL Community-Based Education may contribute to the solution of the problem of inequity in service delivery makes health services available to the community as soon as students begin to learn in that community The school may play an influential role in regional health policy development (through its staff, students and graduates) Prevention and health promotion as well as curative care WHY?

RATIONALE OF COBES PROGRAMMES IN GENERAL CBE may improve health professions education Enables students to relate theoretical knowledge and practical training Contextual learning (close resemblance between the learning situation and “real life” leads to better performance) CBE may equip students with competencies which they will never learn otherwise WHY?

RATIONALE OF COBES PROGRAMMES IN GENERAL CBE renders opportunities for partnership between the community, university and government CBE may help to develop and update the curriculum using health priority data CBE offers students an opportunity to learn and work with other health professionals WHY?

Its aim is to produce community-oriented health workers who are able and willing to serve their communities and deal effectively with health problems at primary, secondary and tertiary level HOPE  DOPE It serves the purpose of a health-oriented physician education (HOPE) rather than a disease-oriented physician education (DOPE) Handbook of Community-Based Education, Schmidt et al, 2000

RATIONALE OF COBES PROGRAMME MAKARERE UNIVERSITY KAMPALA (Dr. Andrew Mwanika, COBES workshop, MUK, 2nd – 5th of August 2005) To facilitate the placement of the university’s graduates in the districts. As most of them are born and grow up in urban areas, they - understandably - have little to bind them to rural districts.

RATIONALE OF COBES PROGRAMME MAKARERE UNIVERSITY KAMPALA (Dr. Andrew Mwanika, COBES workshop, MUK, 2nd – 5th of August 2005) To facilitate the placement of the university’s graduates in the districts. As most of them are born and grow up in urban areas, they - understandably - have little to bind them to rural districts. To achieve contextual learning, by confronting students with the day-to-day realities of the health care delivery system in Uganda from the early stages of their training

RATIONALE OF COBES PROGRAMME MAKARERE UNIVERSITY KAMPALA (Dr. Andrew Mwanika, COBES workshop, MUK, 2nd – 5th of August 2005) To facilitate the placement of the university’s graduates in the districts. As most of them are born and grow up in urban areas, they - understandably - have little to bind them to rural districts. To achieve contextual learning, by confronting students with the day-to-day realities of the health care delivery system in Uganda from the early stages of their training To integrate the priority health programmes of the Ministry of Health in to the undergraduate medical education

RATIONALE OF COBES PROGRAMME MAKARERE UNIVERSITY KAMPALA (Dr. Andrew Mwanika, COBES workshop, MUK, 2nd – 5th of August 2005) To facilitate the placement of the university’s graduates in the districts. As most of them are born and grow up in urban areas, they - understandably - have little to bind them to rural districts. To achieve contextual learning, by confronting students with the day-to-day realities of the health care delivery system in Uganda from the early stages of their training To integrate the priority health programmes of the Ministry of Health in to the undergraduate medical education COBES MUK

SO WHAT? OR WHAT CAN WE DO?

HOW CAN THE COBES PROGRAM BE STRENGHTENED BY OUR DEPARTMENT? HOW CAN OUR DEPARTMENT BENEFIT FROM THE COBES PROGRAM? HOW CAN THE COBES PROGRAM BE STRENGHTENED BY OUR DEPARTMENT? End

WHAT IS COBES? A compulsory component of the curriculum  students can not graduate if they do not take part in COBES A response to certain needs in the country: maldistribution of health professionals: rural  urban graduates lack knowledge about community health needs graduates will work in decentralized district health services graduates lack leadership and management skills need for more community research graduates lack cultural competence

COBES GOALS To integrate priority national health programs into the undergraduate training program To produce graduates who are well equipped to function effectively in the districts Serve as a tool for integrating strategic and synergic interests

Community participation Facility based activities COBES OBJECTIVES Acclimatization Home based care School health Community participation Facility based activities Management and administration Partnerships with CBO’s Curricular objectives (tutorials)

STRUCTURE OF COBES Pre-placement - district entry - criteria of site selection - training of site tutors - briefing of students - grouping of students - student and tutor guides - money

No specific COBES activities STRUCTURE OF COBES COBES activities   First semester Second semester Recess 1st year 8 weeks (2+6) 2nd year 5 weeks (4+1) 3rd year 4th 5th No specific COBES activities 5 weeks (4 + 1)

- progressive (logbooks / reports) - panel assessment - summative STRUCTURE OF COBES Supervision - site tutor - faculty of MUK-FoM Assessment - progressive (logbooks / reports) - panel assessment - summative Group work

BENEFITS OF COBES Now three years of experience and students remain positive (even less complaints than previously) Communities and staff at the health care facilities are very happy about the programme District authorities also very pleased, several districts wanting to be included as well

BENEFITS OF COBES Students have learned a lot of practical skills but also knowledge about the health care system and traditional health care Faculty staff is exposed to community health problems as well as the students Partnership with AIM  track patients in the community (e.g. all medicines mixed up together, lack of treatment education)

CHALLENGES Sustainability - fees - partnerships - donor support Supervision - high turnover of site tutors - “touristic visits” by faculty staff Learning materials Administration Assessment