E-learning boost for medical outreach training programme

The Community Based Education Research and Service, a mandatory component of the health professions curricula implemented by medical schools in Uganda since 2003, has proved effective as an innovative student-centred problem-based learning programme. Now, another innovation in the form of Open Deliver, an online e-learning platform, is to be integrated into the programme to improve its efficacy even further.

Known as COBERS, the community-based education research and service programme gives medical students an opportunity to experience working in public health facilities in rural areas. In a country where rural hospitals have trouble recruiting staff, the COBERS programme addresses acclimatisation of medical students to working conditions and challenges in the rural areas.

Students are randomly allocated to multicultural, multidisciplinary groups and live and work there for four to six weeks.

Ugandan ministry of health figures show that nearly 70% of doctors and dentists, 80% of pharmacists, and 40% of nurses and midwives work in urban areas, serving just 13% of the population.

Rural exposure through community-based education is expected to positively influence students’ attitudes towards working in rural areas, said Hussein Oria, a pharmacist and the chairperson of COBERS at Makerere University College of Health Services, or MakCHS.

Oria said COBERS gives medical schools an opportunity to teach medical students skills essential for working with communities and the ‘real environment’ in which they might work.

Dr Christopher Oleke, in charge of the community health workers' programme at the ministry of health, said it is great that COBERS takes a modern student to the village where the majority of the people don't have basic amenities.

“Ultimately, it should not be like a visiting programme. The students should get a feel of what the village people go through,” said Oleke.

Rural challenges

Rural facilities are generally poorly equipped and understaffed with erratic water and power supplies, but patient demand is high and knowledge of disease control and prevention among rural populations generally low. But COBERS, which now operates in 75 sites in rural lower-level health facilities, is helping to change that.

Oria said there is a wide acceptance of the COBERS programme among health facilities. Students appreciate the ‘hands-on experiences’ and employability in remote areas is improved.

“The students usually want to come back. We didn't have a constant flow of water but they still they came back to work at Kiboga Hospital,” said Dr Musiitwa.

More so, a number of district health officers are demanding COBER students and Makerere University gets feedback that the health behaviour in the community improves after the students go there, according to Oria.

Through international partnerships, the COBERS programme has also been able to support sites with computers and internet modems, effect building renovations and ultimately train Ugandan health workers with various competencies.

Fourth-year Makerere nursing student Angel Moureen Kanyange, who was posted under the COBERS programme to Hoima Regional Referral Hospital, a rural public health facility about 200km west of Kampala, was part of a group of 13 medical undergraduates, randomly selected and making a strong multidisciplinary team. Finding housing was a problem and without the comfort of the luxuries they enjoy in the urban areas, it was not easy.

“Out there you get to know the real life and how to hussle. You have to figure out everything,” said Kanyange.

“If the community is receptive and the working environment is good, medical workers will always be willing to work in rural areas,” she said.

Kanyange’s group spent most of their time at the hospital receiving hands-on training. Among their tasks were dispensing drugs, ward rounds under the supervision of senior staff, assisting in and observing surgeries, registering patients and changing cannulas or drips.

The students proved popular with patients.

“At rural health facilities, patients preferred us, students, because we had a lot of time. If you are confident they very easily trust you,” said Kanyange.

Student-generated health interventions

With the help of senior nursing and medical officers who act as supervisors or site tutors, the students are required to come up with a health intervention for the community as part of their marks towards their degree.

At the end of the training the graduate should be able not only to provide health care, but most importantly, engage with the community to define and track their health needs and promote health and prevention of disease, according to Oria.

“The students are heavily engaged in health promotion and they learn to work with the community,” said Dr Michael Musiitwa Mugwanya, the district health officer for Kiboga General Hospital.

As a site tutor for COBERS, Mugwanya ensures that the students work with the local leadership and the community to identify key health problems. They then design an intervention to promote disease prevention and control.

As they engage with the community they are also required to pass on health promotion messages, such as the need to clear garbage, wash hands and sleep under treated mosquito nets.

Kanyange’s group worked on teaching the community how to make and install tippy taps, a simple and economical technology that encourages hand-washing and conserves water. The tap is basically a jerry can filled with water and hoisted in an upright position on a T-shaped wooden frame. It is tied with a string usually made of banana fibre on the upper and lower end. When the jerry can is tipped, by stepping on the lower end, it releases water.


With the new Open Deliver platform, hopes are high that knowledge gaps on the part of health workers will be addressed.

Open Deliver is a joint demonstration project under the Uganda Chartered Healthnet, the Uganda UK Health Alliance and UNICEF, and will optimise resource use by collecting, digitising and centralising medical information in a single library, said Edward Kakooza, the Open Deliver project coordinator at MakCHS.

An app that can be downloaded on an android smartphone will be used by health workers to access medical content configured to Uganda’s setting, without requiring internet connection. Open Deliver is already used in Ethiopia, Nigeria, and Ghana.

“We want to use students as change agents. It is open source and the content will be modified to Uganda’s setting and be taken up by the government,” said Kakooza.

“As a country we have not made use of online learning. Open Deliver will boost the training of our students especially through COBERS. If it has worked elsewhere it can also work in Uganda,” said Professor Charles Ibingira, the principal of MakCHS.

Professor Nelson Sewankambo from Uganda Chartered Healthnet said the ministry of health, with whom they hope to partner, expects that health workers will get continuous training and gain more knowledge with Open Deliver.

“We have been yearning for this for a long time. It is the value addition for health worker training, said Charles Isabirye from the ministry of health. “If this goes through beyond a project it will enable us to increase the number of health workers,” he said.

“This will bring different players together to have a comprehensive approach that can support knowledge management under one platform,” said Dr Eddie Mukooyo, assistant commissioner of health services in the division of health information in the ministry of health in Uganda.

A medical student who said he speaks on behalf of “lazy students” said they can use the app for tutorials.