ABSTRACT
Objectives. To review data collected during an evaluation of the Flinders University Parallel Rural Community Curriculum (PRCC) in order to reflect on its relevance for medical education in Africa.Setting. The PRCC offers a community-based longitudinal curriculum as an alternative for students in their pre-final year of medical training. Design. Individual and focus group interviews were conducted with students; staff; health service managers; preceptors and community members. Results. Students are exposed to comprehensive; holistic; relationship-based care of patients; with a graded increase in responsibility. Students have varying experience at different sites; yet achieve the same outcomes. There is a strong partnership with the health service.Conclusions. The principle of balancing sound education and exposure to a variety of contexts; including longitudinal community-based attachments; deserves consideration by medical educators in Africa
Subject(s)
Education, Medical , Employee Incentive Plans , Rural Health , South Africa , Students, MedicalABSTRACT
Despite the availability of technically sound approaches; maternal mortality and other reproductive health problems persist in Uganda and other developing countries. Utilisation of maternal health services remains very low; especially delivery attended by skilled birth attendants. In Oyam and other Ugandan districts smarting out of prolonged insurgency; reproductive health services are generally poorly utilised. Doctors with Africa-CUAMM; an Italian NGO; together with other partners and with funding from the EU; initiated a programme intended to improve the uptake and quality of repro- ductive health services in Oyam District. A baseline study was conducted in 2008 to document the initial pattern of use and quality of the existing maternal healthcare services in order to generate baseline data against which the performance of the programme will be evaluated. Its objectives were to establish the level of utilisation of maternal healthcare; the factors underlying mothers' health-seeking behaviour; the quality of maternal healthcare services; and to describe the outcome of pregnancies carried within the previous 5 years. The study had three major components: a household survey (1472 households); a survey of community resource persons (30 TBAs; and 9 senior women leaders); and a health facilities survey (1 hospital; 1 HC IV; and 5 HC IIIs). Government-owned facilities were the most prevalent and most utilised (by 84.7). The median age of the mothers at the last pregnancy was 24 years and by that age; most mothers had had 3 pregnancies. At the first onset of labour; most women consulted an untrained friend or relative; and TBAs due to proximity. Overall; 41of the deliveries in the district take place in health facilities; and 44at the TBAs but 3.2are not attended to. PNC services are not well utilised despite high levels of awareness of the presence and utility of the services (by 73). Most mothers utilize injectable hormonal contraceptives and natural methods. Resistance from spouses and perceived negative effects of FP methods are major hindrances to FP utilisation. Over 90of the pregnancies had a positive outcome for the mother and child. The study recommends focusing on quality improvement through implementation of the standard package of reproductive health services and support supervision