1. COMMUNITY BASED EDUCATION & SERVICE(COBES) By: Andrew Mwanika

2. BACKGROUND Decentralisation Feasibility study. Curriculum change.

3. COBES What its not. A tool or learning strategy.

4. AS TOOL/STRATEGY Authentic learning context. Service Provision. Civic responsibility Strategic partnerships for Health

5. OBJECTIVES Prepare students for Rural Practice. Integrate Priority Health Programs into Training. Acclimatize students to rural districts Align training to Health needs. Focus on households.

6. AUTHENTIC LEARNING CONTEXT Life is unstructured. COBES Motto: “train Health workers in the communities they will serve” Experiential learning. Assessment- Portfolio.

7. SERVICE PROVISION Primary health care & Family medicine Access to Health. Quality time. Service Penetration.

8. ACHEIVEMENTS Presence in 43 districts in all regions. High Level of acceptance. Community Based Health Projects. Effective learning. Partnerships.

9. Benefits of COBES to communities cont’d Kalisizo students’ project implementation report, January 2007 page iv, “We visited 22 Households in Nininzi village, installed 17 hand washing facilities in 17 households, increased availability of sanitary facilities in households of Nninzi, held a health information seminar and pioneered creation of a MODEL village in Kalisizo Town Council” Wakiso Project implementation report, November 2007, Page 5, “Successful de-worming of all people over 14 years who visited the out-patients department during the implementation period. De- worming of students and staff at selected schools was also accomplished successfully. Total coverage was 1,942 individuals. 800 were students and 1142 were people who had come to attend Out Patients department”.

10. Benefits of COBES to communities cont’d Improving the life of the communities they are placed: One of the household members using the hand washing facility installed by the 4th year students of Kalisizo

11. Benefits of COBES to communities cont’d Health Education: One of the 4th year students at Wakiso Health Center giving a health talk before de-worming at the out patient unit

12. Benefits of COBES to communities cont’d Iganga students ’ sanitation project visited 25 households in Nakavule village. We joined the town council in a sanitation drive to clean the town. We got involved in cleaning of the town; sweeping the reads and collection of rubbish ”. (Students in red undergraduate coats)

13. A table showing students’ COBES projects proposed and implemented in 2007 Name of site Title of projects proposed by 3 rd year students Iganga HospitalImproving sanitation in Iganga Town Council Kayunga HospitalA community project on Latrine covers and Hand washing facilities Gombe HospitalHome-Based HIV Counselling and Testing in Gombe Community Nkozi HospitalIncreasing awareness of STIs other than HIV/AIDS among sexually active age group (15-49 years) in Nkozi sub county Kiruddu Health Center Assessment of the Nutritional status of children under 5 years in Makindye Division Kawolo HospitalTo reduce the morbidity and mortality due to malaria in Kawolo hospital catchments area St. Stephen’s Hospital, Mpererwe Reduction of HIV Prevalence among the youth in Mpererwe parish, Kawempe Division Ndejje Health Center Assessing the knowledge, attitudes and practice of alternative and conventional medicine in Ndejje community Kumi HospitalImproving sexual and Reproductive Health in Ongino sub county, Kumi district Kinoni Health Center Assessment of the determining factors for the high burden of Malaria in Kinoni Health Sub County

14. A table cont’d Name of site Title of projects proposed by 3 rd year students Buluba Hospital Home based water disinfections and safe storage Lira HospitalReduction of Malaria morbidity and Mortality among children below 5 years in Adekokwoki sub county, Lira district Kiyeyi HCImproving adolescent health and contraceptive use in Kiyeyi Health Center III catchment area, Tororo Rugazi HCReduction of Malaria prevalence among pregnant women in Ryeru sub county, Bushenyi District Kalisizo Hospital Oral Health promotion among school going children aged between 6-12 years in Kalisizo Wakiso HCImproving the human excreta disposal through health education in Bongole zone, Makindye Sabagabo sub county, Wakiso District Projects Implemented by 4 th year students Wakiso HCIntestinal Worm Control in Wakiso Town Council Kalisizo Hospital To Promote personal and environmental sanitation and hygiene in Kalisizo community so as to reduce the disease burden thus ensuring an improved quality of life. Kayunga Hospital Diarrhoeal disease control in Children under five years in Kayunga Town Council

15. A table cont’d Name of site Kawolo Hospital To increase awareness on sanitation among the community in Kinyoro Village Kinoni HCPrevention of Malaria among under 5 Year old children in Kyabashukura village; Rwampara sub country, Mbarara District Hoima Hospital Information, Communication and Education about HIV/AIDS and STIs among adolescents in Hoima Town Council Kawolo Hospital Interventions geared towards the reduction of Malaria morbidity and mortality in Kawolo Hospital catchement area Kiyeyi Health Center Improving adolescent health and contraceptive use in Kiyeyi Health Center III catchment area, Tororo Kalisizo Hospital Promoting reduction of malaria prevalence in Kalisizo town Council

16. CHALLENGES Access to Learning Materials. Supervision. Student Welfare Sustainability.

17. POSSIBLE SOLUTIONS District resource centres. Family Medicine/ Portfolio District budgets, Fees, Transport National Policy, National budget, Partnerships.

18. CONCLUSION High Potential: Skill Shortage. H.R.H.crisis. Roll out to all tertiary institutions. National service.