Influence of community-based education on undergraduate health professions students’ decision to work in underserved areas in Uganda
Kizito et al. BMC Res Notes
Influence of community-based education on undergraduate health professions students' decision to work in underserved areas in Uganda
Samuel Kizito 0 3
Rhona Baingana 3
Kintu Mugagga 2
Peter Akera 1
Nelson K. Sewankambo 3
0 Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University , Kampala , Uganda
1 Faculty of Medicine, Gulu University , Gulu , Uganda
2 School of Health Sciences, Kampala International University , Kampala , Uganda
3 Makerere University College of Health Sciences , Kampala , Uganda
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.
Doctor; Mal-distribution; Rural areas; Uganda
In addition to a high disease burden, Uganda is faced
with a severe shortage of health workers [
]. Of the
already insufficient doctors, a significant proportion
emigrates . Close to three-quarters of those that remain
in Uganda mainly practice within urban areas [
failure to attract and retain health workers leaves the
hard-to-reach areas underserved yet the majority of the
population lives in rural areas [
]. This mal-distribution
of health workers constrains the overall health care
Several interventions to increase the number of
doctors that graduate from the medical schools, to ensure
their retention, as well as their equitable distribution to
cater for the hard-to-reach areas have been proposed and
implemented in sub-Saharan Africa including in Uganda.
Among these are: salary supplements, recruiting medical
students from rural areas and improving the
infrastructure and social amenities in rural areas [
However, these have not yet succeeded in combatting health
workforce mal-distribution [
5, 8, 10
Education (CBE) is one of the approaches being used to
address the challenge of recruiting and retaining health
workers in sub-Saharan Africa . CBE has the
potential to enhance the willingness of trainees to remain in
their home countries after qualification and to practice in
rural areas [
The medical training institutions in Uganda under the
Medical Education for Equitable Services for All
Ugandans Consortium (MESAU) [
CommunityBased Education, Research and Services (COBERS) as a
compulsory curriculum component [
]. The major goals
of COBERS are to sensitize and acclimatize students to
working in underserved communities and to enable them
acquire the appropriate attitudes towards working in
these areas [
]. However it has not been documented
whether COBERS influences students’ attitudes towards
working in Uganda and especially in underserved areas.
Therefore the aim of this study was to explore the
influence of COBERS on: (1) students’ attitudes towards
working in rural areas, [
] factors associated with
students’ intention to work in the rural areas, and [
factors that influence the duration of time that the students
intend to practice in rural areas after graduating.
Medical education for equitable services to all Ugandans
Five medical universities in Uganda formed a
consortium, Medical Education for Equitable Services to All
Ugandans (MESAU), in 2010 in order to address
challenges in health professions education [
universities are: Makerere University College of Health Sciences
(MakCHS), Mbarara University of Science and
Technology (MUST), Gulu University (GU), Kampala
International University (KIU) and Busitema University (BU)
]. MESAU was established with funding from the US
Government through the Medical Education Partnership
Initiative (MEPI) and technical support from Johns
Hopkins University [
]. MESAU aims to standardize
medical education and develop the partner institutions into
centers of excellence in medical education, research and
service that address local and national needs to improve
health in Uganda [
]. MESAU intends to produce health
workers that are competent and well motivated to offer
services that are locally relevant. The MESAU institutions
have included Community-Based Education, Research
and Service (COBERS) in their health professions
curricula as one of the strategies to realize its overall aims [
Community‑Based Education Research and Services
Mbarara University of Science and Technology (MUST)
at its inception in 1989 embraced CBE as the
philosophy for health professions’ education within the Faculty
of Medicine. In 2003, MakCHS introduced
CommunityBased Education and Services (COBES) into its
] after a feasibility study carried out in 2000. The
other medical universities in Uganda then followed suit.
A component of research was added to the program,
whereby the students identify a community problem
for which they develop interventions. Having
implemented the interventions, students also evaluate their
]. COBERS is compulsory for medical,
nursing, dentistry, pharmacy, biomedical engineering,
cytotechnology, radiography and medical laboratory sciences
The program has different timing across the
universities with MakCHS and KIU offering it once annually
throughout the 5-year medical program, with each
placement lasting 2–5 weeks [
]. Other universities offer the
program once but for longer durations. The main
components of COBERS are community health, community
diagnosis, demography, communication skills,
epidemiology, primary health care, biostatistics, health
education and promotion, immunization, nutrition assessment
and community engagement [
]. The services that
students offer include: immunization, health education,
patient clerkship, and community health promotion, and
other community as well as health facility services as
Each of the sites where students are placed has a site
tutor who is a medically trained health worker at the
hosting health facility and is responsible for
facilitating and coordinating students’ learning activities and
their assessment. Sites are assigned additional
supervisors from the university who makes physical visits to the
COBERS sites to monitor students’ progress. Throughout
the COBERS placements, students are evaluated [
This evaluation comprises weekly assessment of
activities entered into already structured logbooks. Further
assessment is through evaluating performance in tutorial,
which is held twice a week during the placement. At the
end of the COBERS, there is a written examination paper
that additionally contributes to the final mark. Other
areas of assessment include reports submitted by
students and oral presentations done by the students
summarizing their activities [
Study design and study setting
This was a before-and-after study among
undergraduate health professions students at four universities of
the MESAU Consortium in Uganda namely: MUST,
MakCHS, Gulu University and KIU. At the time of
conducting the study, the Faculty of Health Sciences at
Busitema University was not yet fully established. Faculty
from the MESAU institutions developed a questionnaire
with technical support from John-Hopkins University
(JHU). The questionnaire was pre-tested at MUST with
students who were not going for COBERS that academic
year. We administered the questionnaire to 525 students
in the 2011/2012 academic year in the month before
they went for their first ever COBERS placement. The
total number of students we had estimated from the
university registers was 550. For Gulu in northern Uganda
these were 4th year students, for KIU in South-western
Uganda and MakCHS in central Uganda they were first
year students and for MUST in South Western they were
assorted. We administered the same questionnaire to 516
students after their first ever COBERS placement, which
lasted 5–8 weeks. Students were invited to participate in
the study through their respective student leaders and
gathered at one location at each institution to complete
the questionnaire before and after their COBERS
placement. The questionnaire was distributed to the students
who accepted to participate in the study and provided
written informed consent.
We collected data on background characteristics
including sex, institutional affiliation, year and program of
study, area of residence during childhood and type of
secondary school attended. For intended career choices
after graduating and the factors that could influence
these career choices, the tool included 28 positively
worded items each with a 4-point Likert response
scale (1 = strongly disagree to 4 = strongly agree). For
intended career choices after graduating, the items
included: practicing in the health sector, working in
a rural area, working in Uganda, working in another
African country, and working outside Africa. For
factors influencing their intended career choice the items
included: high salary, availability of reliable transport,
electricity, security, infrastructure, medical supplies
and equipment, Internet coverage, housing, good local
schools for children, clean water and social amenities.
Other factors included closeness to home area, ability
to speak the local language, ability to interact with the
university and other health professionals, being posted
by the Ministry, being made in-charge of the health
unit, access to long distance education courses, access
to online medical literature, extra allowance, and having
the necessary skills to practice in the rural areas.
Information about the duration of time in completed years
the students intended to practice in the rural areas was
Data management and analysis
Data from all institutions was entered centrally into one
Excel spreadsheet database at MakCHS, was checked
for errors, and a copy was frozen. The data was exported
to STATA version 12 for analysis. Data was adjusted for
clustering at institution level. Analysis was stratified to
before and after COBERS placement. Descriptive data
were summarized and presented as means for continuous
data and percentages for the categorical data.
Likert-scale values for each item in the tool were
categorized into a binary variable. ‘Strongly disagree’ and
‘Disagree’ were grouped together as ‘Disagree’ while
‘Agree’ and ‘Strongly agree’ were grouped into a
single variable ‘Agree’. Comparisons were made between
the two generated groups before and after the COBERS
placement using the McNemar’s Chi square test.
Significance was set at a p value of 0.05 or less.
For all the mathematical models, factors from the
Likert scale were dichotomized as described above. For each
of the factors, a model was run for the students before
the COBERS placement and another model for after the
placement. To assess the factors that influence the
students’ intention to work in rural areas, the outcome was
dichotomized as ‘Disagree’ or ‘Agree’ to work in rural
areas. A logistic regression model was then run. Odds
ratios (OR) were the measure of association used. For the
factors influencing the number of years of practicing in
rural areas, the outcome was a count in completed years.
A Poisson regression model was employed after assessing
and ruling out suitability for negative binomial model.
Incidence rate ratio [
] was used as measure of
association. For all the models only factors with p values of 0.1
or less at bivariate analysis were entered in a multivariate
model. Confounding factors were assessed at a 10%
difference between the measure of association for the
unadjusted and adjusted models.
A total of 525 students participated in the survey before
COBERS while 516 students participated in the survey
following the community placement. A few
questionnaires had some missing information such as gender and
year of study.
Of the 525 students who participated in the survey
before their first COBERS placement, the majority
were males, 355/510 (69.6%). MakCHS had the most
students, 194/525 (37.0%). Most students were doing
medicine, 283/514 (55.1%) and were in their first year
of study, 301/515 (58.5%). Details are shown in Table 1.
Comparable proportions were seen among the students
that participated in the survey following their COBERS
placement. The mean duration of time the students
intended to practice in rural areas was 2.6 ± 3.3 years
with median 2 (1, 3) years.
Effect of COBERS on attitudes towards work in rural areas
Before COBERS, 228/518 (44.0%; 95% CI 39.7–48.3%)
indicated that they intended to work in rural areas
as compared to 245/506 (48.4%; CI 44.1–52.8%) after
the COBERS placement (p = 0.03). The proportion of
students intending to work in the health profession after
graduation reduced from 493 (95.5%) before COBERS to
462 (91.1%) after COBERS (p = 0.005). The proportion
of students that reported the following social and
professional factors as influencing them to work in rural areas
reduced following COBERS placement: reliable transport
from 472 (90.6%) to 441 (86.6%), p value 0.046; reliable
electricity from 464 (88.9%) to 415 (82.7%), p value 0.04;
good security from 498 (95.2%) to 459 (90%), p value
0.001; good housing from 451 (87.1%) to 409 (82.6%), p
value 0.049; high salary from 430 (82.9%) to 361 (71.5%),
p value 0.01; access to medical literature from 372 (71.5%)
to 332 (65.4%), p value 0.033 and having the
necessary skills in community health from 447 (85.8%) to 400
(80.2%), p value 0.016. Details are highlighted in Table 2.
Factors influencing the decision to work in the rural areas
As shown in Table 3, before undertaking the COBERS
placement, the factors that were associated with
intention to work in a rural area at multivariate analysis were:
geographic area (urban or rural) where student spent his
or her childhood, access to long distance medical courses
(OR = 2.3; 95% CI 1.0–5.8), receiving an extra allowance
to work in the rural areas (OR = 0.2; 95% CI 0.1–0.6),
being posted by the Ministry (OR = 4.8; 95% CI 2.3–9.7)
and availability of social amenities (OR = 0.2; 95% CI
After the COBERS placement at multivariate
analysis the factors that were significantly associated with
choice to work in the rural areas included: access to long
distance courses (OR = 2.0; 95% CI 1.0–3.7), and being
posted in the rural areas by the ministry (OR = 15.0; 95%
CI 6.5–35.5). Details are shown in Table 4.
Factors influencing intended duration of work in rural areas
Before the COBERS placement, at multivariate
analysis the factors that influenced the intended
duration of work in the rural areas included: being female
(IRR = 0.6; 95% CI 0.4–0.9), attending urban secondary
school (IRR = 0.5; 95% CI 0.3–0.8), availability of
reliable electricity (IRR = 0.6; 95% CI 0.3–1.0) and
Internet (IRR = 1.5; 95% CI 1.0–2.3), being paid high salary
(IRR = 0.4; 95% CI 0.3–0.7), and having the necessary
skills to practice in a rural setting (IRR = 2.0; 95% CI 1.3–
3.1) as shown in Table 5.
Table 6 shows the factors associated with intended
duration of work in the rural areas after students had undergone
a COBERS placement. These included university attended,
availability of reliable electricity (IRR = 0.5; 95% CI 0.3–
0.8), access to long distance medical courses (IRR = 2.1;
95% CI 1.4–3.1), and having the intention to work in
another African country (IRR = 0.5; 95% CI 0.4–0.8).
Choice of career destination
I intend to work in a rural area
I intend to work in a health profession after I graduate
I intend to work in a Uganda after I graduate
I intend to work in another African country after I graduate
I intend to work outside Africa after I graduate
Factors influencing intentions to work in the rural areas
Availability of clean water
Availability of good local schools for my children
Working close to where I grew up
Being able to speak the local language
Being able to interact with a university
Being able to interact with other health professionals
Being posted in the rural area
Being made the in-charge of the hospital
Having access to long distance education courses
Having access to electronic medical literature
Being given extra allowance to work in rural areas
Having specific skills in community health
Having adequate medical supplies and equipment
COBERS Community-Based Education, Research and Services
This study assessed health professions students’ intentions
to practice in a rural environment, their intended
duration of practice in this setting, the factors influencing their
intentions and the effect of a COBERS placement during
their training on their intentions. Our study is unique in
that it included all established medical training institutions
in Uganda at the time. We found that both before and after
a COBERS placement lasting 5–8 weeks, less than half
of the students expressed intentions to practice in rural
areas. However, the proportion of students who expressed
intentions to practice in rural areas increased following
the COBERS placement. Even though we only assessed
intentions, the findings from this study are in parallel with
findings about the actual maldistribution of health
professionals in low-income countries [
Factors influencing choice to practice in the rural areas
Before COBERS, the students that grew up in Kampala,
the capital city of Uganda, were more than three times
willing to work in the rural areas compared to students
who grew up in municipalities beyond Kampala and in
the rural areas. A similar finding was reported in Ghana
where an overwhelming majority of graduates from the
towns and cities were willing to work in the rural areas
]. This could be due to a desire to serve as a gesture
of compassion [
]. In contrast, a study in eight
low-tomiddle-income countries found that students who had
prolonged exposures to rural settings were the ones more
likely to express intentions towards a rural career [
The findings demonstrate a change in students’
attitudes towards work in rural areas after the COBERS
placement in that they are less influenced by the social
amenities than they were before COBERS. This implies
that COBERS has the potential to increase on the
number of students likely to work in rural areas by
changing their attitudes regarding the relative importance
of social amenities as an influencing factor for their
decisions. Having opportunities for long distance
courses positively influenced students’ intention to
work in rural areas. Additionally, students expressed
more willingness to practice in rural areas if the
Ministry posted them there. These findings are in parallel
with previous studies [
]. In contrast, receiving
extra allowances and availability of social amenities in
the rural areas negatively impacted the students’
intention to practice in the rural areas. This demonstrates
that some students career preferences are not centered
on remuneration but on their passion and the need to
pay back to society .
Factors influencing the duration students are willing to practice in rural areas following graduation
Before the COBERS rotation, being female, attending
an urban day school as opposed to boarding school, and
being offered a high salary were associated with a
reduction in the intended duration of working in the rural
setting. Students that have not had rural exposure have
negatively biased views regarding practicing in remote
]. Just like findings from other studies, females
are less likely to stay and practice in rural areas for long.
This could be explained by prevailing cultural values
where by women follow their spouses on their job
Availability of reliable Internet and having the necessary
skills were associated with a higher intended duration
of working in rural areas. After the COBERS placement,
unreliable electricity was associated with a reduction in
the intended duration of working in the rural areas. The
majority of students are youths who use mobile
technology and computers for academics as well as recreation.
This accounts for reliable electricity and reliable
Internet being a major influence on intended career location
]. Having access to long distance courses was
associated with significantly higher intended duration of
practicing in the rural areas. Students who had the intention
of working in another African country were more likely
to spend 50% less time working in the rural areas as
compared to their counterparts who did not express the
intention to work in another African country [
The majority of students took the survey both before and
after COBERS, which could have created dependence.
This was however accounted for by applying methods for
dependence during data analysis and performing
stratified analysis for the study population before and after
COBERS placement. We did not link individual students’
before and after interviews but rather used aggregated
responses. Since we did not achieve maximum response
rate, we cannot ascertain overlap in the before and after
responses per individual. However, the non-response
rates were considerably low for both interviews which
meant that the overlap was high as would be desired. The
study assessed future intentions, which may not
necessarily result into the same actions after graduation. The
researchers relied on self-report and this is prone to
social desirability biases. Our study assessed student’s
intentions after a short period, 5–8 weeks of COBERS
exposure. It is not known whether a longer single
exposure or multiple exposures during the course of their
training will lead to different results. This could be
ascertained when follow-up studies are conducted. The data
was aggregated across all years of study among the
different universities. First year students are likely to have
different knowledge and experience, which could confound
the findings. In our study, we did not employ qualitative
research methods. These would add more valuable
information in understanding students’ decisions to work in
rural areas. Given that all health professions students at
the MESAU institutions all have to undergo COBERS
placements as part of the approved curricula, we did not
have a control group. This would have added more
information regarding the influence of COBERS.
The majority of health professions students do not intend
to work in rural areas after they graduate; however,
there was a slight increase in the proportion of students
expressing intentions to work in rural areas after they
graduate. Going by the factors that influenced the
students’ intentions, improving the welfare of health
professionals working in rural areas could attract more health
professionals to rural areas thus addressing the
mal-distribution of health workers in Uganda.
COBERS: Community-Based Education, Research and Services; HIV: Human
Immunodeficiency Virus; IRR: incident rate ratios; JHU: Johns-Hopkins
University; KIU: Kampala International University; MakCHS: Makerere University
College of Health Sciences; MUST: Mbarara University of Science and Technology;
OR: odds ratio; UNCST: Uganda National Council for Science and Technology.
KS was involved in the conception of the ideas, analyzed the data, made the
initial draft of the manuscript and was involved in all edits of the manuscript.
RB was involved in conception of the proposal, collected the data, involved
in the analysis plan, made contributions to edits of the draft manuscript. KM
and PA were involved in conception of the ideas, data collection, review of the
draft manuscript. NS conceived the project proposal, made contributions to
the methodological aspects of the study, made immense edits of the drafts of
the manuscripts. All authors read and approved the final manuscript.
We are sincerely grateful to the health professions students who participated
in this study and to the medical institutions involved in this survey for the
The authors declare that they have no competing interests.
Availability of data
Data cannot be shared because relevant approvals from the institutions that
participated are not in place. However, the data is available at the MESAU
Consortium Secretariat at Makerere University College of Health Sciences.
Consent for publication
Ethics approval and consent to participate
We obtained approval to undertake this study from the Makerere University
College of Health Sciences, School of Medicine Research and Ethics
Committee FWA #00001293. The study was registered with the Uganda National
Council for Science and Technology (UNCST). Each of the students offered
written informed consent prior to study enrollment and participation in this
This work was supported by MEPI Grant Number 5R24TW008886 supported
by OGAC, National Institutes of Health (NIH) and Health Resources and Service
Administration (HRSA). The contents in here are solely the responsibility of
the authors and do not necessarily represent the official views of the Fogarty
International Center or the National Institutes of Health.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
1. Rockers PC , Jaskiewicz W , Wurts L , Kruk ME , Mgomella GS , Ntalazi F , Tulenko K. Preferences for working in rural clinics among trainee health professionals in Uganda: a discrete choice experiment . BMC Health Serv Res . 2012 ; 12 : 212 .
2. Kizito S , Mukunya D , Nakitende J , Nambasa S , Nampogo A , Kalyesubula R , Katamba A , Sewankambo N. Career intentions of final year medical students in Uganda after graduating: the burden of brain drain . BMC Med Educ . 2015 ; 15 : 122 .
3. Uganda Bureau of Statistics, MEASURE DHS ICF International. Uganda demographic and health survey 2011 . Kampala: Uganda Bureau of Statistics; 2012 .
4. Songstad NG , Moland KM , Massay DA , Blystad A . Why do health workers in rural Tanzania prefer public sector employment? BMC Health Serv Res . 2012 ; 12 : 92 .
5. Lori JR , Rominski SD , Gyakobo M , Muriu EW , Kweku NE , Agyei-Baffour P . Perceived barriers and motivating factors influencing student midwives' acceptance of rural postings in Ghana . Hum Resour Health . 2012 ; 10 : 17 .
6. Kotha SR , Johnson JC , Galea S , Agyei-Baffour P , Nakua E , Asabir K , Kwansah J , Gyakobo M , Dzodzomenyo M , Kruk ME . Lifecourse factors and likelihood of rural practice and emigration: a survey of Ghanaian medical students . Rural Remote Health . 1898 ; 2012 : 12 .
7. Bailey N , Mandeville KL , Rhodes T , Mipando M , Muula AS . Postgraduate career intentions of medical students and recent graduates in Malawi: a qualitative interview study . BMC Med Educ . 2012 ; 12 : 87 .
8. Ageyi-Baffour P , Rominski S , Nakua E , Gyakobo M , Lori JR . Factors that influence midwifery students in Ghana when deciding where to practice: a discrete choice experiment . BMC Med Educ . 2013 ; 13 : 64 .
9. Eyal N , Barnighausen T. Precommitting to serve the underserved . Am J Bioethics AJOB . 2012 ; 12 ( 5 ): 23 - 34 .
10. George G , Gow J , Bachoo S. Understanding the factors influencing health-worker employment decisions in South Africa . Hum Resour Health . 2013 ; 11 : 15 .
11. Willcox ML , Peersman W , Daou P , Diakite C , Bajunirwe F , Mubangizi V , Mahmoud EH , Moosa S , Phaladze N , Nkomazana O , et al. Human resources for primary health care in sub-Saharan Africa: progress or stagnation? Hum Resour Health . 2015 ; 13 : 76 .
12. Mariam DH , Sagay AS , Arubaku W , Bailey RJ , Baingana RK , Burani A , Couper ID , Deery CB , de Villiers M , Matsika A , et al. Community-based education programs in Africa: faculty experience within the Medical Education Partnership Initiative (MEPI) network . Acad Med . 2014 ; 89 ( 8 Suppl) : S50 - 4 .
13. Omaswa FG . The contribution of the Medical Education Partnership Initiative to Africa's renewal . Acad Med . 2014 ; 89 ( 8 Suppl) : S16 - 8 .
14. Kiguli S , Baingana R , Paina L , Mafigiri D , Groves S , Katende G , KiguliMalwadde E , Kiguli J , Galukande M , Roy M , et al. 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 .
15. Klionsky DJ , Abdelmohsen K , Abe A , Abedin MJ , Abeliovich H , Acevedo Arozena A , Adachi H , Adams CM , Adams PD , Adeli K , et al. Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) . Autophagy . 2016 ; 12 ( 1 ): 1 - 222 .
16. Atuyambe LM , Baingana RK , Kibira SP , Katahoire A , Okello E , Mafigiri DK , Ayebare F , Oboke H , Acio C , Muggaga K , et al. 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 .
17. Mubuuke AG , Mwesigwa C , Maling S , Rukundo G , Kagawa M , Kitara DL , Kiguli S. 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. 2014 ; 19 : 382 .
18. Bailey RJ , Baingana RK , Couper ID , Deery CB , Nestel D , Ross H , Sagay AS , Talib ZM . Evaluating community-based medical education programmes in Africa: a workshop report . Afr J Health Prof Educ . 2015 ; 7 ( 1 Suppl 1 ): 140 - 4 .
19. Kiguli-Malwadde E , Kijjambu S , Kiguli S , Galukande M , Mwanika A , Luboga S , Sewankambo N. Problem Based Learning, curriculum development and change process at Faculty of Medicine , Makerere University, Uganda. Afr Health Sci . 2006 ; 6 ( 2 ): 127 - 30 .
20. Talib ZM , Baingana RK , Sagay AS , Van Schalkwyk SC , Mehtsun S , KiguliMalwadde 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 .
21. Wakida EK , Ruzaaza G , Muggaga K , Akera P , Oria H , Kiguli S . Health-profession students' teaching and learning expectations in Ugandan medical schools: pre- and post-community placement comparison . Adv Med Educ Pract . 2015 ; 6 : 641 - 56 .
22. Kiguli S , Mubuuke R , Baingana R , Kijjambu S , Maling S , Waako P , Obua C , Ovuga E , Kaawa-Mafigiri D , Nshaho J , et al. A consortium approach to competency-based undergraduate medical education in Uganda: process, opportunities and challenges . Educ Health (Abingdon) . 2014 ; 27 ( 2 ): 163 - 9 .
23. Silvestri DM , Blevins M , Afzal AR , Andrews B , Derbew M , Kaur S , Mipando M , Mkony CA , Mwachaka PM , Ranjit N , et al. 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 .
24. Amalba A , van Mook WN , Mogre V , Scherpbier AJ . 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 .
25. Johnson JC , Nakua E , Dzodzomenyo M , Agyei-Baffour P , Gyakobo M , Asabir K , Kwansah J , Kotha SR , Snow RC , Kruk ME . 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 .
26. McMillan WJ , Barrie RB . Recruiting and retaining rural students: evidence from a faculty of dentistry in South Africa . Rural Remote Health . 1855 ; 2012 : 12 .