THE ROLE OF COMMUNITY-BASED EDUCATION AND SERVICE (COBES) IN UNDERGRADUATE MEDICAL EDUCATION IN REDUCING THE MAL-DISTRIBUTION OF MEDICAL DOCTORS IN RURAL AREAS IN AFRICA: A SYSTEMATIC REVIEW

Abstract

Introduction: Community-Based Education and Service (COBES) and rural outreach programmes are increasingly being used in the delivery of undergraduate medical education in rural communities to address the disparity of health workers across the world, especially in the developing countries. This systematic review describes whether COBES as part of the undergraduate medical training, aids in addressing the maldistribution of doctors in Africa. Methods: A critical literature search through key data sources identified studies that focused on COBES as an educational intervention which addressed recruitment and retention challenges in Africa. Data are presented as a narrative synthesis due to the varied methodological designs adopted by the various studies reviewed. Results: This review reveals that relatively few medical schools are so far using innovative curricula incorporating COBES and rural outreach programmes to train medical students with the hope that they will opt for rural practice after graduating. Given the gaps in human resources for healthcare especially in the rural areas and lower levels of service delivery in Africa, students’ contributions to health delivery at facilities and in communities are expected to bridge the gaps in services delivery at the primary health care level. Some medical schools from African countries, have consequently scaled up their rural components in the undergraduate curricula, thus responding to changes in health and making medical education more relevant to the needs of rural communities. There is now increasing evidence that COBES and rural outreach programmes are indeed making an impact on health services delivery in the rural areas. Graduates of institutions that incorporate COBES and rural outreach programmes have testified that their present practice location in the rural communities was influenced by the undergraduate rural exposure through COBES. There is growing evidence that exposure of health professions students, especially medical students, to the rural areas influences their eventual choice to work in the rural areas after graduation.