Transformative Education
for Health Professionals

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Designing for impact; The University of Zimbabwe College of Health Sciences (UZCHS) rural attachment programme.

Designing for impact; The University of Zimbabwe College of Health Sciences (UZCHS) rural attachment programme.

Julian Fisher (JF) interviews Dr Antony Matsika (AM) about the University of Zimbabwe College of Health Sciences (UZCHS) rural attachment programme.

JF; We are currently running a poll in the Transformative Education LinkedIn group “should strengthening the health workforce through the appropriate and effective supervisory and service linkages between health professional, mid level and community health workforce be a priority ?”

From your perspective, has the UZCHS rural attachment programme impacted on the supervisory and service linkage between health professional, mid level and community health workforce ?

AM; Our programme is producing high caliber health professionals who hold key positions in health sector and are making an important contribution to health services and care delivery. However although we have 34 publications in peer reviewed journals, there is still weak evidence in terms of this specific impact.

But I agree that appropriate and effective supervisory and service linkages between health professional, mid level and community health workforce are critical to serving the increasingly complex and diverse needs of both our rural and urban communities in Zimbabwe.

The UZCHS rural programme is enabling the College to produce graduates who are team players and can articulate and solve health problems. They can be able to (1) identify the main health problems in Zimbabwe (2) provide competent, relevant and integrated health care at district level (3) plan, organize and teach health care appropriate to the needs of the various communities (4) find the provision of community oriented health care challenging and satisfying.

 Click to view video

Mr Antony Matsika describes UZCHS rural attachment programme, highlighting some of the challenges and solutions that they are implementing. 

JF: One of the challenges you note is that the UZCHS programme identified that ‘having a rural background might not necessarily mean one would be motivated to go back for a clinical practice in the rural area’.

AM: I think the video captures some of the challenges that we are facing and they are not unique to our situation in Zimbabwe. Poor local community infrastructure, in terms of inadequate accommodation and bedding, for example at Murehwa, which has a complex of 10 rooms shared on rotation by several groups e.g. nurses, environmental health officers, physiotherapists and medical students. This venue also has erratic water and electricity supply.

A three key aspects are:

i. Fewer professional growth opportunities; the lack of access to resources / facilities for continuation of study while the students are in the community, particularly the lack of internet connectivity and distance learning opportunities, as the majority of hospital staff have ongoing research and professional studies.

ii. inadequate supervision and mentoring, which affects the number of students deployed at each site.

iii. Family considerations, as well as career progress as professional development is deemed faster in urban areas.


JF; I understand that you are working with the Medical Education Partnership Initiative (MEPI) to implement solutions?

AM; Yes, MEPI has renovated the hostels including repainting, retiling, plumping and carpentry, curtaining and purchased mattresses. A 10000 litre tank has been installed at Murehwa to easy erratic water supply.

MEPI is also planning to establish Internet connectivity to facilitate access to e-resources, online studies and other research.

Through partnership with Stanford University MEPI Zimbabwe is planning to make available tablets to students going on the rural field attachment. The tablets will be loaded with SMILE (e-learning technology), e-granary and other resources, such as Khan Academy resources. Eventually when there is sustained internet connectivity there are plans to introduce distance learning.

We are also implementing training of District Medical Officers in supervision and mentoring.


JF; What if any has been the impact of the programme on faculty leadership and development?

AM; Through MEPI our faculty has been participating in faculty development workshops, covering various topics in teaching such as multiple choice questions, mentoring and supervision, student assessment, team-based learning, adult learning, Presentations.

Although these areas are not directly for rural attachment, the various topics covered are very relevant for capacity building and development of our faculty.

JF; You highlight the issue of sustainable funding, how has the UZCHS rural attachment programme ensured a secure and regular flow of funds?

AM: Some challenges highlighted above have to do with inadequate financing of the field attachment programme. Currently the programme is partly financed by students’ fees through a $20 field attachment fee charged to every medical student.  The funds have not been enough to meet the students’ needs in the field, such as maintenance of hostels, transport, internet etc. A proposal was made by the College to increase the field attachment fee to $150, however it was noted that most students were finding it difficult to raise the required tuition fees and therefore would be a burden to make them pay additional rural attachment fees.

The engagement of MEPI has helped to easy transport problems, as they have provided a 32-seater bus to carry students to field sites. In addition at two sites - Murehwa and Howard Hospitals-  students accommodation have been renovated as pilot sites for scaling up community Based Education (CBE). There are also plans to establish Internet connectivity at the sites. However there are inadequate funds to expand this initiative to other training sites.


JF; Does UZCHS have plans for scaling up the rural attachment programme?

AM: There are plans to scale up programmatic aspects of CBE. Because of low resources the same cannot be said about infrastructural expansion, such as accommodation for students.

The following programmatic scaling up has started:

- Transition from field attachment to CBE concept.

- Partnership with Capacity Plus to do a peer review of the rural attachment/CBE.

- Review of the curriculum to include best/good practices of CBE from other schools, which is more competency based i.e. expand and include other relevant areas/topics, such as family medicine and longer period of attachment.

- Training of District Medical Officer’s on supervision and mentoring to make it easy for them to supervise and mentor.

- Involve MMeds in the rural attachment, who can provide backup clinical services and supervision at the two sites, so that the numbers and time for supervision can be increased.

- Evaluate the CBE programme.


Details about the UZCHS rural attachment programme:

2 Major components of field education

1. Undergraduate Field Attachment

  1. 2nd year students go on field attachment for 4 weeks: Students gain exposure through immersion in rural communities (meeting families, traditional healers, faith-based healers, herbalists, Chiefs, Councillors etc). The method of learning is through special surveys, observations, group discussion and meeting key informants.
  2. 3rd year students spend 4 weeks in district hospitals and deals with Health Systems and Health Planning through understanding health problems in the district and their epidemiology. The method of learning is through review of available health information, interviews with patients and visits to Primary Health Care facilities.
  3. 5th year students also spend 4 weeks at district hospitals. The main focus of learning is on competently managing major health problems. The method of learning is through participation in patient care in the hospital and other activities. In addition they do outreach programmes and auditing of at least one health activity.  
  4. Assessment of students includes field supervision, feedback presentations, reports write up. No student will graduate without passing field attachment

2. Masters in Public Health

*     Established in 1993

*     Competency based training

*     30% classroom teaching

*     70% on the job training

*     Field training sites (15) are provided by Ministry of Health &Child Care

*     Use of programme graduates as field supervisors.

*     Use of guest lecturers from development sector.

*     Thesis development based field investigations.

*     Six core activities supervised and mentored by field supervisors.

*     Topics covered include: outbreak investigation, surveillance system evaluation, management and health economics, program evaluation, secondary data analysis, field study








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