Perceptions and valuation of a community-based education and service (COBES) program in Uganda

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Abstract
Community-based education and service (COBES) has been promoted to improve the education of health professionals, particularly in low-resource settings. However, few evaluations have been performed to guide program development. This study assessed student and educator perceptions and valuation of a Ugandan COBES program. We administered an internet-based survey to students, faculty, and site tutors associated with the Makerere University College of Health Sciences COBES program. 255 surveys were completed. Response rates varied (students, 188/684, 27.5%; faculty-site supervisors, 15/23, 65.2%; faculty general, 38/312, 12.2%; site tutors, 14/27, 51.9%). Students valued the COBES program (93.5% some/high value). Tutors enjoyed their work (92.9% agreeing/strongly agreeing). Faculty (n = 53) felt COBES was valuable (90.2% agreeing/strongly agreeing). High student valuation was associated with high quality accommodation (aOR 4.7, 95% CI = 1.6-13.4), free accommodation (aOR 2.9, 95% CI = 1.2-6.8), and tutors who demonstrated enthusiasm for teaching (aOR 3.4, 95% CI = 1.1-10.0). Areas identified for improvement included financial support, student preparation, and tutor training, feedback, and supervision. In this study, COBES was perceived positively by students and educators and learning environment and quality of teaching both contributed to valuation of COBES. Well-implemented COBES programs may offer an opportunity to enhance health sciences education.