Facilitators and barriers to implementing a community rotation to the internship training in Kenya
Date of Award
Master of Medicine (MMed)
Dr Fleur De Meijer
Dr Adelaide Lusambili
Dr Catherine Gathu
Family Medicine (East Africa)
Background: Primary care is increasingly being prioritized all over the world more so in developing countries in an effort geared towards achieving health equity. The availability of skilled human resources at the community level has been shown to improve health outcomes. However, doctor numbers remain low in sub-Saharan countries. Kenya’s policy on universal health coverage aims to enable access to essential health services by all its citizens by 2022. The introduction of community placements among undergraduate medical students has proven beneficial in understanding community health problems, the role of primary care in health as well as increasing the likelihood of pursuing a primary care career. However, the implementation of these placements has not been without challenges. Medical interns in Kenya starting in 2020 have a newly introduced community health rotation with a goal of equipping the doctor with community intervention skills, community follow-up, and preventive as well as promotive health skills. There is a need for evidence-based information to guide policymakers and implementing parties to improve the rotation. This work serves as the first step aimed at achieving this goal.
Objective: To describe the successes and challenges the medical officer interns and their preceptors encountered in the implementation of the community health rotation.
Methods: An exploratory qualitative study was conducted using online in-depth interviews. Participants included community health rotation preceptors and medical officer interns in four internship centers. The interns were within three months to completion and six months after the conclusion of their internship. The interviews were audio-recorded, transcribed verbatim and thematically analyzed via NVivo software.
Results: Thirteen online in-depth interviews were conducted via Zoom in four internship centres, two urban and two rural. The six themes that emerged from the analysis were: (a) communication before community rotation implementation, (b) implementation during the COVID 19 pandemic, (c) contribution to the development of primary care competencies, (d) dynamic rotation implementation (e) limited community health exposure before internship and (f) implementation of community rotation dependent on local resources. Contribution to the development of primary care competencies, dynamic rotation implementation and the use of technology for patient follow-up during the COVID 19 pandemic were identified as successes in the implementation of the community rotation. Conversely, insufficient communication before the implementation of community health rotation, limited community health exposure among medical graduates before internship as well as fear of getting or spreading COVID 19 were challenges experienced by the participants.
Conclusion: The implementation of the community health rotation was characterized by successful preceptor communication with the interns and innovative community follow-up strategies in the era of COVID 19. On the other hand, opportunities exist for stakeholder engagement and communication by the government and strengthening of the undergraduate medical training in community health competencies.
Kioko, P. M. (2022). Facilitators and barriers to implementing a community rotation to the internship training in Kenya (Unpublished master's dissertation). Aga Khan University, East Africa.