Assessment of the community-based training

programme at Jimma University, Ethiopia

Mulatu Tegegne, Makonnen Asefa, Fasil Tessema, Kumsa Kebede
Abstract: Many educational institutions are showing growing interest in evaluating
the process and outcome of their curricula due to a sense of obligation and social
accountability. Accordingly, a study was carried out to assess the performance of an
innovative programme at the process level at Jimma University (formerly Jimma
Institute of Health Sciences). In the study, students, community leaders and
community members were involved. For data collection, both structured and nonstructured formats were used. The majority of students with a mean score of 3.66 and
82% of community leaders had adequate orientation and knowledge about the concept,
principles, and objectives of a community-based training programme (CBTP). About
88.0% of community members were aware of CBTP activities but did not seem to
know well its objectives. Most members of the study groups had expressed a positive
attitude towards CBTP. According to the students, orientation and attitudes of their
supervisors/teachers towards CBTP and the support of the CBTP coordinating office
was not satisfactory. Implementation of action plans of the different activities of
CBTP
was low due to shortage of resources and poor follow-up. Despite these shortcomings
all groups agreed to have benefited from CBTP. All groups also supported the
continuity of the programme. Suggestions are made on possible measures to be taken
by the University to remedy the problems encountered in the programme. [Ethiop. J.
Health Dev. 2000;14:239-252]
1. Introduction
Jimma University (JU), formerly Jimma
Institute of Health Sciences (JIHS), is an
innovative education center. Its educational
strategy is community-based education
(CBE). This strategy is applied through the
following programmes. Community-based
training programme (CBTP) embraces
students learning activities in communities
(urban/rural 'kebeles).
Students are
assigned in-groups for one month followed
___________________________________
Jimma University, P.O. Box 378, Jimma, Ethiopia

by a regular follow-up every year during

their entire education period (1). In the
Team Training Programme (TTP), different
categories of health science students are
assigned to work for 10 weeks at Training
Health Centers (THC) as a team during their
final years. The student health team based
on community diagnosis renders promotive,
preventive, curative, and rehabilitative
services for the catchment population (2). In
the Student Research Project (SRP), final

240 Ethiop.J.Health Dev.

year students carry out independent research

projects that enhance their skills in problem
identification and proposing of solutions..
The study is community-based and actionoriented (3).
JIHS, like other similar institutions, has gone
through several difficulties during the imple
mentation of the new curriculum: resource
shortage, teachers' resistance (almost all
being trained in traditional schools) which is
still rampant, and student anxiety. Despite
all these hurdles, it has graduated 10 cohorts
of medical students since 1991.
However the University has not comprehensively evaluated its curriculum up to
now. JU (the new university) needs such
information to review and develop its
curriculum. Cognizant of the above facts,
the University has attempted to evaluate its
innovative programmes as presented in this
study.
Currently CBTP is being practiced in 26
urban and 39 rural kebeles. JIHS has been
trying to implement CBTP since 1985/86.
2. Methods and Materials
2.1 Study design, area and period
A cross-sectional study on the performance
of CBTP at Jimma Institute of Health
Sciences (now Jimma University) from the
perspectives of students of the Institute,
leaders, and members of communities in
Jimma and Seka Towns, and three rural
kebeles from four districts where more than
one CBTP attachment was conducted from
November 13, 1999 to January 8, 2000.
2.2 Population and sample
In this study the population consisted of
students of the University, community

members and leaders of the kebeles where

CBTP is being practiced.
2.3 Sampling technique
Samples for students were divided among of
each medical students year and graduating
post-basic students1 using probabilityproportional-to-size technique. Every 2nd
student was selected from an alphabetical list
and 195 students were selected in this
manner.
A total of 13 kebeles were selected randomly
among the different kebeles where more than
one CBTP attachment have been conducted
by students who are found in Mana, Kersa,
Deddo, and Chekorsa Districts. A total
sample size of 768 households was
distributed among the sampled kebeles using
probability- proportional-to-size allocation
technique and the study households were
selected systematically using house numbers
as identification. All community leaders
(chairpersons) of each sampled kebele were
included in the study.
2.4 Measurements
A pre-tested questionnaire consisting of both
structured and non-structured questions was
used for data collection. For students, the
questionnaire consisted of 55 questions on
KAP, actual activities of students,
performance assessment, and felt advantages
and disad vantages on CBTP.
The
questionnaire for community members
consisted of 24 questions focusing on soicodemographic characteristics and pertinent
questions on 'KAP' of CBTP. For the
community
__________________________________________
1
Post basic students were diploma graduates in nursing
and environmental health. After service, they joined
nursing, environmental health, and public health
programmes to earn baccalaureate degrees after being
trained for 2 years in each area.

Assessment of acommunity-based training programme

241

leaders, the questions were focused only on

'KAP' assessment of CBTP based on 28
questions.
For those variables where
summary values were computed, a fivepoint scale was used to measure the
variables: 1=Very poor, 2=Poor, 3=Fair,
4=Good and 5=Very good. Or 1=Strongly
disagree, 2=Disagree, 3= Neutral,
4=Agree, and 5=Strongly agree.
2.5 Data collectors, data collection, and
supervision
A self-administered questionnaire was used
to collect data from students. For the
household level data, head of households or
elder member of the families and community
leaders were interviewed.
For the
community level data, data collectors were
selected based on their ability to speak the
local language, familiarity to local practices,
and having completed 12th grade education.
After the selection of data collectors, training
was given on the data collection instruments
and procedures to be used during selection of
study subjects. The data collectors were
strictly supervised by the principal
investigator during the whole period of data
collection.
Community leaders were
interviewed by the principal investigator.
2.6 Data analysis and processing
Data were entered into computer and routine
checking and cleaning of the data was made.
Both descriptive and analytical, methods
were used to analyze data using SPSS 7.5.1
for windows. During the analysis chi-square
test and analysis of variance (ANOVA) were
used and p-values below 5% were considered
to be statistically significant.
3. Results
3.1 Students
The sample of 179 students, (136 medical or
M and 43 graduating post-basic or PB) were
interviewed with a total response rate of

90.9%, (89.5% for medical and (96.0% for

graduating post-basic students) (Table 1).
3.1.1 Knowledge and attitude towards
CBTP
The overall students' evaluation of their
knowledge and orientation on the concepts,
principles, and objectives of CBTP was
found to be more than average (3.67) in a
five-point scale. Though not statistically
significant, post-basic students scored higher
in their attitude compared to medical
students. Students agreed on the fact that
CBTP was problem-oriented with good
correlation between classroom teaching and
community attachment with no variations on
mean score between schools (Table 2).
Only 27% of the students believed that all or
most supervisors had adequate orientation
and knowledge about CBTP. A further
57.5% believed some of the supervisors had
adequate orientation and knowledge. Only
27% of the students believed that all or most
supervisors had positive attitude towards
CBTP, and 55.3% believed some of the
supervisors had positive attitude towards
CBTP.
3.1.2 Performance during CBTP
Although students overall rate was fair
(mean score was 3.15) about their efforts of
awareness creation to the community on
CBTP,

242 Ethiop.J.Health Dev.

Table 1: Distribution of students by category, academic year, and response rate, JU, March 2000
Category of students

Academic
Year

Total No. of student of

each class

Sample size
determined

Response rate from each

year
Number

81

40

36

90.0

70

35

27

77.1

66

33

30

91.0

46

23

23

100.0

42

21

20

95.2

Sub-total

305

152

136

89.5

Nursing

26

13

13

100.0

Environmental Health

20

10

10

100.0

Public Health

44

22

20

91.0

Sub-total

90

45

43

96.0

395

197

179

90.9

Medical

Post-basic students

Total

medical students' performance was low.

Students ratings about their efforts towards
discussing each of the CBTP activities with
the community so as to make the community
members participate in the various processes
of identifying, prioritizing and planning the
community problems was less than average
with no significant variation among the
different categories of students (Table 3).
Though the overall community participation
was low on prioritization, planning,
implementation, and evaluation of CBTP
activities, most community members were
cooperative and showed good participation
during data collection. Support from health
sector institutions for CBTP, working
relation of students with supervisors

and with community leaders were found to

be good according to students evaluation.
Furthermore students agreed that the overall
supervisors effort to make CBTP fruitful in
general was less satisfactory with a mean
score of 2.69, but students ratings on the
efforts of all students to make CBTP fruitful
was average with a mean score of 3.10.
Of the total students included in the study,
138 (77.1%) of them (98 medical and 40
post-basic students) claimed that they have
committed themselves in collecting efficient
and reliable data during their CBTP
attachment.

Assessment of acommunity-based training programme

243

Table 2: Summary of students ratings related to their knowledge and attitude towards CBTP, by school., JU, March 2000
Schools Mean Scores
Measurements
M

PB

F-test

P-value

Overall
mean

Your Orientation about the concepts, principles and objectives of

CBTP

3.69

3.63

3.68

0.13

0.715

Your attitude towards CBTP

3.24

3.63

3.34

3.14

0.064

CBTP is problem-oriented

3.50

3.23

3.43

1.79

0.183

3.26

3.09

3.22

0.84

0.360

Correlation between classroom teaching and community practice

M= medical

PB= Post-basic

of CBTP office.
Among the students who have implemented
all, most and/or few of their action plans,
75.9% were implementing immunization
practice, 68.7% MCH/FP practice, and
61.5% environmental health activities.
Among the students who responded to have
implemented none of their action plans,
87.2% indicated the absence of follow-up
system to be the reason for their failure;
other reasons mentioned were lack of
resources and lack of support from the
Institute.
On issues related with the CBTP
coordinating office, time allotted for the
program and transportation facility were
rated fair or more than fair. However postbasic students rating for adequacy of time
was significantly different from medical
students, believing it was insufficient.
Students were equivocal about the food,
stationery, and other supplies (Table 4). On
the remaining items related to CBTP office
performance, the rating was below average,
including equipment and chemical supply
(2.58), general organization and coordination
(2.57), supervision quality (2.40), follow-up
system (2.01), and evaluation system (2.09)

3.1.3 General assessment of advantages

and disadvantages of CBTP
According to the overall students judgement,
the advantages of CBTP were (Table 5):
1. Understanding of the communitys health
problem
2. Advantage for research endeavors
3. Good sense of social responsibility
4. Holistic professional competence
5. Good leadership quality
6. Generating of database for the Institute
7. Complementing of health services for the
Zonal and District health facilities
8. Sensitization of community about health
issues
9. Solving communitys health problems
Ninety percent of medical, 92.7% of postbasic, and 90.7% of the whole group
believed that CBTP should be modified,
mainly by restructuring CBE with no
statistically significant differences between
schools. Only four students stated that
CBTP should stopped. Students also
suggested computer training as a prerequisite
course for CBTP.

244 Ethiop.J.Health Dev.

Table 3: Summary of students ratings related to their performance during CBTP attachement, by school., JU, March 2000
Schools Mean Scores
Measurements
M

PB

F-test

P-value

Overall
mean

Efforts of supervisors to make CBTP fruitfull

2.71

2.67

2.70

0.04

0.85

Efforts of students to make CBTP fruitfull

2.99

3.42

3.10

5.17

0.024

Your participation in the development of format for each

CBTP,

2.93

3.14

2.98

0.92

0.34

Your effort towards creating awareness to the community

about objectives, principles, and concepts of CBTP

3.05

3.44

3.15

4.66

0.03

Your effort towards discussing the results of each CBTP

activity to the community members concerned

2.63

2.76

2.66

0.41

0.52

Community participation in all activities of CBTP, including

data collection prioritization of problem, planning, and
implementing

2.76

2.47

2.69

2.60

0.10

Support of health sector institutions for CBTP activities

3.11

3.12

3.11

0.00

0.98

Your working relationshiop with supervisors

3.12

3.09

3.11

0.02

0.89

Your working relationship with community leaders

3.68

3.77

3.70

0.46

0.50

M = Medical

PB = Post-basic

3.2 Community Members

From a total of 786 community members,
720 participated in the study with a response
rate of 93.8%, 92.2% for urban and 95.3%
for rural kebeles. In the rural kebeles 68%
were illiterate and 76% were farmers. In the
urban kebeles illiterates were 3%. By
occupation, they were mainly merchants
(40%),
farmers
(33%)
government
employees (5%).
3.2.1 Knowledge, attitude, and practice of
community members
The majority of the community members
(87.9%) (i.e., 315 or 88.9% from rural and
318 or 86.8% from urban kebeles). were
aware of the presence of community based
training program activities in their kebeles
by students of JIHS. The rural people were
significantly different from those of their
urban counterparts in their knowledge about
the objective of students CBTP activity in
their kebele, i.e., 220 (69.8%) from rural

and 254 (79.8%) from urban kebeles were

found to be knowledgeable about the
objective of CBTP. However, a significant
proportion of those who claimed to know the
objective of CBTP mentioned mixed wrong
and right objectives when they were asked to
state it. Only 99 (31.1%) of the rural and
104 (33.0%) of the urban community
members were aware of the results of
students' studies in their CBTP attachment.
Of those who had knowledge about students
findings, only 22 (21.2%) of the rural and 14
(14.1%) of urban community members had
participated in discussing their problems, in
priority setting and in planning with students.
Students level of understanding of the
community health problems was rated more
than fair by 538 (85.0%) of the community
members, ie, 271 (86.0%) for rural and
267 (84.0%) for urban

Assessment of acommunity-based training programme

245

Table 4: Summary of students ratings related to the performance of CBTP Coordinating Office, by school. JU, March 2000
Schools Mean Scores
F-test

Measurements
M

PB

P-value

Overall
mean

Time allotted to the programme

3.47

2.63

3.27

26.69

0.000

General organization and coordination

2.58

2.53

2.57

0.06

0.801

Follow-up systems of the programme to implement action

plans

2.00

2.05

2.01

0.07

0.79

Students evaluation system

2.19

1.80

2.09

4.43

0.037

Supervision quality

2.48

2.16

2.40

3.42

0.066

Transportation

3.48

3.74

3.54

2.48

0.117

Food

2.87

2.81

2.85

0.09

0.76

Stationery

3.05

2.88

3.01

0.93

0.34

2.61

2.51

2.58

0.29

0.59

Others (equipment, chemicals, etc.)

M = Medical

PB = Post-basic

communities. Students general interaction

skill was also rated more than fair by 589
(93.0%) of the community members, i.e.,
290 (92.1%) for rural and 299 (94.2%) for
urban community members. Five hundred
sixteen (81.5%) of the community members,
i.e., 261 (82.1%) from urban and 255
(80.9%) from rural, were not aware whether
teachers/supervisors had been involved in
CBTP activities with students. The urban
people showed relatively greater feeling of
discomfort due to the repeated visit of
students, although the percentage was small,
ie, (58 or 9.2% of the community members:
16 (5.1%) of rural and 42 (13.2%) of urban.
Five hundred eighteen (81.8%) of the
community members believed on the future
benefits of CBTP even if it continues at the
present level.
Five hundred thirty five (74.3%) of the
community members suggested the
collaboration
of government, health
professionals, and the community to be
effective in handling public health problems.

3.3 Community Leaders

A total of 11 community leaders were
interviewed out of the expected 13
community leaders (one from each kebele).
The rural community leaders were farmers
while the urban were merchants and
government employees and all of them were
literate.
3.3.1 Knowledge, attitude, and practice of
community leaders towards CBTP
Nine (82%) of all the community leaders
were well aware of the concepts, principles,
and objectives of CBTP. Eight (72%) of
them had good attitude towards CBTP, three
of them were not favoring CBTP stating that
nothing was done to them by the presence of
the programme. The majority of them knew
the objective of CBTP.

246 Ethiop.J.Health Dev.

Table 5: Summary of students ratings related to advantages of CBTP to the students and the community, JU, March 2000
Schools Mean Scores
Measurements

F-test
M

PB

P-value

Overall
mean

Some of the health problems of the community were

solved

2.57

2.85

2.64

1.32

0.25

Community is sensitized about health and health related

issues

3.04

3.29

3.10

1.43

0.23

It enables the student to know more about the community

health problems

3.98

4.24

4.04

2.98

0.09

It enables a student to gain a sense of social responsibility

at large

3.90

3.90

3.90

0.00

0.98

It has tremendous advantages of knowledge and skills

relevant to research

4.02

4.05

4.02

0.047

0.83

It enables a student to have a holistic professional

competence

3.62

3.69

3.64

0.18

0.69

It enables students to gain good leadership quality

3.67

3.45

3.62

1.52

0.22

Helps to generate a database for research and planning

purposes

3.48

3.67

3.53

1.03

0.31

Helps Zonal and District health facilities in complementing

services

3.23

3.33

3.25

0.33

0.57

M = Medical

PB = Post-basic

All of them perceived the problems identified

by students as their real problems.
Communication with JIHS was through
official letters. Nine (82%) of them had the
experience of discussing, prioritizing, and
planning on the identified health problems.
Three of the community leaders (all from
rural) used to discuss about CBTP with
community members.
Some of the benefits mentioned by
community leaders were:
- Construction of safe water supply
- Construction of community health post.
- Construction of latrines.
- Health education.
- Treatment for minor illnesses.
- MCH/FP practices, and
- Immunization of children and mothers.

The majority of them believed that the

community members generally had favorable
attitude towards the presence of students in
their kebele. Only one community leader
believed that the community members were
offended because of repeated visits of
students for nothing. Most of them used to
cooperate with students by facilitating
activities to students and giving all the
necessary information they wanted. All of
the leaders communicate to the institute only
during students' CBTP attachment. No
problem has been encountered because of
students' presence. Nine of the community
leaders believed that their kebele would be
benefiting if other students continue with a
similar activity. Two of them stated that
even though their kebeles did not benefit
and may not be

benefiting in the future, they believe CBTP

has value because of the fact that the students

are trained well, and directly or indirectly,

help the community in general. All of them

Assessment of acommunity-based training programme

247

agreed that the government, health

professionals, the community, and the
development sectors and other professionals
should work together to solve the
communities health problems in general.
4. Discussion
4.1. Knowledge
When analyzing findings from all the
participants of the study, the majority of
students with a mean score of 3.66 and 82%
of community leaders were found to have
adequate orientation and or knowledge about
the concept, principles, and objectives of
CBTP. Most community members were
aware of the presence of CBTP activities by
students of JIHS in their respective kebeles.
However community members did not seem
to know well the objectives of CBTP since a
significant number of them mentioned either
a wrong or both wrong and right objectives
of CBTP. Literacy and occupational status
were significantly associated (p < 0.001 and
p=0.019, respectively) with community
members' knowledge about the objectives of
CBTP.
Other
socio-demographic
characteristics
were
not
associated
significantly to community members'
knowledge of the objectives of CBTP.
In general, the following were knowledge
related findings of the present assessment.
- Only 28% of those 11 community leaders,
used to discuss about CBTP with their
community members (all from rural
community).
- Students effort in awareness creation
Most community members (88.8% from
rural and 74.8% from urban) believed CBTP
to be beneficial even if it continues in a
similar manner. Most community leaders
share this opinion. Majority of students also
suggested to modify CBTP rather than

about CBTP to the community was only

about average (mean = 3.15) with a
better effort by post basic students
- Students' effort in discussing about their
CBTP findings with the community was
found to be low with a mean score of
2.66
- According to students opinion, the over
all effort of students and supervisors to
make CBTP fruitful was not to the
expected level with a mean score of 3.10
and 2.70, respectively.
- 68% illiteracy rate among the rural
community
All the above findings indicate that there is a
need for a concerted effort among students,
supervisors, CBTP coordinating office,
community leaders, and the education sector
in raising the awareness of the community
members on CBTP.

4.2 Attitude
The majority of students with a mean score
of 3.31 and 82% of community leaders had
positive attitude towards CBTP. Twenty
four percent of the students had poor and
very poor outlook to CBTP and 78% of these
students gave inability to implement action
plans due to low resources as their reasons
for their poor outlook. Few community
leaders also mentioned that CBTP could not
help their kebeles because of low
implementation. Most community leaders
believe that most community members have
greater than fair outlook towards CBTP.
completely stopping which were indicatives
of their fair attitude. In general, students,
community leaders and community members
had positive attitude towards CBTP despite
the low implementation rate.

248 Ethiop.J.Health Dev.

Students rated more than average on the

correlation of classroom teaching and CBTP
and agreed on the fact that CBTP was
problem-oriented. In general students had
positive attitude for the different aspects of
CBTP with no statistically significant
difference between the two groups
(p=0.064).
Weaknessess
mentioned
on
CBTP
supervision support is a formidable task
which challenges the program.
The
weaknesses mainly arise due to rapid
turnover of staff of the University which is a
common occurrence in rural-based tertiary
level education centers in the country. This
has resulted in losing the relatively well
oriented and motivated ones in an unabated
rate. This issue needs to be addressed by all
concerned at a country level. Similar
problems were observed in other African
countries (10). Helpful measures to be taken
by the University include assessment of staff
attitude during recruitment, continuous
orientation to staff members through
workshops, and relieving staff from routine
academic
activities
during
CBTP
supervision.
4.3 Performance
Eventhough most students rated to have good
knowledge and positive attitude about CBTP,
students' performance was below average on
most of CBTP activities. The following were
reflections of their performances.
- Students effort in the development of
formats in each CBTP attachment was
Analysis of results from students, community
members and community leaders showed that
community participation in most activities of
CBTP (including, discussion of their health
problems with students, prioritizing
problems,
planning,
monitoring,
implementation and evaluation of their work)
was low.
This was reflected in the

rated 2.98
- Students' effort in awareness creation about
CBTP to the community was 3.15 with a
better performance among post- basic
students
- Students effort in discussing the results of
each CBTP activities with the community
was 2.66
- Students rating about the general efforts of
students to make CBTP fruitful was
average (3.1), however, post-basic
students rated relatively greater than
average (3.42)
Despite the above deficiencies of students
performances, their working relationship
with supervisors, community leaders, and
the community was good. Support from the
health sector was fair. Students effort in
quality data collection and awareness
creation about CBTP to the community was
found to be more than fair. Studies on
innovative schools in Africa showed similar
findings (12,15).
The majority of the students believed that
most of their supervisors had no adequate
orientation and/or knowledge and positive
attitude towards CBTP with no significant
variation among the different categories of
students. The general efforts of supervisors
to make CBTP fruitful were also rated less
than average (2.69) by majority of students.
Moreover, only 19% of the rural and 28% of
urban community members were aware of
supervisors' involvement in CBTP.
following:
- Students' rating about community
participation was below average 2.69.
- A less satisfactory communication
between the community leaders and
community members was observed. The
majority of the community leaders did
not develop the tradition of discussion

Assessment of acommunity-based training programme

249

with
the
community
members.
Furthermore, all community leaders
have never been asked about CBTP from
their community members.
- Only 31.1% of rural and 33.0% of urban
community members were aware of the
students findings of CBTP in their
kebeles. Furthermore, only a small
percentage (17.7) of those aware of the
identified problems had participated in
planning solutions.
Despite a very low level of discussing,
prioritizing, and planning experience about
their problems, a good percentage of the
community members (rural 74%, urban
61%) responded to have known about the
presence of health-related benefits from the
programme. The majority of community
members were also not experiencing
discomfort due to repeated CBTP
attachments. This could be due to the
positive perceptions of community members
about the benefits of CBTP.
The rural people compared to their urban
counterparts were better pre-informed and
knowledgeable on CBTP and felt less
discomfort
by
studenst
repeated
attachments. This could be partly explained
by the relatively low health service
coverage in the rural kebeles.
The
participation of other sectors except health in
CBTP activities was low.
Possible
explanation could include the sparseness of
other sector agents at the kebele level. This
needs a concerted effort by students and the
community to take the issue at the district
level where all sectors are represented.
The majority of the students rated the
performance of CBTP coordinating office as
less than average (<3) in most of the
office's activities: general organization,
coordination, follow-up system, evaluation

system, supervision quality, some logistics

and supplies. It is known that CBTP has an
in-built evaluation mechanism at the end of
each attachment but only 7.9% of all
students knew about the results of the yearly
programme evaluation. The office did not
seem to have the experience of discussing
about program evaluation (feedback) with
students. It was also found that only a small
percentage of the community (12.5%) was
informed before students went to each kebele
for CBTP attachment.
Lack of
encouragement from CBTP office was
claimed to be the major reason for the poor
experience of intersectoral collaboration.
Imple-mentation failure which was ascribed
to the poor performances of students in many
of the activities was found to be due to lack
of facilitation of follow-up programs to
students by the office according to majority
of students judgment. The majority of
community leaders also had mentioned that
their communication with the Institute was
only during CBTP attachment and only few
of them had personal communication with
the officers of CBTP coordinating office.
4.4 Advantages and disadvantages of
CBTP from the perspectives of students,
community members and community
leaders
Despite the low performances by the
different parties, the majority of the students
agreed that CBTP had several advantages to
themselves: enabling them to gain a sense of
social responsibility and to acquire
knowledge and skills in community-based
research. Moreover, 85% of community
members felt that students were good in
understanding community health problems.
Most community leaders also had the same
impression. About 75% of the rural and
61% of the urban community leaders
reported as having benefited from CBTP.
The rural people were better both in their

250 Ethiop.J.Health Dev.

knowledge and experiencing the benefits.

The major benefits they mentioned were
immunization, FP/MCH activities and
constructions of latrines and springs.
Moreover, the majority of community
members and most community leaders
agreed that CBTP would benefit them even if
it continues in a similar manner. Farmers
had better faith in the future benefit of
CBTP. The limited benefit they experienced
from the CBTP activities had relatively
impressed them because of their poor access
to health services.
Students did not accept claims that CBTP
may have disadvantages and objected any
suggestion of its discontinuation even though
they felt the need for some modification.
Implementation of action plans is a problem
in poor communities. Studies in similar
schools
in
Africa
had
identified
organizational and financial problems as
obstacles to such programmes (10, 15).
Attempts should be made to develop the plan
within local resources. But there should also
be an attempt by the University and other
stakeholders to contribute to the needed
resources the shortage of which hinders the
intended performance of CBTP by all
involved (16,17).
5.1.6 Most community members and leaders
showed favorable attitude to students and
they appreciated some of the health benefits
they experienced and would like the
programme to continue in the future.
5.1.7
When combining students,
community leaders and community
members evaluation, it appeared that CBTP
had many advantages to the students and
some advantages for the community, despite
the problems mentioned above.
All
respondents (students, community leaders,

5. Conclusions and Recommendation

5.1 Conclusion
5.1.1 Students knowledge and attitude
towards the general concepts and principles
of CBTP was found to be generally good.
However students disagreed with the point
that some of the health problems of the
studied communities were solved by CBTP.
5.1.2 Ratings of the majority of students
showed that supervisors had inadequate
orientation/ knowledge, poor attitude and are
less committed to the successful achievement
of the objectives of the program. This fact is
also strengthened by the finding that only a
minority of the community members were
aware of the involvement of supervisors,
though supervisors are supposed to be
continuously involved in CBTP program.
5.1.3 Students actual experience in CBTP
attachment revealed that their performance
was in general below average.
5.1.4 Generally students had good working
relationship with community leaders and
community members with a fair support
from health sector institutions.
5.1.5 According to the students evaluation
the CBTP coordinating office had been
ineffective in performing its activities.
and community members) agreed that CBTP
should continue in the future with
modifications in its organization and
function.
5.2 Recommendations
The following recommendations are given in
view of the above findings:
5.2.1 Restructure CBE by establishing a
university CBE board, represented by each
faculty.

Assessment of acommunity-based training programme

251

5.2.2 CBE should be autonomous, headed

by a vice president, and with relevant
manpower, facilities and budget.
5.2.3 There is a need of sub-coordinators of
CBTP for each faculty/school.
5.2.4 CBE in general, CBTP in particular,
should address a holistic development issue
in the community in light of the different
faculties in the University.
5.2.5
The University should have a
continuous orientation and sensitization
mechanism on CBTP through workshops and
seminars for students, and other
stakeholders.
5.2.6 Supervisors should be relieved from
other routine academic tasks during their
CBTP supervision attachment.
5.2.7 The University should promote CBE
at the national, regional and zone levels.
5.2.8 Students follow-up attachment for
intervention should be reinstated.
5.2.9 CBE should be implemented closely
7. References
1. Department of Community Health.
Community Based Training Program
Manual, Part I. Jimma: Jimma Institute of
Health Sciences, 1987;1-63.
2. Department of Community Health. Team
Training Programme Manual, Part II.
Jimma: Jimma Institute of Health Sciences,
1988;1-26.
3. Department of Community Health.
Manual for Student Research Project.
Jimma: Jimma Institute of Health Sciences,
1996;1-71.
4. Woodward C. Some reflections of
evaluations of outcomes of innovative
medical education programme during the

with all stakeholders at regional, zone,

woreda and community level.
5.2.10 Evaluation outcome of each CBTP
attachment by students, supervisors,
community leaders, and the health sector
should be presented to a bigger audience in a
symposium.
5.2.11 The University needs to assign
experienced, and above all, committed and
strong academics for the different
coordinating offices of CBE.
5.2.12 The University should establish
'Monitoring and Evaluation Unit' which
could avail information on the performance
and outcome of the different curricula. This
will also help the University to discharge its
social responsibility.
6. Acknowledgement
Our acknowledgement goes to the
community members, community leaders,
and students who participated in this study.
Our appreciation also goes to W/ro Zinash
Solomon for her technical assistance. This
study was funded by Jimma University.
practice period Annals of CommunityOriented Education, 1992;5:181-91.
5.
Kamien M, Boelen C, Heck J.
Measuring social responsiveness of medical
schools. Education for Health, 1999;12:919.
6. Moja EA, Ghetti V.
Assessing
performance of medical schools. Annals of
Community-Oriented
Education,
1995;8:247-253.
7. Seefeldt M. Evaluating community-based
health programmes. In Schmidt M. et al,
eds.
Handbook of community-based
education: theory and practices. Maastricht:
Network Publications, 2000:345-360.
8. Kamien M. Responding to society needs

252 Ethiop.J.Health Dev.

on one criterion in evaluating the education

of general practitioners. Education for
Health, 1996;9:147-153.
9. Mennin SP, Friedman M, Woodward C.
Evaluating innovative medical education
programs: common questions and problems.
Annals of Community Oriented Education,
1992;5:123-133.
10. Magzoub M & Hamad B. The struggle
for relevance in medical education:
experience at the University of Gezira.
Education for Health, 1996;9:179-188.
11. Joson R. Formative evaluation of an
innovative medical curriculum. Education
for Health, 1996;9:201-208.
12. Magzoub M & Schmidt H. Community
Bbased programmes: what is their impact?
Education for Health, 1996;9:209-219.
13. Guilbert J. Success or failure in
change? A personal reflection. Education
for Health, 1996;9:189-200.
14. DAS M, Murdoch J, Mpofu D, Bener A.
The role of peer and self-assessment during
experiential learning in community settings.
Education for Health, 1996;9:239-249.
15. Sims P. Community-based education-the
Zambian experience. Education for Health,
1997;10:301-310.
16. WHO study groups. Increasing the
relevance of education for health
professionals.
WHO Technical Report
Serves, No 838, 1993.
17. Feletti G. Implementation of communitybased curricula. In: Schmidt H. et al, eds.
Handbook of community-based education:
theory and practices. Masstricht: Network
publications, 2000:147-199.
18. Kamien M, Boelen C, Heek J.
Measuring social responsiveness of medical
schools. Education for health, 1999;12:919.