Perceptions of medical students towards healthcare devolution: an online cross-sectional study.

INTRODUCTION: There have been worries concerning the preparedness and capacity of the counties to take over health care services. As the current medical students are going into this new system, we sought their opinions on the issue of devolution. The objective is to assess beliefs and attitudes of medical students towards devolution of healthcare services. METHODS: A cross sectional survey was conducted at University of Nairobi medical school during the period of February-May 2014. Though a calculated random sample of 384 medical students was powerful enough to fulfill our objectives, all eligible medical students were invited by email to fill in a semi structured online questionnaire. Computed results from Google sheets were reported in frequencies and percentages. RESULTS: Data was collected from 191 respondents with majority of them in their clinical years (levels 3, 4 and 5) of study. More participants considered working in private/ mission health institution (40%) after graduating as compared to public or non health institution (30%). The media provided most of information concerning devolution (77%). Few respondents reported using government documents (36%) or public forums (24%) to get information on healthcare devolution. While most of the respondents were of the opinion that health information system (68%), health finance (63%), procurement of medical products (54%), leadership and governance (73) should be devolved, only 18% wanted health personnel to be devolved. Most of the opinions on healthcare devolution were not in agreement with the goal of devolution: more than 50% thought the process would not result in improved efficiency, resource allocation, disease control programs or maintenance of infrastructure. CONCLUSION: Despite the envisioned benefits of healthcare devolution, there is a low opinion among medical trainees concerning these reforms and their implementation. Nevertheless, it is early to speculate whether such viewpoints will be carried to the future once teething problems are dealt with.

Medical trainees' experiences and perceptions towards elective period; a cross sectional study.

INTRODUCTION: Medical electives make significant contribution in the training of medical students on healthcare outside their affiliated academic institutions. During this period, learners get exposed to different healthcare systems, diagnostic, medical and surgical techniques as well as appreciate existing challenges. OBJECTIVE: To assess experiences encountered by medical students during their electives. METHODS: A cross sectional study was commissioned among level 5 medical students of University of Nairobi in July 2013. A random sample of 125 students was invited to fill in self structured questionnaires after obtaining informed consent. The questionnaire which had initially been pretested on 25 nursing students comprised bio data, place, duration, funding, experiences and challenges of electives. Data obtained was analyzed using SPSS 20 and computed in terms of frequencies and percentages. RESULTS: There were 76 (60.8% response rate) respondents with majority being males and staying in university hostel. Most of them had undertaken electives in Africa which were organized by themselves and funded mostly by their parents. There was overall positive attitude towards electives with majority (80.3%) claiming it to provide all rounded training. However, financial, transport and language barrier were identified as the main challenges (41.1%, 18.8% and 14.3%, respectively). There was a call by more than 80% of respondents for the university to collaborate with host institutions and provide stipend to cover living expenses mostly. CONCLUSION: The acquisition of practical skills involved in the treatment of patients forms the basis for high expectation of electives among medical trainees. It is evident that most of the participants would desire the scaling up of entire elective period through institutional collaborations and logistical support.