The Ugandan private students scheme at Makerere University School of Medicine and its effect on increasing the number of medical doctors enrolled and trained from 1993 to 2004

Abstract

Background: The global human resources for health crisis has affected Uganda deeply as is evidenced by grossly inadequate medical doctor to population ratios. Strategies to increase training and retention initiatives have been identified as the most promising ways to address the problem. In Uganda, the dual track tuition policy of higher education (called the Private Students Scheme or PSS) at the University of Makerere was initiated in the academic year 1993/94, to boost student intake and to supplement university revenue. However, the impact of this scheme on the enrolment and graduation of medical students at this University is unknown. Aim: This study aimed to assess the effect of the PSS on enrolment, time to completion, attrition and number of graduated medical students at Makerere University Medical School after (post-) the Private Students Scheme (PSS). Study design: A quantitative cross-sectional descriptive study based on a retrospective review of enrolment and graduation records of medical students was conducted comparing records of students enrolled five years before and after the privatisation scheme. Numbers enrolled, attrition rates, time to completion and graduation numbers were analysed. Results: There were 895 students enrolled in the study period, 612 (72.2%) males and 236 (27.6%) females. Pre- and post-PSS periods had 401 and 494 enrolments respectively (a net increase of 93 students). During the post-PSS period, 447 (90.5%) government sponsored students were enrolled - 351 (71.1%) males and 143 (28.9% females); in the same period, 47 (9.5%) private students were enrolled, 30 (63.8%) male and 17 (36.2%) female. Graduation rates for the entire study period were 96% (859), which represented 44% (378) in the pre-PSS and 56% (481) in the post-PSS periods. Private students contributed 8.9% (43) of the graduates 9in the post-PSS period. The majority of students (90.4%) graduated in five years. Thirty four students (3.8%) dropped out in the entire period, constituting significantly more in the pre-PSS - 22 (5.5%) than in the post PSS-period - 12 (2.4%). Males were more likely to drop out: 31 males did so (4.4%) compared with 3 (1.2%) females. In the post-PSS period, males made up 83.3% (10/12) of the attrition rate. Nine of them were government sponsored while three were private students. Conclusions: The PSS resulted in a 10% increase in enrolments when compared to the pre-PSS period. Furthermore the number of private medical student enrolments contributed 8.9% of the total graduations indicating that PSS succeeded in increasing the number of medical doctors graduated at MUSM. More males than females enrolled across all the years which might indicate a tendency for females to pursue non-medical professions which should be discouraged. Attrition of students was low which is encouraging but the finding that males were more likely to drop out than females deserves attention.