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What works well in primary care education in your locality, region or country? • The new undergraduate social and community medicine training (iSOCO) in Rwanda focuses on crosscutting skills, knowledge and attitudes in primary health care delivery. What challenges have you faced? • Challenges faced include programme sustainability (PHC), large student group teaching, limited resources and students being unfamiliar with the new online teaching platform with unstable internet accessibility. How have you addressed them? • The iSOCO development and teaching team was motivated to work with the limited resources available and to develop an innovative training with available resources. Strong focus of the Ministry of Health on PHC, the need of the College of Medicine and Health Sciences to become more socially accountable and long-term commitment of external partners increased the programme sustainability. What is the generalisable learning? • When students are exposed to the principles of PHC and social and community medicine early in the medical education, it is more likely they will become patient-centred and community-oriented health care providers who are good communicators, collaborators, managers, scholars, health advocates and professionals, as described in the ‘desired Rwandan health care. provider' [ABSTRACT FROM AUTHOR]

Introduction: diabetes is a leading cause of death, disability, and high healthcare costs, especially among patients with poor glycemic control. Providing decentralized diabetes care to patients in low-income countries remains a major challenge. We aimed to assess hemoglobin A1C (HbA1c) level of patients enrolled in primary-level non-communicable disease clinics of Rwamagana, Rwanda, and identify predictors associated with a) change in HbA1c level over a 6-month period or b) achieving HbA1c <7%. We also explored whether living in a community with a home-based care practitioner was associated with HbA1c-related outcomes. Methods: we conducted structured interviews and HbA1c testing among patients with type 2 diabetes at baseline and after six months. Multivariable linear regression and multivariable logistic regression were used. Results: one hundred and thirty (130) participants enrolled at baseline, and 123 patients remained in the study after six months. At baseline, 26% of patients had HbA1c <7%. After 6 months, 37% of patients had HbA1c <7%. Factors correlated with the greatest improvements in HbA1c were having HbA1c >9% at baseline, while factors associated with having HbA1c <7% after six months included older age and having HbA1c <7% at baseline. We did not find significant associations between home-based care practitioners and improvement in HbA1c level or achieving HbA1c <7% Conclusion: the number of patients with well-controlled glycemia improved over time during this study but was still low overall. Care provided by home-based care practitioners was not associated with six-month HbA1c outcomes. Enhanced care is needed to achieve glycemia control in primary healthcare settings. [ABSTRACT FROM AUTHOR]