Table 9 Implementation of family medicine in different African countries
Country | Development of FM | Focus of care/roles of FP | Positioning in the health system | References |
|---|---|---|---|---|
South Africa | In 1968 University of Pretoria started with PG training, followed by the 7 other health sciences faculties. In 1997 FaMEC (Family Medicine Educational Consortium) was developed for standardization of the training and examination. In 2007 the government officially acknowledged the specialty. Presently there are 9 training programmes in place. | The 6 key roles as shown in Figure 5: Care provider, consultant, clinical trainer, capacity builder, leader of clinical governance, champion of COPC. Providing comprehensive care (preventative, curative, rehabilitative and palliative care) | At all levels of care; in primary, secondary and tertiary care settings. The FP functions at the district level, in district clinical specialist teams, at district hospitals and in health centres or sub-districts with multiple clinics. In rural as well as urban areas. FPs are also working in private general practice, non-public institutions. | |
Nigeria | In 1970 General Medical Practice training started, in 1985 the first graduates entered the Nigerian health system. In 2004 the name changed to Family Medicine. | General physician, surgeon, obstetrician, gynaecologist and as community physicians | At all levels of care; in primary, secondary and tertiary care setting. In various settings such as military, universities, health centres, oil and other service industries, missionary hospitals, local governments, private practices and academia. In rural and urban district hospitals | |
Ghana | In 1991 FM extended from Nigeria to Ghana, where in 1999 the first residency programme officially started. In 2016 36 family physicians had been trained. | General physician, surgeon obstetrician, gynaecologist and as community physicians | In government health care facilities, mainly at the district hospital level. Around 15% in the private, military and quasi-government health facilities. In rural and urban areas | |
Kenya | In 1998 first discussion took place with policymakers and subsequently a curriculum was developed. In 2005, the first trainees started the programme. By 2017, 29 Kenyan trained FPs had been deployed in the districts. Presently there are now 5 training programmes in country. | District health care with both inpatient and outpatient care, outreach to the community and emergency surgery and obstetrical skills | At all levels of care; in tertiary, secondary and primary care settings. The FP functions in the district health services, which includes clinics and district hospitals and extends to rural as well as urban areas | |
Sudan | Two year training programme started in 2010 with strong support from the government (the Gezira Family Medicine Program). In 2012, 207 FPs graduated from the first batch. | Lead the PHC team within the catchment area, comprehensive and community-oriented focus of care | Rural community health centres | |
Uganda | Family Medicine was recognized by the government at its inception in 1989. In 2005 a national plan to train 1 FP per 75,000 inhabitants was conceived, but by 2013 only 20 out of these 400 were trained. This plan was revised and scaled up to train 600 FPs by 2025. | They are placed in roles as hospital directors and heads of community health departments, as well as clinicians caring for both in- and out-patients. Some head health districts providing leadership to district health teams | The Ministry of Health has positions for family physicians in national and regional referral hospitals and district hospitals, urban and rural | |
Malawi | Discussion started in 2001, undergraduate FM clerkship started in 2011 and postgraduate FM training in 2015. | Competencies specific to the Malawian context; care provider, consultant, clinical leader and manager, community-oriented primary care leader, mentor and clinical teacher (including support of front-line primary care workers), researcher | District-level physicians and in primary health care teams, urban and rural | [50] |
Botswana | In 2008 the Botswana Health Professions Council added FM to the list of registered specialties (they were trained in South Africa). The first school of medicine started in 2009 and FM training started in 2011. The first graduates have been employed in the health system. | Generalist doctors who can function within primary hospitals and lead primary care to transform quality and access to health care | Primary and secondary hospitals with outreach to the PHC platform | |
Ethiopia | Since 2001 the programme has been developed and in 2016 the first FPs graduated. | Generalists with internal medicine, pediatrics, surgery, psychiatry, emergency medicine, obstetrics and gynaecology, community medicine and public health competencies in order to lead a primary health care team in a local health care system | In well-equipped PHC facilities and district hospitals | |
Zambia | The FM training programme scheduled to start in 2015, officially started in 2018. | Holistic clinical and preventive care, healthcare management, research and clinical leadership | In rural, remote and underserved community-based settings within district health services | [61] |
Rwanda | In 2008 the training programme started, but in 2010 the vision of the Ministry of Health changed, therefore ending the programme. The 9 graduated FPs have been taken up in the health system. | Presently none | Presently none | [18] |
Mali | In 2017, a Master programme was being implemented. | No further information available | No further information available | |
Somaliland | In 2017 a Master programme was being implemented. | No further information available | No further information available | [4] |