Abstract
Family medicine is a relatively new but rapidly expanding medical discipline in Sub-Saharan Africa. Specialization in family medicine is an effective means for building and retaining a highly skilled rural physician workforce in low- and middle-income countries. The Lesotho Boston Health Alliance Family Medicine Specialty Training Program is the first and only postgraduate family medicine program and the only accredited postgraduate training program in the Kingdom of Lesotho. Lesotho has unique challenges as a small mountainous enclave of South Africa with one of the lowest physician-to-patient ratios in the world. Most health professionals are based in the capital city, and the kingdom faces challenging health problems such as high human immunodeficiency virus prevalence, high maternal mortality, and malnutrition, as well as increasing burdens of non-communicable diseases such as hypertension, diabetes, and obesity. In response to these health crises and the severe shortage of health professionals, Lesotho Boston Health Alliance partnered with the Lesotho Ministry of Health in 2008 to introduce family medicine as a new specialty in order to recruit home and retain Basotho doctors. Family medicine training in Lesotho uses a unique decentralized, non-university-based model with trainees posted at rural district hospitals throughout the country. While family medicine in Lesotho is still in the early stages of development, this model of decentralized training demonstrates an effective strategy to develop the rural health workforce in Lesotho, has the potential to change the physician workforce and health care system of Lesotho, and can be a model for physician training in similar environments.
Highlights
Specialization in family medicine (FM) is an effective means of building and retaining a highly skilled rural physician workforce in low- and middle-income countries
The Lesotho Boston Health Alliance (LeBoHA) Family Medicine Specialty Training Program (FMSTP) is unique in that family physicians are trained in a decentralized environment outside of a national university, the program is a fully accredited postgraduate academic institution
The LeBoHA FMSTP provides opportunities for continued career development for graduates, and these benefits are proving effective in motivating the training and retention of highly skilled rural family physicians
Summary
Specialization in family medicine (FM) is an effective means of building and retaining a highly skilled rural physician workforce in low- and middle-income countries. The poor retention of Basotho doctors is complex; difficult working conditions, little opportunity for continuing education, isolation in rural hospitals, limited opportunities for advancement or career development, and challenges from working in a poorly functioning health care system are all major contributing factors Because of these challenges and the enormous burden physicians face, unsurprisingly burnout and poor attrition are common [11]. Boston University has partnered with the Lesotho MOH since the 1990s to support the Lesotho health care system through capacity building, human resource development, and strengthening of civil society This long-term partnership culminated in the formation of LeBoHA in 2001 and the development of the FMSTP in 2008. Supervised clinical rotations are geared toward providing registrars opportunities to learn specialized skills and procedures previously only available at the referral level in order to decentralize some of these to the district level They complete a community-oriented primary care project, a quality improvement initiative, and a research thesis. Many registrars hold leadership positions as medical superintendent or district medical officer
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