Abstract
The 2019 Primary Care and Family Medicine Education network (Primafamed) meeting in Kampala, Uganda, included a workshop that aimed to assess the state of postgraduate family medicine training programmes in the Primafamed network. Forty-six people from 14 African and five other countries were present. The evaluation of programmes or countries according to the stages of change model was compared to a previous assessment made 5 years ago. Most countries have remained at the same stage of change. Two countries appeared to have reversed their readiness to change as Rwanda moved from relapse to pre-contemplation and Mozambique moved from action to contemplation. Malawi, Zambia and Zimbabwe increased their readiness to change and moved from contemplation to action. Countries in the region remain quite diverse in terms of their commitment to family medicine training. Within Primafamed, it is possible for countries with a more advanced stage of change to assist countries with an earlier stage. Primafamed is also supported by a variety of partners outside of Africa. Five years after the previous country-level assessment, family medicine in Africa continues to span across all levels of the stages of change model. Stage-matched interventions aligned with the needs of individual countries should follow. Consequently, this workshop report will serve as a mandate and compass for Primafamed’s actions over the next few years, aimed at designing and delivering these interventions. As reiterated in the 2019 Kampala commitment, we should continue developing the discipline of family medicine (the medical ‘specialty’ of primary care), through alignment of our training programmes to the health needs in the African region.
Highlights
The roles of the family physician differ between countries and are still debated, it is clear that in Africa, the family physician often works at the district hospital as well as in primary care teams.[7,8,9]
Generate research evidence of the contribution of family medicine to health systems and the role of family physicians in our context, as well as evidence that supports the development of family medicine education
Five years after the previous country-level assessment, family medicine in Africa continues to span across all levels of the stages of change model
Summary
Medicine is making a valuable contribution to strengthening district health services in several countries in sub-Saharan Africa and has published a consensus statement on the role of the family physician.[1,2,3,4,5,6] the roles of the family physician differ between countries and are still debated, it is clear that in Africa, the family physician often works at the district hospital as well as in primary care teams.[7,8,9] Their roles are often different from that of family physicians in more highly resourced countries and they are seldom the first point of contact, which is usually with a nurse or clinical officer.[10]. Stellenbosch University Rural Medical Education Partnership Initiative has used this model to understand how policymakers in key institutions change in their commitment towards implementing postgraduate training in family medicine.[14] This 2-h workshop was part of a Primafamed meeting (4–5 June 2019) held before the 2019 WONCA Africa Conference in Kampala, Uganda. The idea of a combined eastern, central and southern African college of family physicians is being explored as a way of combining resources and expertise in assessment Another strength is the Training of Clinical Trainers faculty development initiative offered in partnership with the RCGP.[18,19] Specialists from other disciplines attended the training, which gave them better insight into family medicine training. There is a challenge with the availability of more posts and the role of family physicians in the primary health care setting is not yet clear within national policy
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