A scoping review on family medicine in sub-Saharan Africa: practice, positioning and impact in African health care systems

Abstract

Background: Family medicine (FM) is a relatively new discipline in sub-Saharan Africa (SSA), still struggling to find its place in the African health systems. The aim of this review was to describe the current status of FM in SSA and to map existing evidence of its strengths, weaknesses, effectiveness and impact, and to identify knowledge gaps. Methods: A scoping review was conducted by systematically searching a wide variety of databases to map the existing evidence. Articles exploring FM as a concept/philosophy, a discipline, and clinical practice in SSA, published in peer-reviewed journals from 2000 onwards and in English language, were included. Included articles were entered in a matrix and then analysed for themes. Findings were presented and validated at a Primafamed network meeting, Gauteng 2018. Results: A total of 73 articles matching the criteria were included. FM was first established in South Africa and Nigeria, followed by Ghana, several East African countries and more recently additional Southern African countries. In 2009, the Rustenburg statement of consensus described FM in SSA. Implementation of the discipline and the roles and responsibilities of family physicians (FPs) varied between and within countries depending on the needs in the health system structure and the local situation. Most FPs were deployed in district hospitals and levels of the health system, other than primary care. The positioning of FPs in SSA health systems is probably due to their scarcity and the broader mal-distribution of physicians. Strengths such as being an "allround specialist", providing mentorship and supervision, as well as weaknesses such as unclear responsibilities and positioning in the health system were identified. Several studies showed positive perceptions of the impact of FM, although only a few health impact studies were done, with mixed results. Conclusions: FM is a developing discipline in SSA. Stronger evidence on the impact of FM on the health of populations requires a critical mass of FPs and shared clarity of their position in the health system. As FM continues to grow in SSA, we suggest improved government support so that its added value and impact on health systems in terms of health equity and universal health coverage can be meaningfully explored.

Family Physician Perceptions of Climate Change, Migration, Health, and Healthcare in Sub-Saharan Africa: An Exploratory Study

“…Participants suggested ways that FP training could be expanded to incorporate aspects of the nexus in curricula, for example, the social and environmental determinants of health, or emergency responses to disasters. Authors have identified opportunities for training and research for FPs and primary care providers to strengthen the resilience of communities and to influence policy and research priorities [18,30]. Such public health and emergency medicine functions are still scarce resources in most SSA health districts [19].…”

Training a Fit-For-Purpose Rural Health Workforce for Low- and Middle-Income Countries (LMICs): How Do Drivers and Enablers of Rural Practice Intention Differ Between Learners From LMICs and High Income Countries?

“…Many LMICs are experiencing challenges in implementing a primary health care approach as the role of family medicine, and training strategies and pathways are developed. Challenges include a low profile of family medicine, strengthening governance of primary care, unclear roles and responsibility for family medicine physicians, public mistrust in rural and primary health care providers, provision of appropriate training for the local context, limited infrastructure and supplies, and lack of evidence to inform policy makers (27,28). While learners from LMICs in our study showed a high intent to practice in rural areas, a lack of policy support may pose significant challenges in realizing a rural workforce.…”

The state of family medicine training programmes within the Primary Care and Family Medicine Education network

“…1,2,3,4,5,6 Although 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 Primary Care and Family Medicine Education network (Primafamed) is a network of academic departments of family medicine and primary care in sub-Saharan Africa (see: primafamed.sun.ac.za).…”