The expanding movement of primary care physicians operating at the first line of healthcare delivery systems in sub-Saharan Africa: A scoping review

Abstract

Introduction In sub-Saharan Africa (SSA), the physicians’ ratio is increasing. There are clear indications that many of them have opted to work at the first-line of healthcare delivery systems, i.e. providing primary care. This constitutes an important change in African healthcare systems where the first line has been under the responsibility of nurse-practitioners for decades. Previous reviews on primary care physicians (PCPs) in SSA focused on the specific case of family physicians in English-speaking countries. This scoping review provides a broader mapping of the PCPs’ practices in SSA, beyond family physicians and including francophone Africa. For this study, we defined PCPs as medical doctors who work at the first-line of healthcare delivery and provide generalist healthcare. Methods We searched five databases and identified additional sources through purposively selected websites, expert recommendations, and citation tracking. Two reviewers independently selected studies and extracted and coded the data. The findings were presented to a range of stakeholders. Findings We included 81 papers, mostly related to the Republic of South Africa. Three categories of PCPs are proposed: family physicians, “médecins généralistes communautaires”, and general practitioners. We analysed the functioning of each along four dimensions that emerged from the data analysis: professional identity, governance, roles and activities, and output/outcome. Our analysis highlighted several challenges about the PCPs’ governance that could threaten their effective contribution to primary care. More research is needed to investigate better the precise nature and performance of the PCPs’ activities. Evidence is particularly needed for PCPs classified in the category of GPs and, more generally, PCPs in African countries other than the Republic of South Africa. Conclusions This review sheds more light on the institutional, organisational and operational realities of PCPs in SSA. It also highlighted persisting gaps that remain in our understanding of the functioning and the potential of African PCPs.

Development, Implementation, and Evaluation of a Distance Learning and Telementoring Program for Cervical Cancer Prevention in Cameroon

“…In Africa, community health care practitioners are at the forefront of caring for women at risk for or diagnosed with cervical cancer and are often the point of referral to specialist consultation . Our study suggests an opportunity to further enhance the knowledge and practices of community-based health care practitioners on cervical cancer prevention and care services.…”

“…In Africa, community health care practitioners are at the forefront of caring for women at risk for or diagnosed with cervical cancer and are often the point of referral to specialist consultation. 24 Our study suggests an opportunity to further enhance the knowledge and practices of community-based health care practitioners on cervical cancer prevention and care services. In our study, level of knowledge about cervical cancer among participating African health care practitioners was low, with just a few respondents who had not attended our ECHO sessions at the time of survey (newcomers) having a satisfactory knowledge score, compared with more than half of the health care practitioners who had attended our ECHO program (prior ECHO attendees).…”

“…In Africa, community health care practitioners are at the forefront of caring for women at risk for or diagnosed with cervical cancer and are often the point of referral to specialist consultation. 24 Our…”

Lessons Learnt From the Experiences of Primary Care Physicians Facing COVID-19 in Benin: A Mixed-Methods Study

“…Interestingly, we did not find significant differences between the public and the private sectors in implementing the COVID-19 control measures. Indeed, private health providers in Benin (and elsewhere in Africa) are often criticized for not properly following the existing guidelines (7,26). Literature from low-and middle-income countries also indicates that private providers comply less with medical standards of practice than public providers do (27).…”

“…The study population consists of PCPs working (exclusively or not) at first-line health facilities in the four selected health districts. Following a scoping review (7) and a cross-sectional study (20), we first distinguished three categories of PCPs in Benin, based on the type of postgraduate training they received (or not):…”