Our fellow generalists have shown realism and honesty combined with academic rigour about the difficulties they face in establishing family medicine in Africa (except in South Africa). The tendency to hope that family medicine will fill the gap is understandable in a continent with such a huge shortage of healthcare workers1 but it sounds as if family medicine in Africa is drifting into becoming a hospital-based specialty and its links with its ‘spiritual home’ in primary care are becoming severely stretched; as evidenced by the comments from Kenya.
Now More than Ever2 promoted universal coverage, services based around peoples’ needs and healthier communities, which are all best addressed in services outside hospitals. Starfield argues for better primary care services for economic3 as well as moral reasons4 and de Maeseneer, although strongly supportive of family medicine in Africa, argues consistently for increasing development of primary care provision, especially through the 15by2015 initiative.5 Finally the looming increase in burden of disease due to non-communicable diseases, that by 2030 in low income countries is predicted to increase to over 50% of the overall burden,6 will be best dealt with in primary care. Thus my question is: ‘does family medicine in Africa need to re-evaluate the direction it’s being drawn into and consider placing itself more strategically in the community?’
Repositioning itself more obviously in the community may also help family medicine to be more distinctive and better understood by others (colleagues as well as patients). This is especially true for training, the goal being to achieve the aspirations as set out by Reid,7 that reach well beyond performing procedures in hospitals. UK generalists have decades of experience training outside hospitals and it may be an area for collaborative work. One possible way the NHS/RCGP could offer support would be to release (and financially protect) some appropriately experienced GP trainers to support carefully selected family medicine training programmes in Africa by providing a training component in the community as an alternative to hospital-based training; this is generally not happening at the moment: in some cases 35 out of 36 months training are in hospital.
- © British Journal of General Practice 2013