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The family medicine theories of the delivery of comprehensive, continuous, personalised, clinical and family-orientated care
to the majority of peoples in Africa describes an ideal that is worth striving for. Family medicine could be positioned to take a
leadership role in helping to define and organise the complexity of health systems that will deliver the care in a systematic,
focused, coordinated and sustainable manner for the benefit of the individuals, families and communities in Africa. Anecdotal evidence suggests that there are various models of the concept of family physician care that serve in a wide variety
of African practice settings. There are the general practitioners in hospital or ambulatory care, the medical officer in general
or church and /or mission hospitals, the family physician residents and /or registrars and the specialist family physician,
to mention a few. Though all of these cadres function in some way as generalists, they do not always work in health systems
that recognise their unique role or provide the enabling environment to maximise their full potential as expert practitioners,
educators and leaders. This discussion paper seeks to highlight the questions that are pertinent to strengthening the various health systems that
deliver continuous, facility-based and community-orientated care to the populace. Each unique context of care delivery by
these cadres of generalists should be able to inform and contribute to the development of the speciality of family medicine
with respect to concept, context, training and standardised service delivery. This workshop is intended to provide a forum for discussion of the following, broad themes that can highlight the potential
collaboration of the various cadres of generalists that work in such diverse sectors of the health care systems of African
countries. Each theme introduction is followed by a set of questions that have been put together to stimulate and guide this discussion.
The nomenclature of generalism
• Is there any difference between a general practitioner and a
family physician in Africa?1,2,3,
4,6,7,8
,9
If there is, what is the difference? If not, why are they referred to differently? Do different terms determine different roles?
How culturally bound are the terms for the generalist doctor? • In Africa, is general practice the same thing
as private practice?4,5,6,
7,8,9 If not, why and how are they the same? • Should we differentiate between the general practitioners in private practice from family physicians in private
practice for the purposes of advancing the speciality of family medicine?4,
5,6,7,9 • What universal nomenclature should we use that would be inclusive of all shades of
functions? 1,2,3,
4,5,6,
7,9 • Are medical officers, working in public general hospital out-patient departments,
general practitioners too?5,10,11 Do they function as family
physicians?5,7,10,
11Should they undergo
training to become family physicians so we can bring them under the umbrella of the family medicine
movement?5,7,10,11 • In which way are African family doctors potentially unique in their roles within various settings of their work?
The roles of academia and faith-based organisations in family medicine education
• What links should family medicine university academic departments have with practising private general
practitioners?7,8,12,
13,15,23,27 • Should practice-based research networks (PBRN) be encouraged?13,22Should the PBRN be
university-linked?13,23,28 Would a PBRN be beneficial to practising private, general
practitioners?13,15,23 In
which other ways can academic university family medicine
departments be useful to practising general practitioners?12,13,
15,22,27 • What other synergies might there be between university family medicine departments and general
practitioners and/or family physicians?12,13,
15,22,27 • What range of roles can the largely public, not-for-profit, faith-based and/or mission institutions
play in the education of family medicine doctors?19,23 Do they have any unique strengths that
complement the family medicine initiatives within education models? • What is the character of the linkage with the academic centre? How should they be supported to continue
the excellent work they are doing in training family physicians?20,24 • What about other private, not-for-profit non-governmental organisations (NGOs) involved in family medicine
training and service?14,17,23,
19 What is their role as educational resource? • What is the role of private, for-profit systems in education? How much contribution can be expected of them,
if 'education takes time' and 'time is money',16,17 (1) as
individual private general
practitioners24 (2) as private general practice
organisations,18,20,21,24 or (3)
as privately owned university departments of family medicine?24 • To what extent should and/or could private training institutions be involved in community-based
family medicine training?17Should they be supported in carrying out such roles?
Integration
• Is it possible for one doctor to integrate all the roles of the primary care consultant, 'specialist' family physician,
the general practitioner and the medical officer?26,27 Is it desirable? Is it possible to integrate these roles? • In which ways can a group of family doctors complement one another to fulfill the various roles required for the breadth
of family medicine in Africa? • Are there roles within the medical fraternity of specialities that African-trained family physicians could fill uniquely?
1. Wikipedia, the free encyclopedia. General Practitioner [homepage on the Internet]. No date [cited 2009 Jan 21]. Available from: http://en.wikipedia.org/wiki/General practitioner 2. Wikipedia, the free encyclopedia. Family Medicine [homepage on the Internet]. No date [cited 2009 Jan 11]. Available from: http://en.wikipedia.org/wiki/Family_Medicine 3. Nationmaster. General Practitioner [homepage on the Internet]. No date [cited 2009 Feb 11]. Available from: http://www.nationmaster.com/index.php 4. Kitamura K, Fetter MD, Ban N. Preconception care by family physicians and general practitioners in Japan. BMC Family Practice [serial online] 2005 [cited no date];6:31. Available from: http://www.biomedcentral.com/1471-2296/6/31 5. Chao DVK, Cheung AKY. Post graduate examination in family medicine for private medical practitioners: was it worth the effort? Hong Kong Medical Journal 1995;1:238-242. 6. Davie G. From General Practitioner to Family Physician. S Afr Med J. 1975;49:1015. 7. European Union of General Practitioners. General Practice in Portugal [homepage on the Internet]. No date [cited no date]. Available from: http://www.uemo.org/site-index/index.htm 8. Department of Health and Aged Care. General Practice in Australia: 2000 Commonwealth of Australia Canberra 2000 [homepage on the Internet]. No date [cited no date]. Available from: http://www.racgp.org.au/content/Navigator menu/statements/default.htm 9. Doctor Connect. Work as a doctor in Australia [homepage on the Internet]. No date [cited 2009 Jan 11]. Available from: http://www.doctorconnect.gov.au/internet/ctd/publishingnsf/content 10. Clements M. Retention of Senior Medical Officers, time for a rethink on career progression? Journal of Military and Veteran's Health 2008;16(4):39-40. 11. Nixon G. Katharina Blattner: for the NZ Rural Hospital Doctors Working Party. Rural hospital medicine in New Zealand: vocational registration and the recognition of a new scope of practice. The New Zealand Medical Journal [serial online]. 2007 [cited no date]; 120:1259. Available from: http://www.mzma.org.nz/journal/120-1259/2654/ 12. Himmel W, Kochen MM. How do academic heads of departments of general practice organize patient care? A European survey. Br J Gen Pract. 1995;45(394):231-234. 13. Mathers N. Carter Y, Marshall M. on behalf of the Uk Heads of the Academic Departments of General Practice. 'New Century New Challenges'. Fam Pract [serial online] 2003 [cited no date];20:360-361. Available from: http://www.fampra.oupjournals.org 14. Global Health Through Education Training and Service. Family Medicine in Africa [homepage on the Internet]. No date [cited no date]. Available from: http://www.ghets.org/index.php 15. University of Cape Town. School of Public Health and Family Medicine [homepage on the Internet]. No date [cited no date]. Available from: http://www.public health.uct.ac.za/ 16. Bristol-Myers Squibb. Baylor College of Medicine establishes paediatric AIDS Corps for Africa [homepage on the Internet]. No date [cited 2009 Mar 03]. Available from: http://www.bcm/edu 17. Hall TI. Global health Education Consortium [homepage on the Internet]. No date [cited 2009 Feb]. Available from: http://www.global health-ec.org 18. American Academy of Family Physicians [homepage on the Internet] No date [cited no date]. Available from: http://www.aafp.org/ 19. Pust R, Dahlman B, Khwa-Otsyula B, Armstrong J, Downing R. Partnerships Creating Post graduate Family Medicine in Kenya. Fam. Med. 2006;38(9):661-666. 20. Wonca President: Our Commitment to Develop Family Medicine in Areas of Need [document on the Internet]. No date [cited no date]. Available from: http://www.globalfamilydoctor.com/ 21. Association of General and Private Medical Practitioners of Nigeria [homepage on the Internet]. No date [cited no date]. Available from: http://www.agpmpn.org/first_page.html 22. Sparks BLW, Gupta SK. Research in Family Medicine in Developing Countries. Annals of Family Medicine 2004,2:S55-S59. 23. De Capua J. CURE International: Building Hospitals, Training Doctors, Healing Children [homepage on the Internet]. No date [cited no date]. Available from: http://www.voanews.com/ 24. O'Mahony D. Training Family Physicians. Opportunity Knocks for the Private Sector. South African Family Practice, 2004;46(8):3-4. 25. Rural Doctors Workforce Agency-South Australia [homepage on the Internet]. No date [cited no date]. Available from: http://www.ruraldoc.com.au/content_sub.php?id=36 26. Katekar LV. The value of hospital employed medical officers in rural Australia. Rural and Remote Health 3 [serial online] 2003 [cited no date]; 150. Available from: http://rrh.deakin.edu.au 27. Government of Australia: Medical Opportunities: An overview [document on the Internet]. No date [cited no date]. Available from. http://www.health.sa.gov.au/Desktop modules/SSA_Documents/LinkClick.aspx?
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