Medical education and primary health care in Nigeria: the Sokoto University experience

Abstract

Despite the acknowledgement and adoption of the Alma-Ata declaration by majority of the countries of the world as a strategy for achieving Health For All, medical educational systems often remain as ivory towers from the health service system. This traditional system of medical education does not adequately prepare doctors in developing countries for their expected leadership role in meeting the health needs for their communities through primary health care. In Nigeria, primary health care forms the basis for an official health policy aimed at meeting the health care needs of the entire population particularly those in the rural areas. This article, while highlighting the need for integration of medical education and the primary health care services, also examines the structural relationships between the two components at the Sokoto University in Nigeria, a West African country with one of the oldest medical educational system in the area.

PIP: Sokoto University in northeastern Nigeria has integrated primary health care (PHC) with its medical curriculum. The faculty exposes students to community and primary health care throughout their 6-year training. Initially they follow the traditional preclinical courses (anatomy, physiology, and biochemistry) as well as courses in behavioral sciences, environmental health, and human ecology. They intermittently visit public health institutions, especially in relation to their environmental health course. Clinical training occurs at the teaching hospital and within the community using the PHC concept. The department of community medicine also involves each medical student in ward rounds and follow-up visits to people in Sokoto. Then each student must do a case report incorporating the physical, biological, and social effects on the patient's pathology. Students must also serve in a rural community for 8 weeks during the final years of medical training. Here they need to apply what they learned about community health and PHC. The intent of the Sokoto medical training program is to prepare PHC physicians. The community medicine department covers treatment of endemic diseases at a rural health center and referral of relevant cases to general and specialist hospitals, identification of community health problems and finding solutions, maternal and child health programs including family planning, and follow-up home visits for health education purposes. Medical faculty continually assess student knowledge and skills. In 1986-87, a community medicine faculty member evaluated student satisfaction with the community and PHC program and the rural posting experience. Even though students looked favorably on their experiences, they believed that these experiences occurred too early in the curriculum. They also objected to lack of basic social amenities at rural postings such as potable water.