Factors affecting family medicine programmes in Sub-Saharan Africa: a narrative review of recent literature

Abstract

Objective: To identify the factors enabling and limiting family medicine (FM) programmes in Sub-Saharan Africa (SSA).

Design: A narrative review was conducted by searching a variety of databases. Papers focusing on the training, deployment, or contribution to healthcare systems of doctors with postgraduate training in FM in SSA, published in peer-reviewed journals from 2015 onwards and in English language were included. Included papers underwent qualitative analysis.

Results: Seventy-one papers were included in the review. 38% focussed on South Africa, while papers focussing on FM in a further 15 countries in SSA were identified. Key factors enabling FM programmes are support from key stakeholders, recognition of family practitioners (FP) as specialists, international collaboration, and dedicated FPs. Key factors limiting FM programmes are a lack of sufficient and well-trained faculty, inappropriate training settings, higher rates of trainee attrition, lack of FM in undergraduate curriculums, lack of career pathways, inappropriate deployment, and a lack of a critical mass.

Conclusions: Support from national stakeholders, the recognition of FPs as specialists, and sustainable international collaboration promote FM programmes. The absence of a defined role within the healthcare system, low numbers of FM faculty, a poor presence in undergraduate curriculum, high attrition rate of trainees and the lack of a critical mass limit FM programmes. The standardisation of the role of FM and the implementation of undergraduate and postgraduate FM programmes with national and international collaboration could enable FM to reach a critical mass and realise its full potential in strengthening primary healthcare in SSA.

Funding: None declared.

Keywords: Family medicine; Sub-Saharan Africa; practice.

Figure 1

Literature selection strategy

Figure 2

Map 1(Left) displays countries in SSA with the differing presences of FM programmes per country. ,– Map 2(Right) displays UHC per country in SSA. Notes to Figure 2 Map (1): Map of Africa representing presence of FM programmes. Red = FM Programme Exists with Graduates, Orange = FM Programme Exists with Graduates Expected Soon, Yellow = FM Programme Under Development, White = No FM Programme, Grey = No data Map (2): Map of Africa. Universal Health Coverage by country. Data from the World Bank Development Indicators. Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access, among the general and the most disadvantaged population). The indicator is an index reported on a unitless scale of 0 to 100, which is computed as the geometric mean of 14 tracer indicators of health service coverage. The tracer indicators are as follows, organized by four components of service coverage: 1. Reproductive, maternal, newborn and child health 2. Infectious diseases 3. Noncommunicable diseases 4. Service capacity and access Red = index value 61-80. Orange = index value 41-60. Yellow = 21-40. White = no data available. *Tanzania: FM training is offered in the private sector affiliated to Aga Khan University. Government policy does not support FM in the public sector.