Health Unit, KIT Royal Tropical Institute, Amsterdam, the Netherlands.
Department of Primary Health Care, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
Hum Resour Health. 2020 Apr 3;18(1):27. doi: 10.1186/s12960-020-0455-4.
Family medicine (FM) is a relatively new discipline in sub-Saharan Africa (SSA), still struggling to find its place in the African health systems. The aim of this review was to describe the current status of FM in SSA and to map existing evidence of its strengths, weaknesses, effectiveness and impact, and to identify knowledge gaps.
A scoping review was conducted by systematically searching a wide variety of databases to map the existing evidence. Articles exploring FM as a concept/philosophy, a discipline, and clinical practice in SSA, published in peer-reviewed journals from 2000 onwards and in English language, were included. Included articles were entered in a matrix and then analysed for themes. Findings were presented and validated at a Primafamed network meeting, Gauteng 2018.
A total of 73 articles matching the criteria were included. FM was first established in South Africa and Nigeria, followed by Ghana, several East African countries and more recently additional Southern African countries. In 2009, the Rustenburg statement of consensus described FM in SSA. Implementation of the discipline and the roles and responsibilities of family physicians (FPs) varied between and within countries depending on the needs in the health system structure and the local situation. Most FPs were deployed in district hospitals and levels of the health system, other than primary care. The positioning of FPs in SSA health systems is probably due to their scarcity and the broader mal-distribution of physicians. Strengths such as being an "all- round specialist", providing mentorship and supervision, as well as weaknesses such as unclear responsibilities and positioning in the health system were identified. Several studies showed positive perceptions of the impact of FM, although only a few health impact studies were done, with mixed results.
FM is a developing discipline in SSA. Stronger evidence on the impact of FM on the health of populations requires a critical mass of FPs and shared clarity of their position in the health system. As FM continues to grow in SSA, we suggest improved government support so that its added value and impact on health systems in terms of health equity and universal health coverage can be meaningfully explored.
家庭医学（FM）在撒哈拉以南非洲（SSA）是一个相对较新的学科，仍在努力在非洲卫生系统中找到自己的位置。本综述的目的是描述 FM 在 SSA 的现状，并绘制现有证据的优势、劣势、有效性和影响，并确定知识空白。
通过系统地搜索各种数据库进行范围界定综述，以绘制现有证据。纳入了 2000 年以后发表在同行评议期刊上、以英语撰写的探索 SSA 中 FM 作为概念/哲学、学科和临床实践的文章。纳入的文章被输入矩阵，然后进行主题分析。研究结果在 2018 年在 Primafamed 网络会议上展示和验证。
共纳入符合标准的 73 篇文章。FM 首先在南非和尼日利亚建立，随后在加纳、几个东非国家和最近的其他南部非洲国家建立。2009 年，鲁斯特堡共识声明描述了 SSA 的 FM。该学科的实施以及家庭医生（FPs）的角色和责任因国家内部和国家之间的卫生系统结构需求和当地情况而异。大多数 FPs 部署在区医院和卫生系统的其他级别，而不是初级保健。FPs 在 SSA 卫生系统中的定位可能是由于其稀缺性和医生的广泛分布不均。确定了一些优势，如作为“全能专家”，提供指导和监督，以及一些劣势，如在卫生系统中职责不明确和定位不明确。有几项研究显示了对 FM 影响的积极看法，尽管只有少数关于健康影响的研究，结果喜忧参半。
FM 是 SSA 一个正在发展的学科。需要有足够数量的 FPs，并明确其在卫生系统中的地位，才能提供更强有力的 FM 对人群健康影响的证据。随着 FM 在 SSA 的不断发展，我们建议政府提供更多支持，以便能够有意义地探索其在卫生公平和全民健康覆盖方面对卫生系统的附加值和影响。
