Mash Robert, Besigye Innocent, Essuman Akye, Lubaki Jean-Pierre Fina, Makasa Mpundu, Makwero Martha, Mohamoud Gulnaz
Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa.
Department of Family Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Fam Med. 2025 Feb 6;57(5):342-8. doi: 10.22454/FamMed.2025.291430.
In this article we reflect on the state of family medicine education and training in sub-Saharan Africa; in particular, we focus on these key issues: advocacy, evidence of impact, barriers and enablers, and implementation strategies. Sub-Saharan Africa is the last region of the world to embrace family medicine, and adoption varies widely among countries. Family physicians with postgraduate training are relatively few. In the public sector, primary care is mostly offered by nurses or physician assistants, while in the private sector, it is offered by general practitioners. Family physicians work in both primary care and primary hospitals, in multidisciplinary teams; as clinicians, consultants, capacity builders, clinical trainers, leaders of clinical governance and may also have some managerial functions. Advocacy for the contribution of family physicians and training programs is needed with departments of health, regulatory bodies, higher education institutions, and other health professions. Evidence of impact in the African context is limited due to the small numbers and limited research outputs. Barriers and enablers to education and training are related to the stage of development. Key issues include a lack of academic and teaching expertise, a need to develop learning environments and clinical trainers, sufficient training posts, and appropriate deployment of new graduates. Implementation strategies to overcome these barriers can be categorized into planning, educational, financial, quality management, and policy related strategies. A South-South-North approach to support and partnerships is advocated. More attention should be given to engaging the public on the contribution of family medicine.
在本文中，我们思考了撒哈拉以南非洲地区家庭医学教育与培训的现状；尤其关注这些关键问题：宣传推广、影响证据、障碍与促进因素以及实施策略。撒哈拉以南非洲是世界上最后一个接纳家庭医学的地区，各国对其接纳程度差异很大。接受过研究生培训的家庭医生相对较少。在公共部门，初级保健大多由护士或医师助理提供，而在私营部门，则由全科医生提供。家庭医生在初级保健机构和一级医院工作，在多学科团队中担任临床医生、顾问、能力建设者、临床培训师、临床治理领导者，还可能承担一些管理职能。需要与卫生部门、监管机构、高等教育机构以及其他卫生专业开展宣传推广，以彰显家庭医生和培训项目的贡献。由于人数较少且研究成果有限，在非洲背景下的影响证据也很有限。教育与培训的障碍和促进因素与发展阶段相关。关键问题包括缺乏学术和教学专业知识、需要打造学习环境和临床培训师、足够的培训岗位以及新毕业生的合理调配。克服这些障碍的实施策略可分为规划、教育、财务、质量管理和政策相关策略。倡导采用南南合作与南北合作的支持及伙伴关系模式。应更加重视让公众了解家庭医学的贡献。
