Felicity Goodyear-Smith is a Professor in the Department of General Practice and Primary Health Care at the University of Auckland, New Zealand
I have just returned from South Africa, where I had the honour of delivering a plenary presentation on building primary care research capacity at the Primafamed (Africa) Network Conference. The meeting was attended by representatives from the family medicine departments of institutions in Sub-Saharan African countries.
Family medicine is in fledgling stage in most of these nations. With some overseas aid and support, the Primafamed project has developed family medicine training programmes in ten universities. (1,2) They have had the opportunity to learn from what works well in resource-rich countries, see that vertical progression from undergraduate to postgraduate training is important and that collaboration with other institutions, other disciplines and stakeholders including their provincial or national departments of health and policy-makers are vital components.
Their challenges are huge. A large percentage of their populations live in poverty and the inverse care law3 is in operation, with health resources dispropotionately available to the affluent. There is a high prevalence of infant and maternal mortality, tuberculosis, HIV/AIDS and other infectious diseases, violence and increasingly non-communicable diseases. There is a ‘brain drain’ from other African countries to South Africa and from South Africa internationally. Health care is confounded by growing populations, famines and wars. Primary heatlth care is the best hope of delivering cost-effective, equitable care to people in need.4
They have recognised that clincal practice, teaching and research each inform the other, hence the necessity to build their research capacity. However developing a research culture and becoming research-active is no easy task. Conducting research requires acquistion of skills and building a research team. The challenge is to obtain the critical mass needed to enable further mentoring and supervising of emerging researchers. Already some solutions are in place. An initiative has been introuduced to ‘twin’ each of the family medicine departments of the eight South African universities with other African countries including those without a university family medicine department.5 The establishment of the African Journal of Primary Health Care and Family Medicine.
I learnt that most international aid is focused on specific diseases and hospital-based programmes. This funding serves to take potential health care providers and researchers away from person and community-based care and research to follow the money. Despite the 1978 Declaration of Alma-Ata, there is a strong hospital-centred focus that provides health care for only a small proportion of the population in need.
Notwithstanding these barriers, great progress is being made in establishing family medicine as a discipline in Sub-Saharan African countries, as attested by the number of institutions and nations represented at this ground-breaking conference.
Although New Zealand is resource-rich, we are a small nation with our own “brain drain” issues. We have a “number eight fencing wire” tradition. As an agricultural country geographically isolated from the rest of the world, we had to invent things we could not easily obtain. Kiwis are said to be able to make almost anything from the ubiquitous resource of “number eight fencing wire”. This has led to a cultural attribute of putting our hands to anything, improvising and adapting to solve problems using readily available resources. I was able to share some of our New Zealand home-grown solutions to building research capacity with a small population and limited funding.
While they share many of the challenges, various African countries have differences in the way health care is delivered. As an executive member of the Wonca Working Party on Research, I introduced our Plenary Panel Project, in which panellists from six countries each present for 10 minutes at a Wonca Regional meeting, followed by a 30 minute discussion from the floor. Using a PowerPoint slide template, each panellist explains how primary care is organised in their country, the benefits and drawbacks of this system, its impact on patient care, the health burdens they face, the ability of the system to respond to challenge, and lessons for other countries. There is also a template tow write standardised monographs for publication. It is planned that one of these panels will be run at the next African WONCA meeting to be held in Accra, Ghana in February 2015.
I felt privileged to be able to make this small contribution during my fleeting visit to Pretoria. The transformation to a primary health system holds the hope for African people to receive the care they need.
- Flinkenflogel M, Essuman A, Chege P, Ayankogbe O. Family Medicine training in Sub-Saharan Africa: South-South cooperation in the Primafamed project as strategy for development. Fam Pract 2014; 31(4).
- Goodyear-Smith F. Sub-Saharan Africa fast-tracks towards family medicine. Fam Pract 2014; 31(4): 10.1093/fampra/cmu023.
- Hart JT. The inverse care law. Lancet 1971; 1(7696): 405-12.
- Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005; 83(3): 457-502.
- Flinkenflogel M, Mash B, Ayankogbe O, Reid S, Essuman A, De Maseneer J. "The African family physician": development of family medicine in the twenty-first century. In: Kidd M, ed. The Contribution of Family Medicine to Improving Health Systems. London & New York: Radcliffe Publishing; 2013: 247-65.