A scoping review on family medicine in sub-Saharan Africa: practice, positioning and impact in African health care systems




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.
机译:家庭医学(FM)是撒哈拉以南非洲(SSA)的一个相对较新的学科,仍在努力在非洲卫生系统中找到它的位置。本综述的目的是描述SSA中FM的现状,并映射其优势,劣势,有效性和影响的现有证据,并识别知识差距。通过系统地搜索各种数据库来映射现有证据来进行范围审查。包括探索FM作为SSA的概念/哲学,在2000年的同伴和英语中发表的概念/哲学,学科和临床实践的文章。包括在矩阵中输入的文章,然后分析主题。在Primafamed网络会议上颁发和验证了调查结果,包括符合标准的73条。 FM首次在南非和尼日利亚建立,其次是加纳,几个东非国家,最近额外的南部非洲国家。 2009年,SSA中的rustenburg达成共识声明描述了FM。根据卫生系统结构和当地情况的需求,各国家庭医生(FPS)的纪律和职责和职责的实施以及在各国之间变化。除初级保健之外,大多数FPS都部署在地区医院和卫生系统水平。 FPS在SSA卫生系统中的定位可能是由于它们的稀缺性和更广泛的医生的混合物。确定了诸如“全方位专家”,提供指导和监督的优势,以及卫生系统中不明确的责任和定位等弱点。若干研究表明对FM的影响的积极看法,尽管只有几项健康影响研究,具有混合结果。 FM是SSA的发展纪律。关于FM对人群健康影响的更强的证据需要批判性的FPS和他们在卫生系统中的职位的清晰度。由于FM继续在SSA中增长,我们建议改善政府支持,以便有意义地探索其在卫生股权和普遍健康覆盖范围内对卫生系统的增加的价值和影响。



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