African leaders’ views on critical human resource issues for the implementation of family medicine in Africa

Human Resources for Health

Robert Mash⁴  Stephen Reid⁵  Stephen Pentz³  Akye Essuman²  Raymond Downing¹  Shabir Moosa³ 

[1] Department of Family Medicine, Moi University, Eldoret, Kenya;Family Medicine Unit, Department of Community Health, University of Ghana, Accra, Ghana;Department of Family Medicine, University of Witwatersrand, Johannesburg, South Africa;Division of Family Medicine and Primary Care, Stellenbosch University, Stellenbosch, South Africa;PHC Directorate, University of Cape Town, Cape Town, South Africa

关键词: Policy;    Human resources;    Family physician;    Development;    Africa;    Primary health care;    Family medicine;   

Others  :  822041
DOI  :  10.1186/1478-4491-12-2

 received in 2013-06-22, accepted in 2013-12-27,  发布年份 2014

【 摘 要 】

Background

The World Health Organisation has advocated for comprehensive primary care teams, which include family physicians. However, despite (or because of) severe doctor shortages in Africa, there is insufficient clarity on the role of the family physician in the primary health care team. Instead there is a trend towards task shifting without thought for teamwork, which runs the risk of dangerous oversimplification. It is not clear how African leaders understand the challenges of implementing family medicine, especially in human resource terms. This study, therefore, sought to explore the views of academic and government leaders on critical human resource issues for implementation of family medicine in Africa.

Method

In this qualitative study, key academic and government leaders were purposively selected from sixteen African countries. In-depth interviews were conducted using an interview guide. All interviews were audio-recorded, transcribed and thematically analysed.

Results

There were 27 interviews conducted with 16 government and 11 academic leaders in nine Sub-Saharan African countries: Botswana, Democratic Republic of Congo, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa and Uganda. Respondents spoke about: educating doctors in family medicine suited to Africa, including procedural skills and holistic care, to address the difficulty of recruiting and retaining doctors in rural and underserved areas; planning for primary health care teams, including family physicians; new supervisory models in primary health care; and general human resource management issues.

Conclusions

Important milestones in African health care fail to specifically address the human resource issues of integrated primary health care teamwork that includes family physicians. Leaders interviewed in this study, however, proposed organising the district health system with a strong embrace of family medicine in Africa, especially with regard to providing clinical leadership in team-based primary health care. Whilst these leaders focussed positively on entry and workforce issues, in terms of the 2006 World Health Report on human resources for health, they did not substantially address retention of family physicians. Family physicians need to respond to the challenge by respondents to articulate human resource policies appropriate to Africa, including the organisational development of the primary health care team with more sophisticated skills and teamwork.

【 授权许可】

   
2014 Moosa et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]African Development Bank: Africa in 50 Years’ Time: The Road Towards Inclusive Growth. Tunis, Tunisia: African Development Bank Group; 2011.
• [2]World Health Organisation: The Health of the People: the African Regional Health Report. Geneva: WHO; 2006.
• [3]World Health Organisation: Report on the Review of Primary Health Care in the African Region. Mauritius: WHO; 2008.
• [4]Dolea C, Stormont L, Braichet J-M: Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bull World Health Organ 2010, 88(5):379-385.
• [5]Padarath BA, Chamberlain C, Mccoy D, Ntuli A, Rowson M, Loewenson R: Health personnel in Southern Africa: confronting maldistribution and brain drain. EQUINET 2003. Discussion Paper No. 3
• [6]World Health Organisation: Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention. Geneva: WHO; 2010.
• [7]World Health Organisation: The World Health Report 2008: Primary Health Care - Now More Than Ever. Geneva: WHO; 2009.
• [8]Starfield B, Shi L, Macinko J: Contribution of primary care to health systems and health. Milbank Q 2005, 83:457-502.
• [9]Starfield B: Primary care and equity in health: the importance to effectiveness and equity of responsiveness to peoples’ needs. Humanity Soc 2009, 33:56-73.
• [10]Sixty-second World Health Assembly: Primary health care, including health system strengthening. World Health Assembly 2009, 62(12):1-3.
• [11]Member States of the African Region WHO: The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: achieving Better Health for Africa in the New Millennium. Brazzaville: Regional Office for Africa, Ouagadougou; 2008.
• [12]World Health Organisation: The Kampala Declaration and Agenda for Global Action. Geneva: WHO; 2008.
• [13]WHO Regional Committee for Africa: Road Map for Scaling up the Human Resources for Health for Improved Health Service Delivery in the African Region 2012 to 2025. Luanda: WHO; 2012.
• [14]Reid SJ, Mash R, Downing RV, Moosa S: Perspectives on key principles of generalist medical practice in public service in Sub-Saharan Africa: a qualitative study. BMC Fam Pract 2011, 12:67. BioMed Central Full Text
• [15]Moosa S, Gibbs A: A focus group study of primary health care in Johannesburg Health District, South Africa: ‘we are just pushing numbers’. S Afr Fam Pract 2013. accepted for publication
• [16]Moosa S, Downing R, Mash B, Reid S, Pentz S, Essuman A: Understanding of family medicine in Africa: a qualitative study of leaders’ views. Br J Gen Pract 2013, 63:209-216.
• [17]Kidd M: The Contribution of Family Medicine to Improving Health Systems: a Guidebook from the World Organisation of Family Doctors. 2nd edition. London: Radcliffe Publishing; 2013.
• [18]Ritchie JSL: Qualitative data analysis for applied policy research. In Anal. Qual. Data. Edited by Bryman A, Burgess R. London: Routledge; 1993:173-194.
• [19]World Health Organisation: Working Together for Health: The World Health Report 2006. Geneva: WHO; 2006.
• [20]Tong A, Sainsbury P, Craig J: Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007, 19:349-357.
• [21]Mash R, Reid SJ: Statement of consensus on family medicine in Africa. African J Prim Health Care Fam Med 2010, 2:4-7.
• [22]Mash B, Downing R, Moosa S, De Maeseneer J: Exploring the key principles of family medicine in Sub-Saharan Africa: international Delphi consensus process. S Afr Fam Pract 2008, 50:60-65.
• [23]World Health Organisation: The World Health Report: Health Systems Financing: the Path to Universal Coverage. Geneva: WHO; 2010.
• [24]Shipp PJ: Workload Indicators of Staffing Need (WISN): a Manual for Implementation. Geneva, Switzerland: WHO Division of Human Resources Development and Capacity Building; 1998.
• [25]De Maeseneer J: Scaling up family medicine and primary health care in Africa: Statement of the PRIMAFAMED network, Victoria Falls, Zimbabwe. African J Prim Health Care Fam Med 2013, 5:5-7.
• [26]National Department of Health: Provincial Guidelines for the Implementation of the Three Streams of PHC Re-engineering. Pretoria: National Department of Health; 2011:1-10.
• [27]Ministry of Health: Kenyan Family Medicine Strategy. Nairobi: Ministry of Health; 2007.
• [28]National Department of Health: Human Resources for Health South Africa: HRH Strategy for the Health Sector: 2012/13 to 2016/17. Pretoria: National Department of Health; 2011.