Perspectives on key principles of generalist medical practice in public service in Sub-Saharan Africa: a qualitative study

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Show simple item record Reid, Stephen J. Mash, Robert Downing, Raymond V. Moosa, Shabir 2011-08-26T10:48:59Z 2011-08-26T10:48:59Z 2011-07-04
dc.identifier.citation Reis, S. J., Mash, R., Downing, R. V. & Moosa, S. 2011, Perspectives on key principles of generalist medical practice in public service in Sub-Saharan Africa: a qualitative study, BMC Family Practice, 12(1):67 en_ZA
dc.identifier.issn en_ZA
dc.description The original publication is available at en_ZA
dc.description.abstract Abstract Background: The principles and practice of Family Medicine that arose in developed Western countries have been imported and adopted in African countries without adequate consideration of their relevance and appropriateness to the African context. In this study we attempted to elicit a priori principles of generalist medical practice from the experience of long-serving medical officers in a variety of African counties, through which we explored emergent principles of Family Medicine in our own context. Methods A descriptive study design was utilized, using qualitative methods. 16 respondents who were clinically active medical practitioners, working as generalists in the public services or non-profit sector for at least 5 years, and who had had no previous formal training or involvement in academic Family Medicine, were purposively selected in 8 different countries in southern, western and east Africa, and interviewed. Results The respondents highlighted a number of key issues with respect to the external environment within which they work, their collective roles, activities and behaviours, as well as the personal values and beliefs that motivate their behaviour. The context is characterized by resource constraints, high workload, traditional health beliefs, and the difficulty of referring patients to the next level of care. Generalist clinicians in sub-Saharan Africa need to be competent across a wide range of clinical disciplines and procedural skills at the level of the district hospital and clinic, in both chronic and emergency care. They need to understand the patient's perspective and context, empowering the patient and building an effective doctor-patient relationship. They are also managers, focused on coordinating and improving the quality of clinical care through teamwork, training and mentoring other health workers in the generalist setting, while being life-long learners themselves. However, their role in the community, was found to be more aspirational than real. Conclusions The study derived a set of principles for the practice of generalist doctors in sub-Saharan Africa based on the reported activities and approaches of the respondents. Patient-centred care using a biopsychosocial approach remains as a common core principle despite wide variations in context. Procedural and hospital care demands a higher level of skills particularly in rural areas, and a community orientation is desirable, but not widely practiced. The results have implications for the postgraduate training of family physicians in sub-Saharan Africa, and highlight questions regarding the realization of community-orientated primary care. en_ZA
dc.format.extent 9 p.
dc.language.iso en_ZA en_ZA
dc.subject Primary health care practice -- Africa, Sub-Saharan en_ZA
dc.subject Medical profession -- Africa, Sub-Saharan -- History en_ZA
dc.subject medical personnel -- Training of -- Africa, Sub-Saharan -- Evaluation en_ZA
dc.subject Family medicine -- Study and teaching -- Africa, Sub-Saharan en_ZA
dc.title Perspectives on key principles of generalist medical practice in public service in Sub-Saharan Africa: a qualitative study en_ZA
dc.type Article en_ZA 2011-07-23T15:03:37Z
dc.description.version Publishers' Version en_ZA
dc.language.rfc3066 en en_ZA
dc.rights.holder Reid et al.; licensee BioMed Central Ltd. en_ZA
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