Exploring the key principles of family medicine in sub-Saharan Africa: International Delphi consensus process
Background: The purpose of this study was to establish consensus on the key principles of Family Medicine for Sub-Saharan Africa. Methods: A three-stage Delphi technique process involving nine countries in sub-Saharan Africa and individuals from two stakeholder groups (teachers or students/graduates of family medicine programmes). Consensus in rounds one and two was defined as at least 70% agreement. Ranking in round three depended on individuals selecting and ranking the top 20 principles; following this, aggregate scores were calculated. Results: Of the participants, 40 gave consent and 28 participated in the first round (23 teachers and 17 students/graduates); 27/40 (67.5%) participated in the second round; 22/40 (60%) in the third round. The 50 principles seen as relevant were ranked in order of importance. Core values and characteristics such as holistic, longitudinal, comprehensive and family-orientated care and community orientation were recognised as relevant, with differences from more developed settings in terms of emphasis. Several key organisational principles, such as home visiting and definition of the practice population, were seen differently. Principles relating to the scope of practice showed the greatest difference, with the need for family physicians to perform major surgery in the district hospital, to act as consultant and teacher to the first-contact primary care team and to include clinical nurse practitioners in the definition of family medicine being raised. Conclusion: The study contributes towards a clearer definition of Family Medicine in the region, which would enable comparison between regions, influence local curriculum content and outcomes, as well as inform the policy makers and managers of the health system.