Perspectives on key principles of generalist medical practice in public service in sub-saharan africa: a qualitative study

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dc.contributor.authorReid, Stephen Jen_ZA
dc.contributor.authorMash, Roberten_ZA
dc.contributor.authorDowning, Raymond Ven_ZA
dc.contributor.authorMoosa, Shabiren_ZA
dc.date.accessioned2015-11-18T03:46:04Z
dc.date.available2015-11-18T03:46:04Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND: 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.identifier.apacitationReid, 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. <i>BMC Family Practice</i>, http://hdl.handle.net/11427/15042en_ZA
dc.identifier.chicagocitationReid, Stephen J, Robert Mash, Raymond V Downing, and Shabir Moosa "Perspectives on key principles of generalist medical practice in public service in sub-saharan africa: a qualitative study." <i>BMC Family Practice</i> (2011) http://hdl.handle.net/11427/15042en_ZA
dc.identifier.citationReid, 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.ris TY - Journal Article AU - Reid, Stephen J AU - Mash, Robert AU - Downing, Raymond V AU - Moosa, Shabir AB - 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. DA - 2011 DB - OpenUCT DO - 10.1186/1471-2296-12-67 DP - University of Cape Town J1 - BMC Family Practice LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Perspectives on key principles of generalist medical practice in public service in sub-saharan africa: a qualitative study TI - Perspectives on key principles of generalist medical practice in public service in sub-saharan africa: a qualitative study UR - http://hdl.handle.net/11427/15042 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/15042
dc.identifier.urihttp://dx.doi.org/10.1186/1471-2296-12-67
dc.identifier.vancouvercitationReid 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 Family Practice. 2011; http://hdl.handle.net/11427/15042.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentPrimary Health Care Directorateen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2011 Reid et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Family Practiceen_ZA
dc.source.urihttp://www.biomedcentral.com/bmcfampract/en_ZA
dc.subject.otherPublic Healthen_ZA
dc.subject.otherGeneral Practiceen_ZA
dc.subject.otherQualitative Researchen_ZA
dc.titlePerspectives on key principles of generalist medical practice in public service in sub-saharan africa: a qualitative studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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