[For front-line community-based general practitioners].

In the past thirty years considerable effort has been devoted to delivering basic health services to rural populations. However the quality of care remains poor. One problem is that the absence of general practitioners working at the community level has resulted in health care systems without doctors. This "missing-link" situation is inconsistent with the availability of a large number of young fully trained medical doctors who graduated from Medical Schools in West African countries and Madagascar. Based on examples in Mali and Madagascar, the authors of this article attempt to show the advantages of a new concept, i.e., community-based general practitioners. These practitioners would not only provide a front-line medical presence but also combine the principles of primary health care (PHC) and family medicine (FM) into a single practice. For this approach to be successful a number of obstacles would have to be overcome and several indispensable accompanying measures would have to be implemented. The goal would be to establish a familiar front-line healthcare provider that village communities could trust.