Kéfilath Bello1,2, Jan De Lepeleire3, Jeff Kabinda M4, Samuel Bosongo4, Jean-Paul Dossou1, Evelyn Waweru2, Ludwig Apers5, Marcel Zannou1,6, Bart Criel2. 1. Centre de Recherche en Reproduction Humaine et en Démographie, Cotonou, Benin. 2. Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. 3. Department of Public Health and Primary Care, General Practice, KU Leuven-University of Leuven, Leuven, Belgium. 4. Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Democratic Republic of Congo. 5. Department Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium. 6. Faculty of Health Sciences, University of Abomey-Calavi, Abomey-Calavi, Benin.
Abstract
INTRODUCTION: In sub-Saharan Africa (SSA), the physicians' ratio is increasing. There are clear indications that many of them have opted to work at the first-line of healthcare delivery systems, i.e. providing primary care. This constitutes an important change in African healthcare systems where the first line has been under the responsibility of nurse-practitioners for decades. Previous reviews on primary care physicians (PCPs) in SSA focused on the specific case of family physicians in English-speaking countries. This scoping review provides a broader mapping of the PCPs' practices in SSA, beyond family physicians and including francophone Africa. For this study, we defined PCPs as medical doctors who work at the first-line of healthcare delivery and provide generalist healthcare. METHODS: We searched five databases and identified additional sources through purposively selected websites, expert recommendations, and citation tracking. Two reviewers independently selected studies and extracted and coded the data. The findings were presented to a range of stakeholders. FINDINGS: We included 81 papers, mostly related to the Republic of South Africa. Three categories of PCPs are proposed: family physicians, "médecins généralistes communautaires", and general practitioners. We analysed the functioning of each along four dimensions that emerged from the data analysis: professional identity, governance, roles and activities, and output/outcome. Our analysis highlighted several challenges about the PCPs' governance that could threaten their effective contribution to primary care. More research is needed to investigate better the precise nature and performance of the PCPs' activities. Evidence is particularly needed for PCPs classified in the category of GPs and, more generally, PCPs in African countries other than the Republic of South Africa. CONCLUSIONS: This review sheds more light on the institutional, organisational and operational realities of PCPs in SSA. It also highlighted persisting gaps that remain in our understanding of the functioning and the potential of African PCPs.
INTRODUCTION: In sub-Saharan Africa (SSA), the physicians' ratio is increasing. There are clear indications that many of them have opted to work at the first-line of healthcare delivery systems, i.e. providing primary care. This constitutes an important change in African healthcare systems where the first line has been under the responsibility of nurse-practitioners for decades. Previous reviews on primary care physicians (PCPs) in SSA focused on the specific case of family physicians in English-speaking countries. This scoping review provides a broader mapping of the PCPs' practices in SSA, beyond family physicians and including francophone Africa. For this study, we defined PCPs as medical doctors who work at the first-line of healthcare delivery and provide generalist healthcare. METHODS: We searched five databases and identified additional sources through purposively selected websites, expert recommendations, and citation tracking. Two reviewers independently selected studies and extracted and coded the data. The findings were presented to a range of stakeholders. FINDINGS: We included 81 papers, mostly related to the Republic of South Africa. Three categories of PCPs are proposed: family physicians, "médecins généralistes communautaires", and general practitioners. We analysed the functioning of each along four dimensions that emerged from the data analysis: professional identity, governance, roles and activities, and output/outcome. Our analysis highlighted several challenges about the PCPs' governance that could threaten their effective contribution to primary care. More research is needed to investigate better the precise nature and performance of the PCPs' activities. Evidence is particularly needed for PCPs classified in the category of GPs and, more generally, PCPs in African countries other than the Republic of South Africa. CONCLUSIONS: This review sheds more light on the institutional, organisational and operational realities of PCPs in SSA. It also highlighted persisting gaps that remain in our understanding of the functioning and the potential of African PCPs.
Authors: Merlin L Willcox; Wim Peersman; Pierre Daou; Chiaka Diakité; Francis Bajunirwe; Vincent Mubangizi; Eman Hassan Mahmoud; Shabir Moosa; Nthabiseng Phaladze; Oathokwa Nkomazana; Mustafa Khogali; Drissa Diallo; Jan De Maeseneer; David Mant Journal: Hum Resour Health Date: 2015-09-10