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      Development of Family Medicine training in Botswana: Views of key stakeholders in Ngamiland Translated title: Lancement d'une Formation en Médecine familiale au Botswana: Points de vue des principales parties prenantes au Ngamiland

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          BACKGROUND: Family Medicine training commenced in Botswana in 2011, and Maun was one of the two sites chosen as a training complex. If it is to be successful there has to be investment in the training programme by all stakeholders in healthcare delivery in the district. AIM: The aim of the study was to explore the attitudes of stakeholders to initiation of Family Medicine training and their perspectives on the future roles of family physicians in Ngami district, Botswana. SETTING: Maun and the surrounding Ngami subdistrict of Botswana METHODS: Thirteen in-depth interviews were conducted with purposively selected key stakeholders in the district health services. Data were recorded, transcribed and analysed using the framework method. RESULTS: Participants welcomed the development of Family Medicine training in Maun and expect that this will result in improved quality of primary care. Participants expect the registrars and family physicians to provide holistic health care that is of higher quality and expertise than currently experienced, relevant research into the health needs of the community, and reduced need for referrals. Inadequate personal welfare facilities, erratic ancillary support services and an inadequate complement of mentors and supervisors for the programme were some of the gaps and challenges highlighted by participants. CONCLUSION: Family Medicine training is welcomed by stakeholders in Ngamiland. With proper planning introduction of the family physician in the district is expected to result in improvement of primary care.

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          CONTEXTE: On a commencé la Formation en Médecine familiale au Botswana en 2011, et Maun était l'un des deux sites choisis comme centre de formation. Pour que le projet réussisse il faut que tous les acteurs des prestations de soins de santé de la région s'investissent dans le programme de formation. OBJECTIF: L'étude avait pour but d'examiner les attitudes des parties prenantes envers le lancement d'une formation en médecine familiale et leurs points de vue concernant le futur rôle des médecins de famille dans le district de Ngami, au Botswana. LIEU: Maun et le sous-district avoisinant de Ngami au Botswana. MÉTHODES: On a effectué des entrevues avec des intervenants clé expressément sélectionnés parmi les services de santé du district. On a enregistré, transcrit et analysé les données suivant la méthodologie du cadre. RÉSULTATS: Les participants ont bien accueilli le développement d'une Formation en Médecine familiale à Maun et espèrent que cela amènera une amélioration de la qualité des soins primaires. Les participants désirent que les directeurs et les médecins de famille offrent des soins de santé holistiques et une expertise de meilleure qualité que celle fournie à l'heure actuelle, fassent des recherches appropriées sur les besoins en santé de la communauté, et réduisent le besoin de référence. Les participants ont souligné certaines lacunes et défis tels que les services insuffisants de bien-être personnel, les services auxiliaires de soutien irréguliers et une équipe insuffisante de mentors et de surveillants pour le programme. CONCLUSION: Les acteurs du Ngamiland ont bien accueilli la formation en médicine familiale. Avec une bonne planification, la mise en place d'un médecin de famille dans le district devrait améliorer les soins primaires.

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          Most cited references 23

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          Statement of consensus on Family Medicine in Africa

          Family Medicine is an emerging speciality in sub-Saharan Africa and yet potential interest in the contribution of Family Medicine to health, primary care and district health services is limited by the lack of a regional definition. Governments, health departments and academic institutions would benefit from a clearer understanding of Family Medicine in an African context.The 2nd African Regional WONCA (World Organisation of Family Doctors) Conference, held in Rustenberg, South Africa in October 2009, engaged participants from sub-Saharan Africa in the development of a consensus statement on Family Medicine. The consensus statement agreed to by the conference defined the contribution of Family Medicine to equity, quality and primary health care within an African context, as well as the role and training requirements of the family physician. Particular attention was given to the contribution of women in Family Medicine.
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            Understanding of family medicine in Africa: a qualitative study of leaders' views.

            The World Health Organization encourages comprehensive primary care within an ongoing personalised relationship, including family physicians in the primary healthcare team, but family medicine is new in Africa, with doctors mostly being hospital based. African family physicians are trying to define family medicine in Africa, however, there is little clarity on the views of African country leadership and their understanding of family medicine and its place in Africa. To understand leaders' views on family medicine in Africa. Qualitative study with in-depth interviews in nine sub-Saharan African countries. Key academic and government leaders were purposively selected. In-depth interviews were conducted using an interview guide, and thematically analysed. Twenty-seven interviews were conducted with government and academic leaders. Responders saw considerable benefits but also had concerns regarding family medicine in Africa. The benefits mentioned were: having a clinically skilled all-rounder at the district hospital; mentoring team-based care in the community; a strong role in leadership and even management in the district healthcare system; and developing a holistic practice of medicine. The concerns were that family medicine is: unknown or poorly understood by broader leadership; poorly recognised by officials; and struggling with policy ambivalence, requiring policy advocacy championed by family medicine itself. The strong district-level clinical and leadership expectations of family physicians are consistent with African research and consensus. However, leaders' understanding of family medicine is couched in terms of specialties and hospital care. African family physicians should be concerned by high expectations without adequate human resource and implementation policies.
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              The World Health Report 2008: Primary Health Care Now More Than Ever


                Author and article information

                Role: ND
                Role: ND
                African Journal of Primary Health Care & Family Medicine
                Afr. j. prim. health care fam. med. (Online)
                AOSIS Publishing (Cape Town )
                : 7
                : 1
                : 1-9
                [1 ] Stellenbosch University South Africa


                Product Information: SciELO South Africa
                Health Care Sciences & Services
                Medicine, General & Internal

                General life sciences, Internal medicine, Health & Social care


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