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      Perceptions regarding the scope of practice of family doctors amongst patients in primary care settings in Nairobi

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          Abstract

          Background

          Primary care (PC) is the foundation of the Kenyan health care system, providing comprehensive care, health promotion and managing all illnesses across the lifecycle. In the private sector in Nairobi, PC is principally offered by the general practitioners, also known as family doctors (FDs). The majority have no postgraduate training. Little is known about how patients perceive their capability.

          Aim

          To assess patients’ perceptions of the scope of practice of FDs working in private sector PC clinics in Nairobi and their awareness of the new category of family physicians (FPs) and the discipline of family medicine.

          Setting

          Private sector PC clinics in Nairobi.

          Methods

          A descriptive survey using a structured, self-administered questionnaire. Simple random sampling was used to recruit 162 patient participants.

          Results

          Of the participants, 30% knew the difference between FPs and FDs. There was a high to moderate confidence that FDs could treat common illnesses; provide lifestyle advice; family planning (66%) and childhood immunisations (64%). In adolescents and adults, low confidence was expressed in their ability to manage tuberculosis (58%), human immunodeficiency virus (55%) and cancer (33%). In the elderly, there was low confidence in their ability to manage depression (55%), anxiety (57%), urinary incontinence (57%) and diabetes (59%). There was low confidence in their ability to provide antenatal care (55%) and Pap smears (42%).

          Conclusion

          Patients did not perceive that FDs could offer fully comprehensive PC services. These perceptions may be addressed by defining the expected package of care, designing a system that encourages the utilisation of PC and employing FPs.

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          Most cited references20

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          Health transition in Africa: practical policy proposals for primary care.

          Sub-Saharan Africa is undergoing health transition as increased globalization and accompanying urbanization are causing a double burden of communicable and noncommunicable diseases. Rates of communicable diseases such as HIV/AIDS, tuberculosis and malaria in Africa are the highest in the world. The impact of noncommunicable diseases is also increasing. For example, age-standardized mortality from cardiovascular disease may be up to three times higher in some African than in some European countries. As the entry point into the health service for most people, primary care plays a key role in delivering communicable disease prevention and care interventions. This role could be extended to focus on noncommunicable diseases as well, within the context of efforts to strengthen health systems by improving primary-care delivery. We put forward practical policy proposals to improve the primary-care response to the problems posed by health transition: (i) improving data on communicable and noncommunicable diseases; (ii) implementing a structured approach to the improved delivery of primary care; (iii) putting the spotlight on quality of clinical care; (iv) aligning the response to health transition with health system strengthening; and (v) capitalizing on a favourable global policy environment. Although these proposals are aimed at primary care in sub-Saharan Africa, they may well be relevant to other regions also facing the challenges of health transition. Implementing these proposals requires action by national and international alliances in mobilizing the necessary investments for improved health of people in developing countries in Africa undergoing health transition.
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            Primary health care and the Sustainable Development Goals.

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              Family medicine training in sub-Saharan Africa: South–South cooperation in the Primafamed project as strategy for development

              Background. Health-care systems based on primary health care (PHC) are more equitable and cost effective. Family medicine trains medical doctors in comprehensive PHC with knowledge and skills that are needed to increase quality of care. Family medicine is a relatively new specialty in sub-Saharan Africa. Objective. To explore the extent to which the Primafamed South–South cooperative project contributed to the development of family medicine in sub-Saharan Africa. Methods. The Primafamed (Primary Health Care and Family Medicine Education) project worked together with 10 partner universities in sub-Saharan Africa to develop family medicine training programmes over a period of 2.5 years. A SWOT (strengths, weaknesses, opportunities and threats) analysis was done and the training development from 2008 to 2010 in the different partner universities was analysed. Results. During the 2.5 years of the Primafamed project, all partner universities made progress in the development of their family medicine training programmes. The SWOT analysis showed that at both national and international levels, the time is ripe to train medical doctors in family medicine and to integrate the specialty into health-care systems, although many barriers, including little awareness, lack of funding, low support from other specialists and reserved support from policymakers, are still present. Conclusions. Family medicine can play an important role in health-care systems in sub-Saharan Africa; however, developing a new discipline is challenging. Advocacy, local ownership, action research and support from governments are necessary to develop family medicine and increase its impact. The Primafamed project showed that development of sustainable family medicine training programmes is a feasible but slow process. The South–South cooperation between the ten partners and the South African departments of family medicine strengthened confidence at both national and international levels.
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                Author and article information

                Journal
                Afr J Prim Health Care Fam Med
                Afr J Prim Health Care Fam Med
                PHCFM
                African Journal of Primary Health Care & Family Medicine
                AOSIS
                2071-2928
                2071-2936
                04 October 2018
                2018
                : 10
                : 1
                : 1818
                Affiliations
                [1 ]Department of Family Medicine, Aga Khan University Hospital, Kenya
                [2 ]Division of Family Medicine and Primary Care, Stellenbosch University, South Africa
                [3 ]Department of Counselling Psychology, Aga Khan University Hospital, Kenya
                [4 ]Aga Khan University Hospital, Nairobi, Kenya
                [5 ]Division of Primary Care and Population Health, Stanford University, United States of America
                Author notes
                Corresponding author: Gulnaz Mohamoud, mmgulnaz@ 123456yahoo.com
                Author information
                https://orcid.org/0000-0002-1795-1959
                https://orcid.org/0000-0001-7373-0774
                https://orcid.org/0000-0003-0599-8781
                https://orcid.org/0000-0001-8717-6073
                https://orcid.org/0000-0001-9166-9575
                Article
                PHCFM-10-1818
                10.4102/phcfm.v10i1.1818
                6191765
                30326721
                5abdb2ac-2ff9-48aa-9e0d-2a4cf8f8dee3
                © 2018. The Authors

                Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.

                History
                : 05 May 2018
                : 26 July 2018
                Categories
                Original Research

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