IntroductionCountries with strong primary healthcare (PHC) report better health outcomes, fewer hospital admissions and lower expenditure. People-centred care that delivers essential elements of primary care (PC) leads to improved health outcomes and reduced costs and disparities. Such outcomes underscore the need for validated instruments that measure the extent to which essential, evidence-based features of PC are available and applied to users; and to ensure quality care and provider accountability.MethodsA systematic scoping review method was used to identify peer-reviewed African studies and grey literature on PC performance measurement. The service delivery dimension in the Primary Healthcare Performance Initiative conceptual framework was used to identify key measurable components of PC.ResultsThe review identified 19 African studies and reports that address measuring elements of PC performance. 13 studies included eight nationally validated performance measuring instruments. Of the eight, the South African and Malawian versions of Primary Care Assessment Tool measured service delivery comprehensively and involved PC user, provider and manager stakeholders.Conclusion40 years after Alma Ata and despite strong evidence for people-centred care, significant gaps remain regarding use of validated instruments to measure PC performance in Africa; few validated instruments have been used. Agreement on indicators, fit-for-purpose validated instruments and harmonising existing instruments is needed. Rigorous performance-based research is necessary to inform policy, resource allocation, practice and health worker training; and to ensure access to high quality care in a universal health coverage (UHC) system—research with potential to promote socially responsive, accountable PHC in the true spirit of the Alma Ata and Astana Declarations.

Background: Strengthening primary care research capacity is a priority globally. Family medicine training programmes in sub-Saharan Africa represent an important opportunity to build primary care research; however, they are often limited by insufficient research training and mentorship. Peers can be used to extend research mentorship capacity, but have not been evaluated in this context.Aim: The aim of this study was to evaluate one family medicine training programme’s research capacity building efforts through a blended research curriculum and peer mentorship.Setting: Lesotho is a landlocked country within South Africa of approximately two million people. The Family Medicine Specialty Training Programme (FMSTP) is the only accredited postgraduate medical education programme in Lesotho.Methods: This two-year mixed-methods evaluation used: (1) Likert-scale surveys measuring trainee research confidence, (2) written evaluations by trainees, peers, programme faculty and administrators and (3) in-depth, semi-structured interviews. Survey data were analysed using Friedman and sign tests. Interview and written data were analysed thematically via a mixed inductive-deductive approach using Cooke’s framework.Results: Family Medicine Specialty Training Programme trainees (n = 8) experienced moderate increases in research confidence that were statistically significant. Skill-building occurred primarily via experiential learning. Research was grounded in trainees’ clinical practice and locally relevant. A positive research culture was created, promising for sustainability. We identified infrastructure gaps, including funding and protected time. Peer research mentorship supported trainees’ motivation and provided a safe space for questions.Conclusion: The FMSTP research curriculum and peer mentorship programme were successful in positively impacting a number of Cooke’s research capacity domains. This evaluation identified improvements that are now being implemented.

Family medicine is a relatively new but rapidly expanding medical discipline in Sub-Saharan Africa. Specialization in family medicine is an effective means for building and retaining a highly skilled rural physician workforce in low- and middle-income countries. The Lesotho Boston Health Alliance Family Medicine Specialty Training Program is the first and only postgraduate family medicine program and the only accredited postgraduate training program in the Kingdom of Lesotho. Lesotho has unique challenges as a small mountainous enclave of South Africa with one of the lowest physician-to-patient ratios in the world. Most health professionals are based in the capital city, and the kingdom faces challenging health problems such as high human immunodeficiency virus prevalence, high maternal mortality, and malnutrition, as well as increasing burdens of non-communicable diseases such as hypertension, diabetes, and obesity. In response to these health crises and the severe shortage of health professionals, Lesotho Boston Health Alliance partnered with the Lesotho Ministry of Health in 2008 to introduce family medicine as a new specialty in order to recruit home and retain Basotho doctors. Family medicine training in Lesotho uses a unique decentralized, non-university-based model with trainees posted at rural district hospitals throughout the country. While family medicine in Lesotho is still in the early stages of development, this model of decentralized training demonstrates an effective strategy to develop the rural health workforce in Lesotho, has the potential to change the physician workforce and health care system of Lesotho, and can be a model for physician training in similar environments.