Family medicine training and practice in Malawi: History, progress, and the anticipated role of the family physician in the Malawian health system

Makwero, Martha; Lutala, Prosper; McDonald, Anna

doi:10.4314/mmj.v29i4.6

Cited by 7 publications

(17 citation statements)

References 8 publications

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“…In international literature, it is often stated that FPs are able to deal with 90% of the disease burden within their context [51]. However, evidence for this in the SSA setting was not found.…”

Section: Table 10mentioning

confidence: 99%

A scoping review on family medicine in sub-Saharan Africa: practice, positioning and impact in African health care systems

et al. 2020

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Background: Family medicine (FM) is a relatively new discipline in sub-Saharan Africa (SSA), still struggling to find its place in the African health systems. The aim of this review was to describe the current status of FM in SSA and to map existing evidence of its strengths, weaknesses, effectiveness and impact, and to identify knowledge gaps. Methods: A scoping review was conducted by systematically searching a wide variety of databases to map the existing evidence. Articles exploring FM as a concept/philosophy, a discipline, and clinical practice in SSA, published in peer-reviewed journals from 2000 onwards and in English language, were included. Included articles were entered in a matrix and then analysed for themes. Findings were presented and validated at a Primafamed network meeting, Gauteng 2018. Results: A total of 73 articles matching the criteria were included. FM was first established in South Africa and Nigeria, followed by Ghana, several East African countries and more recently additional Southern African countries. In 2009, the Rustenburg statement of consensus described FM in SSA. Implementation of the discipline and the roles and responsibilities of family physicians (FPs) varied between and within countries depending on the needs in the health system structure and the local situation. Most FPs were deployed in district hospitals and levels of the health system, other than primary care. The positioning of FPs in SSA health systems is probably due to their scarcity and the broader mal-distribution of physicians. Strengths such as being an "allround specialist", providing mentorship and supervision, as well as weaknesses such as unclear responsibilities and positioning in the health system were identified. Several studies showed positive perceptions of the impact of FM, although only a few health impact studies were done, with mixed results. Conclusions: FM is a developing discipline in SSA. Stronger evidence on the impact of FM on the health of populations requires a critical mass of FPs and shared clarity of their position in the health system. As FM continues to grow in SSA, we suggest improved government support so that its added value and impact on health systems in terms of health equity and universal health coverage can be meaningfully explored.

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Section: Table 10mentioning

confidence: 99%

A scoping review on family medicine in sub-Saharan Africa: practice, positioning and impact in African health care systems

et al. 2020

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“…Specific to physicians practising in Malawi, the University of Malawi College of Medicine launched the School of Public Health and Family Medicine in 2013. The school offers a Master of Medicine programme in Family Medicine that trains physicians to practice in rural areas of Malawi, with the goal of addressing community health needs (Makwero, Lutala, and McDonald 2017, 313). Family physicians are also trained to work with nurses and other allied health professionals such as health surveillance assistants (HSAs) (Makwero, Lutala, and McDonald 2017, 315).…”

Section: Implications For Healthcare Professionalsmentioning

confidence: 99%

“…The school offers a Master of Medicine programme in Family Medicine that trains physicians to practice in rural areas of Malawi, with the goal of addressing community health needs (Makwero, Lutala, and McDonald 2017, 313). Family physicians are also trained to work with nurses and other allied health professionals such as health surveillance assistants (HSAs) (Makwero, Lutala, and McDonald 2017, 315). HSAs provide nutrition education in rural areas, and support nurses in health promotion efforts (Dressel et al 2020, 372).…”

Section: Implications For Healthcare Professionalsmentioning

confidence: 99%

A black dog enters the home: hunger and malnutrition in Malawi

et al. 2021

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Hunger and inadequate nutrition are ongoing concerns in rural Malawi and are exemplified in traditional proverbs. Traditional proverbs and common expressions offer insight into commonly held truths across societies throughout sub-Saharan Africa. Strong oral traditions allow community beliefs embodied in proverbs to be passed down from generation to generation. In our qualitative study, we conducted 8 individual and 12 focus group interviews with a total of 83 participants across two districts in rural central Malawi with the aim of soliciting context-specific details on men and women’s knowledge, attitudes and practices related to nutrition, gender equality and women’s empowerment. Each interview began by asking participants to share common proverbs related to nutrition. Our qualitative analysis, informed by an indigenous-based theoretical framework that recognises and centres African indigenous knowledge production, yielded six themes: ‘a black dog enters the home’, ‘don’t stay with your hands hanging’, ‘a man is at the stomach’, ‘showers have fallen’, ‘we lack peace in our hearts’ and ‘the hunger season’. Traditional proverbs can provide insight into the underlying causes of hunger and malnutrition. Physicians, nurses and other allied health professionals around the world have a role to play in addressing hunger and malnutrition, which have been exacerbated by climate change. We have an ethical duty to educate ourselves and others, and change our behaviours, to mitigate the root causes of climate change, which are contributing to food insecurity and resultant poor health outcomes in countries like Malawi.

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“…Some key areas are improving the quality of clinical governance, increased access to better quality of care, advocacy for better allocation of resources for PHC, training and retention of a more skilled rural workforce. 12 Another contribution is that FM is committed to capacity building of the multidisciplinary teams within PHC as a whole. 12 …”

Section: The Contribution Of Family Medicinementioning

confidence: 99%

“… 12 Another contribution is that FM is committed to capacity building of the multidisciplinary teams within PHC as a whole. 12 …”

Section: The Contribution Of Family Medicinementioning

confidence: 99%

Delivery of primary health care in Malawi

Makwero

2018

Afr. j. prim. health care fam. med.

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Malawi is a landlocked country with a population of 17 million. The delivery of the health care system is based on primary health care (PHC). The PHC structures are acceptable; however, the system is marked by maldistribution of resources, fragmentation of services and shortage of staff. This hampers the function of the set, well-meaning PHC frameworks. Family medicine offers training and retention of the PHC and rural workforce, harnessing clinical governance and capacity building. Family medicine’s role extends to involve advocacy for the PHC to improve its performance.

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Family medicine training and practice in Malawi: History, progress, and the anticipated role of the family physician in the Malawian health system

Cited by 7 publications

References 8 publications

A scoping review on family medicine in sub-Saharan Africa: practice, positioning and impact in African health care systems

A scoping review on family medicine in sub-Saharan Africa: practice, positioning and impact in African health care systems

A black dog enters the home: hunger and malnutrition in Malawi

Delivery of primary health care in Malawi

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