Family Medicine Training in Lesotho: A Strategy of Decentralized Training for Rural Physician Workforce Development

Abstract

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.

Factors affecting family medicine programmes in Sub-Saharan Africa: a narrative review of recent literature

“…Support from key stakeholders Support from government was identified as a crucial factor in the successful launch of FM within a country. 27,28,44,55,56 Clear government policies advocating for the adoption of FM within healthcare systems, including strategies for the training and deployment of FPs, were a significant enabler for the roll out of FM. 48 Conversely, opposition or ambivalence by governments posed a significant barrier to the successful adoption of FM.…”

“…36,49 International Collaboration Eighteen papers emphasised the role of international collaboration in supporting FP training programmes, particularly during their infancy. 15,21,22,27,28,33,40,48,55,[60][61][62][63][64][65][66][67][68][69] Primary Care and Family Medicine Network for sub-Saharan Africa (PRIMAFAMED) was important for enhancing regional cooperation and providing support to newly established training programmes. 14,27,56,60 The possibility of a regional college of FPs is currently being investigated.…”

“…27 Support from North American and European institutions included the provision of short courses and training, expertise in faculty development, the provision of staff, grants for programme development, programme review and feedback, sharing of educational resources, and peerto-peer research support. 22,28,33,40,61,62,64,66,67,69 The value of long-term, trusted collaborations and honest communication was highlighted. 22 There was an acceptance that, although support from overseas faculty is welcome, it is important to plan for a transition to local faculty as more FPs are trained to take up these positions.…”

“…22 There was an acceptance that, although support from overseas faculty is welcome, it is important to plan for a transition to local faculty as more FPs are trained to take up these positions. 28,66,67 It was recognised that partners often had differing motivation and goals and so developing an understanding of these factors was important. 55 Several papers described the learning that FPs and FM trainees gained from attendance at international conferences or from experience of FM in settings where the specialty was better established.…”

Perceptions of postgraduate family medicine supervision at decentralised training sites, South Africa

“…28 Postgraduate family medicine (FM) training at DCT sites in African countries is in varying phases of development. 9,29,30,31 Family medicine was recognised as a speciality in SA in 2007. 32 Before this, many other African countries (like Uganda and Kenya) had established academic FM decentralisedtraining complexes to strengthen their PHC services.…”