Roles and challenges of family physicians in Uganda: A qualitative study

Abstract

BackgroundThe World Health report (2008), the World Health Assembly (2009) and the Declaration of Astana (2018) acknowledge the significant contribution of family physicians (FPs) in clinical and primary healthcare. Given the lack of resources and low numbers of FPs coupled with the contextual nature of family medicine (FM), the scope of practice of African FPs is likely to differ from that of colleagues in America and Europe. Thus, this study explored the roles of Ugandan FPs and the challenges they face.MethodsThis cross-sectional qualitative study was conducted through in-depth interviews with FPs who are working in Uganda. Participants who work in public and private healthcare systems including non-governmental organisations and in all geographical regions were purposively selected. Interviews were conducted from July 2016 to June 2017. Qualitative thematic content analysis of the transcripts was performed using a framework approach.ResultsThe study team identified three and six thematic roles and challenges, respectively, from the interview transcripts. The roles were clinician, leadership and teaching and learning. Challenges included lack of common identity, low numbers of FPs, conflicting roles, unrealistic expectations, poor organisational infrastructure and lack of incentives.ConclusionThe major roles of FPs in Uganda are similar to those of their counterparts in other parts of the world. Family physicians provide clinical care for patients, including preventive and curative services; providing leadership, management and mentorship to clinical teams; and teaching and learning. However, their roles are exercised differently as a result of lack of proper institutionalisation of FM within the Uganda health system. Family physicians in Uganda have found many opportunities to contribute to healthcare leadership, education and service, but have not yet found a stable niche within the healthcare system.

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

“…Lack of defined FM role within healthcare system A major limiting factor is the lack of a defined role of FM within the healthcare system. 10,21,24,35,41,46,56,57,65,[72][73][74][75][76][77][78] The key reasons for this were identified as a lack of career pathway, inappropriate deployment, and lack of critical mass to be visible within the healthcare system. Confusion over the role of FPs extended to policymakers, patients, other doctors, medical students and FPs.…”

“…Confusion over the role of FPs extended to policymakers, patients, other doctors, medical students and FPs. 24,32,35,41,46,74,75 Many sources noted that there is an absence of a clear career path and a lack of consultant posts. 58,65,79 Such problems contribute to reduced interest in applying for FP training and a 'brain drain' whereby FPs, frustrated by the lack of opportunities to advance their careers, take jobs in other countries or in other specialties or sectors.…”

“…20 Several sources mentioned other specialties being suspicious of, or looking down on, FM, fuelled by a lack of clearly defined roles and scope of practice for FPs. 21,35,46 Lack of FM faculty A shortage of FPs who can act as faculty within FM programmes was identified. 19,20,36,58,62,63,66,77,79,80 It was found that, whilst graduating FPs were encouraged to work within FM faculty, they lack the necessary training to work as educators.…”

“…56 FPs often work in isolation, resulting in a lack of colleagues to discuss professional matters with. 46 A further consequence, is that a limited number of FPs within the HCS limits the impact that the specialty intends to achieve. 88,89…”

The state of family medicine training programmes within the Primary Care and Family Medicine Education network

“…1,2,3,4,5,6 Although the roles of the family physician differ between countries and are still debated, it is clear that in Africa, the family physician often works at the district hospital as well as in primary care teams. 7,8,9 Their roles are often different from that of family physicians in more highly resourced countries and they are seldom the first point of contact, which is usually with a nurse or clinical officer. 10 Primary Care and Family Medicine Education network (Primafamed) is a network of academic departments of family medicine and primary care in sub-Saharan Africa (see: primafamed.sun.ac.za).…”