Potential for the specialty of Family Medicine in Botswana: A discussion paper

Abstract

Family Medicine is developing rapidly as a medical and academic specialty in sub-Saharan Africa. The multifactorial policy drivers are not well described, but include population health needs, the World Health Organisation’s initiative1 to re-energise primary care in their 2008 report, failure of hospital services and even vertical programmes to cope with the continuing HIV epidemic in many sub-Saharan countries in Africa, and a growing middle class which expects more and better quality from primary care.2,3 These are but a few reasons why Primary Health Care and Family Medicine are enjoying a resurgence of interest, investment and recruitment. Botswana is one of the latest countries in sub-Sahara Africa to open a School of Medicine (2009) and establish an Academic Department of Family Medicine (2010) to offer undergraduate and postgraduate training. The aim is to produce appropriately skilled generalist doctors who can function within and lead primary care to transform quality and access to health care. The curriculum is based on the regional definition of Family Medicine in an African context, articulated in the 2010 Statement of Consensus on Family Medicine in Africa.4,5 However, the debate has already begun within Botswana about whether this definition and our training programme are too Euro-centric and academic.6 It is expected that in Southern Africa, accredited family physicians will be competent to meet 90% of the health needs of communities in their designated districts.78 Meeting this challenging target with doctors drawn from and rooted in local communities who are familiar with local culture, language and traditions is the aim of Botswana’s new specialty of Family Medicine. This article explores these aspirations and the potential for Family Medicine in Botswana at the beginning of this new training programme.