Family medicine in Ghana
Introduction
WONCA has declared today, 19th May, as World Family Doctor Day and countries all over the world are celebrating it. In Ghana, Family Physicians want to commemorate this by increasing awareness about the specialty – our history, attributes, training, and role in health care delivery in Ghana.
Family Medicine is the body of knowledge and skills that constitute the medical discipline; which when applied to the care of patients and their families becomes the specialty of Family Practice. Family Practice is therefore the medical specialty which provides continuing and comprehensive health care for the individual and the family. It is the specialty in breadth that integrates the biologic, clinical and behavioural sciences, encompassing all ages, sexes, each organ system and every disease entity. The Family Physician therefore is physician who is educated and trained in the discipline of family medicine.
History of Family Medicine
In the 1800s the US population was mostly settled in small towns, and farming and production of goods were the major foundations of the economy. Health care was unstructured and the doctor often visited his patients by horse and buggy, hence the use of the term ‘the horse and buggy doctor’. This “generalist doctor” knew his patients very well. He delivered babies, set fractures, treated a multitude of illnesses, and helped those who were dying. The payment was fee for service and often goods were brought to the doctors as a form of payment.
The establishment of a solid scientific foundation for clinical medicine in the 1900s led to extensive specialization. By early 1960s the general public began to express their dissatisfaction with the state of medicine. There was a shortage of physicians in rural areas and inner cities, high cost of medical care, increased depersonalization of medicine and fragmentation of care. Patients had to move across towns and cities in search of specialist for different problems in the same individual. There was the need to create another specialty to embody the knowledge, skills and ideals of primary care.
In 1966, general practice vocational training was commenced in the United Kingdom. In 1969, the American Board of Family Physicians (AAFP) was born for the new specialty of family practice. This specialty distinguished itself as being the first specialty board to require recertification every seven years to ensure ongoing competence of its members.
In Africa, South Africa was the first country to adopt Family Medicine as a specialty. In West Africa, the faculty of Family Medicine was established in 1988 and the first set of graduates was examined in 1993. Currently, over 500 fellows have been trained
in the sub region.
In Ghana, the first group of elected fellows were awarded in 1989 however it was not until 1998 when the first hospital was accredited – Narh Bita hospital in Tema, and in April 2005, the first fellow graduated under the West African college. Currently there are 16 Fellows of the college in Ghana. The Ghana College of Physicians and Surgeons, which was established in 2003, has Family Medicine as a specialty under the division of physicians. To date there are 45 foundation fellows, 7 elected fellows, 10 members and over 20 residents in training both in Accra and Kumasi.
Attributes of a Family Doctor/Physician
A Family Doctor/Physician is the physician who is primarily responsible for providing comprehensive health care to every individual seeking medical care; and arranging for other health personnel to provide services when necessary. This physician functions as a generalist who accepts everyone seeking health care, whereas other providers limit access to their services on the basis of age, sex and/or diagnosis. The Family Physician cares for the individual in the context of the family and community irrespective of the race, culture or social class.
Training
The West African College of Physicians (WACP) and the Ghana College of Physicians and Surgeons (GCPS) have a three tire training programme. The first level exam (Primaries/Part one) enjoys reciprocity between the two colleges. Level 2 – Membership examination – is preceded by 2-3 years of training. It is an exit examination with the award of MWACP/MGCP and recognition as a Specialist in the Ministry of Health (MOH). Level 3 – Fellowship – requires a minimum of 2 years further training structured differently in the two colleges leading to the award of FWACP/FGCP and recognition as a Senior Specialist in the MOH. At this level, the family physician can opt for an academic career or continue to work in the community/district. It
is envisaged that in the near future, doctors who want to work in private practice will acquire a minimum of Membership training before being licensed to operate private clinics/ hospitals in Ghana.
Role in Healthcare delivery in Ghana
A country’s health status is likely to influence its social and economic well-being. This interdependent relationship makes it important for governments to employ their finite budgets and available resources judiciously as they strive to achieve maximal health outcomes.
In a study done with data from UK and USA in 1961, it was discovered that in an adult population of 1000 persons, 750 (75%) experienced some form of illness each month. Of these, 250 (25%) consulted a physician, only 5 (0.5%) were referred to a consultant and just one (0.1%) was hospitalized at a university medical center. This study was repeated forty years later in 2001, and the results were strikingly similar. In an adult population of 1000 persons, 800 (80%) report symptoms in a month; 217 (21.7%) consulted a physician (of which 113 visits were to primary care physicians), only 8 (0.8%) were referred to a consultant and just one (0.1%) was hospitalized at a university medical center.
This means the bulk of health care remains in primary care. The World Health Organization (WHO) annual report for 2008 observed that health systems are developing in directions that contribute little to equity and social justice. They suggest that putting people first in health care delivery is the way to go.
The family physician by training and practice is best suited for this task. Governments are encouraged to support the training of this specialty and healthcare will benefit immensely.
Dr Henry Lawson. Chairman, Faculty of Family Medicine, WACP (Ghana Chapter).
Dr Charles Quaofio. Chairman, Faculty of Family Medicine, GCPS.