We must learn from regional countries and benefit from their experiences
ducation and training facilities for primary-care physicians in Pakistan are inadequate. One of the major obstacles in this regard is a lack of teaching faculty. Given the severe deficiency of faculty, the sustainability of this discipline is dependent entirely on post-graduate training.
Formal standardised and structured training programmes help participants acquire necessary knowledge, skills (communication, interpersonal, patient management, skills in research, administrative and managerial skills) and develop commitment to high standards of professionalism.
A suitable faculty development programme to improve knowledge and academic performance of family medicine faculty can help solve some of these issues. Academicians produced in such programmes will have an overall positive impact on undergraduate as well as post graduate education and training in family medicine.
Offering master trainers’ courses in family medicine to deal with paucity of faculty has its pros and cons. Most post graduates in family medicine who will be attending such courses will have acquired their qualifications through an experience-based pathway. They will require further training in areas like: medical education, clinical governance/ audit, evidence-based medicine and clinical research.
Teaching sessions/ modules to cover these areas, in addition to the fundamentals in family medicine, consultation skills and clinical topics will need particular focus. Quality assurance, inspection of training sites and standards of training will be needed. Clinics of private GPs who become master trainers can become training sites for structured run-through programmes. A master trainers’ programme, however, may not be an alternative to a faculty development programme.
The College of Physicians and Surgeons Pakistan (CPSP) is encouraging post graduate trainings in family medicine. It already offers membership (MCPS) and fellowship (FCPS) programmes in family medicine. Membership is acquired through two pathways: on the basis of five-year experience or two years of run-through training.
The World Health Organisation Eastern Mediterranean regional office (WHO-EMRO) has already developed and implemented a bridging programme in the eastern Mediterranean region, including Pakistan. Similar programmes have been running successfully in other countries of the region. The length of courses varies between six months and two years that include on-job training and both face-to-face and online teaching sessions. Saudi Arabia, Sudan, Jordan and Lebanon are amongst other countries of the Eastern Mediterranean region that have started family medicine courses for primary-care physicians.
Most of these courses are developed in such a way that these physicians can get training on-the-job followed by certification in family medicine.
To reach the target of three family physicians per 10,000 by 2030 we require a multimodal strategy. The goal can be achieved through a bridging programme for capacity building of our primary care physicians, including private general practitioners.
A regional professional diploma programme that has already been endorsed by family medicine experts in Pakistan has been started or is about to begin in Khyber Medical University, Health Services Academy, Rawalpindi Medical University, Jinnah Sindh Medical University and University of Health Sciences, Lahore. The programme has a blended learning approach with online sessions, face-to-face sessions and on-site hands-on training.
To reach the target of three family physicians per 10,000 by 2030 we require a multimodal strategy. The goal can be achieved through a bridging programme for capacity building of our primary-care physicians including private GPs.
Tasks at hand include, upgrading the skills of registered medical practitioners, general practitioners and medical officers working in primary health care centres. All the stake holders, including Pakistan Medical & Dental Council (PM&DC), medical universities and Departments of Health need to consider capacity building courses for practicing physicians.
These capacity building programmes may be arranged in the form of regular continuing medical education/ continuous professional development sessions, certificate courses or professional diplomas. Another approach could be organising bridging programmes that enable physicians to sit for qualifying examinations like the MCPS or MRCGP (International). Such courses can become a part of a national bridging programme. By no means will these courses be a replacement for a full training of family physicians. These will, however, serves as an interim arrangement for existing general practitioners.
Once the transformation of existing generation of general practitioners to family physicians has taken place, all new medical graduates will have to undertake full training to become qualified family physicians.
The Islamic Republic of Iran has recognised the need for cost-effective and preventive healthcare and embarked on implementing the family medicine model. A master of public health (MPH) programme in family medicine through distant training for general practitioners was introduced in 2015.
In 2016, Morocco developed a bridging programme where general practitioners with four years’ work experience can participate in a two-year training course managed by the Public Health Institute in Rabat (a diploma in family health). The two-year training course is divided into theory and practical phases, with the practical sessions held at the participants’ own health care facilities.
We must learn from regional countries and benefit from their experiences. Action is needed. Departments of Health must be committed to making the strategy work and implement a national bridging programme to upgrade general practitioners into family physicians. They can incentivise the transformation by developing a family physician cadre to give recognition to the primary-care physicians with post graduate qualification in family medicine.
In future a qualification in family medicine can be made mandatory for a doctor wishing to open a primary-care health centre that can be linked with a social health initiative/ Sehat Sahulat Card programme. This will be a way forward to achieving universal health coverage by developing family physician-led comprehensive primary care.
Dr Hina Jawaid is an assistant professor in family medicine at the University of Health Sciences, Lahore
Dr Abdul Jalil Khan is an assistant professor in family medicine at the Khyber Medical University, Peshawar