DEVELOPING FAMILY MEDICINE AS AN ACADEMIC DISCIPLINE IN MALAWI AAFP GLOBAL HEALTH CONFERENCE MINNEAPOLIS, 6 SEPTEMBER, 2012. LUCKSON WANDANI DULLIE MBBS,Dip Obst,Dip HIV Man, M Fam Med

MALAWI: DISTRICTS

HEALTH INDICATORS POPULATION: 14 MILLION ( 85% RURAL ) HIV PREVALENCE: 10.3% ADULT POPULATION LIFE EXPECTANCY: 40/50 YEARS MATERNAL MORTALITY: 600/100 000 NEONATAL DEATHS: 25/1000 HEALTH CARE WORKERS: 2 DOCTORS/100 000

Health care in malawi Government Church Private(for profit) Central hospitals District hospitals Health centres Government hospitals Church Private(for profit)

PUBLIC HEALTH SYSTEM BACKGROUND 3 CENTRAL HOSPITALS SPECIALISTS MEDICAL OFFICERS CLINICAL OFFICERS 28 DISTRICT 18 MISSION HOSPITALS MEDICAL ASSISTANTS HEALTH CENTRES (-+400) COMMUNITY HEALTH NURSES AND MEDICAL ASSISSTANTS

GOVERNMENT’S COMMITMENT TO PHC (ALMA ATA, 1978) EHP SINCE 2000 malaria; acute respiratory infection and immunizable diseases; acute diarrhoeal disease; nutritional conditions/deficiencies; maternal conditions/pregnancy complications;

EHP….. sexually transmitted diseases, including HIV/AIDS; tuberculosis; eye and ear infections; injuries; schistosomiasis

Providers of phc Clinical Officers Community Health nurses/Nurse-midwives Medical assistants Health Surveillance assistants

CURRENT PRIMARY CARE FOCUS ON ILLNESS AND CURE RELATIONSHIP LIMITED TO THE MOMENT OF CONSULTATION EPISODIC CURATIVE CARE RESPONSIBILITY LIMITED TO EFFECTIVE AND SAFE ADVICE TO THE PATIENT AT THE MOMENT OF CONSULTATION USERS ARE CONSUMERS OF THE SERVICE

OUAGADOUGOU….2008 DECLARATION ON PHC & HEALTH SYSTEMS: ACHIEVING BETTER HEALTH FOR AFRICA IN THE NEW MILLENIUM 2008 WHO REPORT: PRIMARY HEALTH CARE: NOW MORE THAN EVER

OUAGADOUGOU…2008 PRINCIPLES ADOPTED PEOPLE CENTRED COMPREHENSIVE & INTEGRATED CARE CONTINUITY OF CARE THINKING POPULATION TEAM WORK

PEOPLE CENTRED PRIMARY CARE FOCUS ON HEALTH NEEDS PEOPLE ARE PARTNERS IN MANAGING THEIR OWN HEALTH AND THAT OF THEIR COMMUNITY COMPREHENSIVE, CONTINUOUS AND PERSON CENTRED CARE

PEOPLE CENTRED PRIMARY CARE…. ENDURING PERSONAL RELATIONSHIP RESPONSIBILITY FOR THE HEALTH OF ALL IN THE COMMUNITY ALONG THE LIFE CYCLE; RESPONSIBILITY FOR TACKLING DETERMINANTS OF ILL-HEALTH

BODY OF KNOWLEDGE, SKILLS AND ATTITUDES REQUIRED FOR THE PROVISION OF PRIMARY, CONTINUING, COMPREHENSIVE, PERSONALISED AND HOLISTIC CARE TO INDIVIDUALS, THEIR FAMILIES AND THE COMMUNITY......

FAMILY MEDICINE

A SHARED DISCIPLINE DISTRICT HOSPITAL HEALTH CENTRE COMMUNITY PERSONNEL DOCTORS 2 CO/NURSE/MA 4 HEALTH SURVEILLANCE ASSISTANTS 10 POPULATION 450,000 – 600,000 20,000 – 30, 000 20,000 – 30,000 RATIO 1: 200,000 – 300, 000 1:5,000 – 7,500 1: 2,000-3,000

FAMILY MEDICINE NEEDS TO BE FRAMED AROUND PROVISION OF LEADERSHIP OF PRIMARY HEALTH CARE TEAMS THAT WILL DELIVER A PEOPLE CENTRED SERVICE

GOVERNMENT’S COMMITMENT REVISION OF PRIMARY HEALTH CARE POLICY RESTRUCTURING OF DISTRICT HEALTH STAFF ESTABLISHMENT CREATION OF SPECIALIST POSITIONS AT DISTRICT HOSPITALS

MEDICAL TRAINING IN MALAWI ONE MEDICAL SCHOOL WITH 100 YEARLY INTAKE 5 YEAR PROGRAM...PLUS PREMEDICAL YEAR FOR POST-SECONDARY CANDIDATES LARGELY FUNDED BY GOVERNMENT SCHOLARSHIPS 18 MONTH INTERNSHIP BEFORE FULL REGISTRATION

Postgraduate medical training in malawi M MED 4 YEAR PROGRAMS TERTIARY HOSPITAL/CLINICAL BASED LINKED TO SOUTH AFRICA/EAST AFRICA

Lake malawi……

HISTORY OF FAMILY MEDICINE IN MALAWI May 2008 – one week pilot teaching course at COM by team from MSU, the University of Edinburgh, Scotland, and Witwatersrand and Stellenbosch Universities, South Africa March 2009 – Family Medicine was agreed to in principle at meeting of Malawi Medical association September 2009 – visit by team from University of Boston and Wits University. Concept paper on post graduate training circulated for submission

Family Medicine pilot training course, Blantyre – May 2008

UNDERGRADUATE FAMILY MEDICINE 2010: REVISED MBBS CURRICULUM SUBMITTED TO SENATE CONTAINED FAM MED MODULE 2011: START OF UNDERGRADUATE FAMILY MEDICINE MODULE

UNDERGRADUATE FM AIM TO INTRODUCE CONCEPTS AND PRINCIPLES OF FAMILY MEDICINE IN MEDICAL TRAINING

UNDERGRADUATE FM OBJECTIVES INTRODUCE BIOPSYCHOSOCIAL APPROACH TO PATIENT CARE DEVELOP SYSTEMATIC APPROACHES TO COMMON SYMPTOMS IN PRIMARY CARE INTRODUCE RURAL/DISTRICT BASED MEDICAL TRAINING ADVOCATE FOR FAMILY MEDICINE

THE FAM MED MODULE WEEK 1 CLASSROOM BASED CORE PRINCIPLES OF FAM MED RURAL HOSPITAL BASED LOGBOOK-GUIDED PRACTICAL EXPERIENCE WEEK 6 REFLECTIONS, END OF BLOCK ASSESSMENTS

HIGHLIGHTS OF UNDERGRADUATE FM: STUDENT/SITE EXPERIENCE OPPORTUNITY TO USE BPS MODEL TO PATIENT APPROACH MORE RESPONSIBILITY IN MANAGING PATIENTS EXPERIENCING UNDIFFERENTIATED PATIENTS CHANGING ATTITUDE TOWARDS RURAL PRACTICE & FAMILY MEDICINE QUALITY IMPROVEMENT ACTIVITIES INITIATED BY STUDENTS

CHALLENGES.. AVAILABILITY OF SUPERVISORS LIBRARY AND LEARNING RESOURCES ACCOMMODATION ( Australian study, 2006)

POSTGRADUATE FAMILY MEDICINE 4 YEAR MASTERS DEGREE DISTRICT HOSPITAL BASED SPECIALIST POSITION

THE CONCEPT OF THE AFRICAN FAMILY PHYSICIAN ( WONCA, 2008) THE FAMILY PHYSICIAN CLINICAL SPECIALIST, EBM DISTRICT PHC TEAM LEADER, TEACHER COMMUNITY LEADER HEALTH RESOURCES MANAGER

TIME LINES 2010: UNDERGRADUATE FM CURRICULUM DEVELOPMENT, & PRECEPTOR TRAINING 2011: UNDERGRADUATE FM, END OF YEAR REVIEW 2012-3: POSTGRADUATE FM CURRICULUM DEVELOPMENT & SITE PREPARATION 2014: START OF POSTGRADUATE FM TRAINING

EXISTING GAPS DEVELOPMENT OF RURAL LEARNING SITES DEVELOPMENT OF CRITICAL ACADEMIC FACULTY ADEQUATE SUPERVISION AT PRECEPTOR SITES INTEGRATION OF PRIMARY HEALTH CARE RESEARCH IN TRAINING/PRACTICE

OPPORTUNITIES FACULTY DEVELOPMENT: THE TEACHING OF FAMILY MEDICINE/PRECEPTORSHIP GLOBAL HEALTH STUDENT/RESIDENT ELECTIVES AT FAMILY MEDICINE PRECEPTOR SITES ADOPT A SITE VISITING LECTURESHIPS

INVITATION TO 3RD WONCA AFRICA CONFERENCE 21 – 24 NOV, 2012