1. 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

3. MALAWI: DISTRICTS

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

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

6. 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

7. 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;

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

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

11. 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

12. 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

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

14. 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

15. 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

16. 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......

17. FAMILY MEDICINE

18. 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

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

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

21. 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

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

23. Lake malawi……

24. 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

25. Family Medicine pilot training course, Blantyre – May 2008

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

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

28. 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

29. 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

30. 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

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

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

33. 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

34. 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

35. 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

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

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