Date Published: April 26, 2018
Author(s): Felicity Goodyear-Smith.
This reflection describes my funded visit to South Africa to assist in primary care research capacity building as Chair, WONCA Working Party on Research (WP-R). The trip included time at the Universities of Walter Sisulu, Limpopo and Stellenbosch to mentor postgraduate students working on master’s and PhD theses. I held one-on-one and group sessions and ran interactive scientific writing workshops. I assisted with the establishment of a Stellenbosch University Family Physician Research Network of faculty academics and family physicians (FP) which will generate research questions from community stakeholders. I also ran a writing workshop at the Joint 5th WONCA Africa and 20th South African National Family Practitioners Conference in Pretoria attended by about 100 conference delegates, ranging from FP registrars to academics with PhDs and peer-reviewed publications. A WP-R panel presentation of international comparisons of primary care systems was also held at this conference, with the countries of Ghana, Malawi, Zimbabwe, Ethiopia and Nigeria presented. During my stay, I reflected on the differences between family medicine in South Africa and in my home country, New Zealand (NZ). In South Africa, there is high prevalence of HIV and tuberculosis, seldom seen in NZ. Donor-funded vertical programmes cause significant fragmentation of care. Family doctors generally work in district hospitals, providing consultancy support to nurse-led clinics. They have a laudable requirement to complete a Master’s in Medicine in conjunction with vocational training. Academic family medicine in South Africa is coming of age. I feel privileged to play a small part in its journey to maturity.
In August 2017, I spent 3 weeks in South Africa. My trip was funded by the National Research Foundation of South Africa, as part of a project on ‘Collaborative Postgraduate Training in Family Medicine and Primary Care’ led by Prof. Bob Mash, Stellenbosch University. The goal of the project was to build research capacity in the discipline of family medicine and primary care, and my role was to mentor researchers at master’s and PhD level, primarily at Walter Sisulu University and the University of Limpopo, and to assist in research capacity building generally.
The role of the FP in SA differs significantly from vocationally trained FPs (known as general practitioners or GPs) in NZ. The free PHC system in SA is provided through nurse-based clinics and community health centres.5 The FPs generally train and work in district hospitals, providing support to the nurse-led clinics in a consultant role.6
Throughout the world, academic general practice or family medicine, with its own educational content and research, is a relatively young discipline.10 It is now recognised as a clinical speciality orientated to personal, family and community-based comprehensive primary care. Studies need to be conducted in the context of community-based settings relevant to the PHC of the population. Relevant research informs both clinical practice and medical teaching. There are now nine departments of family medicine in universities throughout South Africa.11 However, it takes time for such departments to mature and for the staff to undertake PhDs and publish papers in peer-reviewed journals. Currently, only two of the nine heads of department hold PhD degrees.
The division of family medicine and primary care at Stellenbosch University has set up a collaborative postgraduate training programme to support other departments in more disadvantaged parts of the country. There are now five academics at Stellenbosch with PhDs, who can start supervising PhD candidates at Walter Sisulu University and the University of Limpopo, and hence strengthen research capacity at these two partner institutions. To assist, my role was to travel to Mthatha and Polokwane, and spend time mentoring the postgraduate students at these two universities. I conducted many one-on-one sessions as well as group sessions with some registrars. My approach was to examine their research questions, ensure that their aims and objectives matched up with these and then to explore with them how they were going to answer this question (determine the methodology).
I also participated in a workshop on developing a local practice-based research network (PBRN) led by Prof. Bob Mash and attended by faculty academics and FPs. I gave a presentation on international perspectives on PBRNs in primary care, which was followed by discussion on how to set up a network that would work in a South African setting. The key component of a PBRN is a group of practices principally devoted to the care of patients which act as a ‘laboratory’ to study populations of patients and care providers in community-based settings. The research questions are generated from community stakeholders, not university researchers, and the study is conducted with, not on, the participants. At the end of the meeting, they had developed a framework document for the Stellenbosch University Family Physician Research Network (SUFPREN) and had put in place plans to progress this initiative.
Over the past 5 years, through the WONCA Working Party on Research (WP-R), of which I am currently the Chair, I have arranged a series of international comparisons of primary care systems with panel presentations at regional and world conferences.12,13,14,15,16 These presentations use standardised templates to enable system comparisons, have mostly focused on health systems of developing nations and have consistently flagged the importance of universal health care coverage and primary care contribution to the health system. Prof. Bob Mash led a similar panel workshop at the WONCA Africa conference, with Drs Osa Olayem, Martha Makwero, Sundanda Ray, Meseret Zerihun and Abraham Gyuse presenting the primary care systems in their countries of Ghana, Malawi, Zimbabwe, Ethiopia and Nigeria, respectively. This will also lead to a peer-reviewed publication, currently under submission.
In conclusion, academic family medicine and PHC in South Africa is coming of age. I feel privileged to have been able to play a small part in its journey to maturity. I am grateful to Prof. Bob Mash and to the National Research Foundation for this rewarding opportunity.