PhD: Emergence of Family Medicine in Africa

Shabir Moosa PhD Emergence FMiA COVERDr. Shabir Moosa, senior clinical lecturer in the Department of Family Medicine in the School of Clinical Medicine was awarded a PhD by Ghent University in Belgium on 28th October 2015. The title of his PhD-thesis was “The emergence of family medicine in Africa”. It consists of five published papers and one submitted for publication.

The overall thesis is cast in the light of reforms recommended by the 2008 World Health Report on Primary Health Care (PHC) on: universal coverage; service delivery; public health in all policies; and government leadership. It explores the challenges with African health systems and human resources, the emerging landscape of national health insurance in South Africa and the prospects for family medicine within that context, given the global movement of family medicine towards teamwork.

The studies were undertaken to understand the emergence of family medicine in Africa: how stakeholders (leaders in sub-Saharan and South Africa and providers at the coalface in Johannesburg, South Africa) view family medicine and the human resource issues; why emigrant healthcare professionals did not take up primary health care posts in Africa; and the views of private general practitioners in groups on engaging National Health Insurance in South Africa.

The results are captured in the various articles but the synthesis presents four main messages:

  1. The growing role of family physicians: growing beyond district hospital and including a leadership role in the district health service.
  2. The impetus to re-organise the PHC system; the involvement of family physicians is seen as opportunity and prerogative to reorganize the health system away from command-and-control organisations to elements of professional organization and complex adaptive systems as in practice form
  3. Human resource issues: doctor leadership with task shifting can address the challenge of skills and staff mix but more robust human resource policy is required for PHC, including organizational units under universal health coverage
  4. Policy implementation challenges: these include ambivalence towards family physicians, requiring astute leadership by family physicians.

The challenge is with family physicians: to explore organizational design with robust team configurations and roles, including the private sector and to advocate for quality in the future of health in Africa.

The five examiners (including an external examiner from Aarhus University in Denmark) provided written assessment and comments, and later engaged Dr. Moosa in an oral internal defense. Once these were accepted Dr. Moosa was invited to a public defense in Ghent University where he presented his thesis, had to field more questions, including the public and then had the ceremony of a capping by the Chair of the examining committee. The PhD-thesis was published as a small book, as is custom in Ghent University and several copies were distributed to colleagues at Wits. A soft copy is available at Dr. Moosa’s website

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