The feasibility of community-based private medical practice in Africa and Madagascar

An ever-growing number of doctors are being trained at the Faculties of Medicine of French-speaking Africa and Madagascar, and yet the shortage of general practitioners in rural and periurban areas continues to be a cause for concern, even though there are more unemployed young medical graduates than ever. More than 20 years ago, the non-governmental organization (NGO) Santé Sud developed the concept of community-based general medicine, along with a professional mechanism that enabled more than 200 doctors to set up practice in Mali, Madagascar and Benin. Five external assessments are now available for evaluating the relevance and feasibility of this new form of local healthcare provision and determining under what conditions it might be extended or integrated into existing healthcare systems. The creation of mixed public/private bodies, with funding allocated under the International Health Partnership (IHP+), is put forward as a desirable way of spreading this experience.De plus en plus de médecins sont formés dans les facultés de médecine d’Afrique francophone et de Madagascar. Pourtant, la pénurie de généralistes dans les zones rurales et péri-urbaines continue à être inquiétante alors que le nombre de jeunes médecins au chômage atteint un taux record. Il y a plus de 20 ans, l’ONG (organisation non-gouvernementale) Santé Sud a développé le concept de médecine générale communautaire, et un mécanisme professionnel qui a permis à plus de 200 médecins d’installer leur cabinet au Mali, à Madagascar et au Bénin. Cinq évaluations externes sont à présent disponibles pour estimer la pertinence et la faisabilité de cette nouvelle forme de prestations de soins au niveau local et déterminer dans quelles conditions elle pourrait être étendue ou intégrée dans les systèmes de soins existants. La création d’organismes mixtes publics/privés, financés dans le cadre de l’IHP+ (International Health Partnership), est proposée comme un moyen adapté pour élargir cette expérience.A pesar de la cantidad casa vez màs importante de médicos capacitados en las facultades de África francófona y de Madagascar, la falta de médicos generalistas que ejerzan en las zonas rurales y periurbanas sigue siendo preocupante, a medida que se multiplica el número de jóvenes diplomados sin empleo. La ONG Santé Sud desarrolla desde hace más de 20 años un concepto (la medicina general comunitaria) y un dispositivo profesional que ha permitido la instalación de más de 200 médicos en Mali, Madagascar y Benín. Cinco evaluaciones externas permiten analizar hoy la pertinencia y la viabilidad de esta nueva oferta de atención de proximidad, así como determinar las condiciones que permitirían su integración o ampliación a los sistemas de salud. La creación de organismos mixtos público-privados, con un presupuesto asignado en el marco del Pacto Global de Salud (IHP por sus siglas inglesas), se presenta como una solución deseable, para extender esta experiencia

The feasibility of community-based private medical practice in Africa and Madagascar

An ever-growing number of doctors are being trained at the Faculties of Medicine of French-speaking Africa and Madagascar, and yet the shortage of general practitioners in rural and periurban areas continues to be a cause for concern, even though there are more unemployed young medical graduates than ever. More than 20 years ago, the non-governmental organization (NGO) Santé Sud developed the concept of community-based general medicine, along with a professional mechanism that enabled more than 200 doctors to set up practice in Mali, Madagascar and Benin. Five external assessments are now available for evaluating the relevance and feasibility of this new form of local healthcare provision and determining under what conditions it might be extended or integrated into existing healthcare systems. The creation of mixed public/private bodies, with funding allocated under the International Health Partnership (IHP+), is put forward as a desirable way of spreading this experience.De plus en plus de médecins sont formés dans les facultés de médecine d’Afrique francophone et de Madagascar. Pourtant, la pénurie de généralistes dans les zones rurales et péri-urbaines continue à être inquiétante alors que le nombre de jeunes médecins au chômage atteint un taux record. Il y a plus de 20 ans, l’ONG (organisation non-gouvernementale) Santé Sud a développé le concept de médecine générale communautaire, et un mécanisme professionnel qui a permis à plus de 200 médecins d’installer leur cabinet au Mali, à Madagascar et au Bénin. Cinq évaluations externes sont à présent disponibles pour estimer la pertinence et la faisabilité de cette nouvelle forme de prestations de soins au niveau local et déterminer dans quelles conditions elle pourrait être étendue ou intégrée dans les systèmes de soins existants. La création d’organismes mixtes publics/privés, financés dans le cadre de l’IHP+ (International Health Partnership), est proposée comme un moyen adapté pour élargir cette expérience.A pesar de la cantidad casa vez màs importante de médicos capacitados en las facultades de África francófona y de Madagascar, la falta de médicos generalistas que ejerzan en las zonas rurales y periurbanas sigue siendo preocupante, a medida que se multiplica el número de jóvenes diplomados sin empleo. La ONG Santé Sud desarrolla desde hace más de 20 años un concepto (la medicina general comunitaria) y un dispositivo profesional que ha permitido la instalación de más de 200 médicos en Mali, Madagascar y Benín. Cinco evaluaciones externas permiten analizar hoy la pertinencia y la viabilidad de esta nueva oferta de atención de proximidad, así como determinar las condiciones que permitirían su integración o ampliación a los sistemas de salud. La creación de organismos mixtos público-privados, con un presupuesto asignado en el marco del Pacto Global de Salud (IHP por sus siglas inglesas), se presenta como una solución deseable, para extender esta experiencia

Colloque « Médecine de proximité : crise des ressources humaines. Regards croisés nord-Sud »

Ce colloque était organisé par l’Union régionale des médecins libéraux de Provence-Alpes Côtes d’Azur (Urml Paca) et Santé Sud, une ONG de développement basée à Marseille. Les raisons de ce rapprochement institutionnel tiennent au constat partagé d’une crise des ressources humaines affectant la médecine de proximité dans des pays « du Nord » (France) et dans des pays « du Sud » (Afrique). Ce déficit d’attractivité pour l’exercice de première ligne, représenté en bonne partie par la médecine g..

Appropriate training and retention of community doctors in rural areas: a case study from Mali

Background While attraction of doctors to rural settings is increasing in Mali, there is concern for their retention. An orientation course for young practicing rural doctors was set up in 2003 by a professional association and a NGO. The underlying assumption was that rurally relevant training would strengthen doctors' competences and self-confidence, improve job satisfaction, and consequently contribute to retention. Methods Programme evaluation distinguished trainees' opinions, competences and behaviour. Data were collected through participant observation, group discussions, satisfaction questionnaires, a monitoring tool of learning progress, and follow up visits. Retention was assessed for all 65 trainees between 2003 and 2007. Results and discussion The programme consisted of four classroom modules – clinical skills, community health, practice management and communication skills – and a practicum supervised by an experienced rural doctor. Out of the 65 trained doctors between 2003 and 2007, 55 were still engaged in rural practice end of 2007, suggesting high retention for the Malian context. Participants viewed the training as crucial to face technical and social problems related to rural practice. Discussing professional experience with senior rural doctors contributed to socialisation to novel professional roles. Mechanisms underlying training effects on retention include increased self confidence, self esteem as rural doctor, and sense of belonging to a professional group sharing a common professional identity. Retention can however not be attributed solely to the training intervention, as rural doctors benefit from other incentives and support mechanisms (follow up visits, continuing training, mentoring...) affecting job satisfaction. Conclusion Training increasing self confidence and self esteem of rural practitioners may contribute to retention of skilled professionals in rural areas. While reorientations of curricula in training institutions are necessary, other types of professional support are needed. This experience suggests that professional associations dedicated to strengthening quality of care can contribute significantly to rural practitioners' morale

Appropriate training and retention of community doctors in rural areas: a case study from Mali

Abstract Background While attraction of doctors to rural settings is increasing in Mali, there is concern for their retention. An orientation course for young practicing rural doctors was set up in 2003 by a professional association and a NGO. The underlying assumption was that rurally relevant training would strengthen doctors' competences and self-confidence, improve job satisfaction, and consequently contribute to retention. Methods Programme evaluation distinguished trainees' opinions, competences and behaviour. Data were collected through participant observation, group discussions, satisfaction questionnaires, a monitoring tool of learning progress, and follow up visits. Retention was assessed for all 65 trainees between 2003 and 2007. Results and discussion The programme consisted of four classroom modules – clinical skills, community health, practice management and communication skills – and a practicum supervised by an experienced rural doctor. Out of the 65 trained doctors between 2003 and 2007, 55 were still engaged in rural practice end of 2007, suggesting high retention for the Malian context. Participants viewed the training as crucial to face technical and social problems related to rural practice. Discussing professional experience with senior rural doctors contributed to socialisation to novel professional roles. Mechanisms underlying training effects on retention include increased self confidence, self esteem as rural doctor, and sense of belonging to a professional group sharing a common professional identity. Retention can however not be attributed solely to the training intervention, as rural doctors benefit from other incentives and support mechanisms (follow up visits, continuing training, mentoring...) affecting job satisfaction. Conclusion Training increasing self confidence and self esteem of rural practitioners may contribute to retention of skilled professionals in rural areas. While reorientations of curricula in training institutions are necessary, other types of professional support are needed. This experience suggests that professional associations dedicated to strengthening quality of care can contribute significantly to rural practitioners' morale.</p