Family and Community Medicine

Family and Community Medicine

Family medicine as a discipline is in its infancy in Ethiopia. There are many GPs in the country, graduates of medical school whose postgraduate training is a one-year hospital-based internship and who play a crucial role in the delivery of care.  However, Ethiopia currently has only one doctor for every 35,000 people, well below the WHO recommended minimum standard of 1 for every 10,000.  The concept of comprehensive patient-centered community-oriented family medicine is only now beginning to grow.

The country’s first-ever family medicine program was inaugurated in February 2013 by the School of Medicine of Addis Ababa University, with support from the Department of Family and Community Medicine (DFCM), University of Toronto under the auspices of the Toronto Addis Ababa Academic Collaboration in Family Medicine (TAAAC-FM) and the Department of Family Medicine at University of Wisconsin through the Medical Education Project Initiative (MEPI).  The program aims to train family physicians for the Ethiopian health care system and to develop faculty who will further expand Family Medicine in Ethiopia. Family physicians are expected to expand the scope and improve the quality of primary care in Ethiopia, with more patient care being provided in the community, reducing the need for referral to distant secondary and tertiary level hospitals. In keeping with the emerging scope of practice typical of family physicians in the African context, Ethiopian family physicians are also expected to play a vital role in delivering lifesaving maternal and perinatal care in the community, favorably impacting one of the main causes of death and ill health in Ethiopia.

The goal of the TAAAC-FM is to foster the development of family medicine in Ethiopia and to support the growth of the specialty including building leadership capacity in family medicine.

In January 2016, the Addis Ababa University (AAU) family medicine program welcomed a fourth cohort of residents to the program. Ethiopia’s first family medicine physicians graduated in February 2016. This first group of graduates will also become Ethiopia’s first Family Medicine faculty.

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Project Contributors

Since the beginning of the residency program in family medicine at AAU, family medicine clinical supervision and program development have been provided by long-term and short-term faculty from the DFCM under the leadership of Ethiopian faculty who have provided general oversight for the program as well as supervision and teaching during the specialty rotations.

  • Dawit Wondimagegn, inaugural Program Director, Addis Ababa University
  • Daniel Zemenfes, current Program Director, Addis Ababa University
  • Brian Cornelson, University of Toronto
  • Jane Philpott, University of Toronto
  • Katherine Rouleau, University of Toronto
  • Gwen Sampson
  • Helen Batty
  • Praseedha Janakiram, University of Toronto
  • Abbas Ghavam-Rassoul, University of Toronto
  • Mahlet Yigeremu, Addis Ababa University
  • Miliard Derbew, Medical Education Program Initiative (MEPI)
  • Cindy Haq, University of Wisconsin
  • Mike Cotterill
  • Anjali Oberai
  • Tarik Taye, senior health officer at Arada Health Centre
  • Ann Evensen, University of Wisconsin
  • Robert Miller, Memorial University of Newfoundland
  • Cheri Bethune, Memorial University of Newfoundland
  • Judith Peranson, University of Toronto
  • Anne Biringer, Mount Sinai Hospital, University of Toronto
  • Risa Bordman, Univeristy of Toronto
  • Judith Peranson, University of Toronto
  • Joanne Laine-Gossin , University of Toronto
  • Rachael Nunn
  • Cara Franey
  • Alexandra Johnson
  • Andrew and Andrea Jansen
  • Solomon Mekonnen
  • And many more!

Activities to Date

Curriculum Development

The Family Medicine residency curriculum was developed in consultation with the Ethiopian medical leadership based on a curriculum common to many international Family Medicine training programs.  It was informed by literature on the role of the family physician in the African context as well as by a time-and-motion study of Ethiopian general practitioners (GPs). The overall goal of the Ethiopian family medicine curriculum is to prepare trainees and eventually graduates to definitively address the common health problems encountered by Ethiopians. The curriculum is intended to be responsive to the learning objectives and experiences of residents while also preparing them to address the health needs of the population they serve. Local champions and family medicine pioneers will continue to develop and review the curriculum as the discipline grows.

Residents

Most of the residents joining the Family Medicine program have considerable clinical experience having served as general practitioners, many as solo physicians in remote locations prior to their residency in family medicine. It bears mentioning that Ethiopian family medicine residents demonstrate bold professional commitment in opting to train in a discipline that is still being defined in Ethiopia.

Resources

AAU has provided the Family Medicine Program with office space on the first floor of the Black Lion Specialized Hospital, including a seminar room with a projector and computer and a room that allows residents to access the Internet from two computers.  A basic library was also established.

The current residents have developed a manual to provide guidance to incoming residents as they begin new rotations. They have also developed an educational resource called The Top 50 List of Commonest Medical Problems as a guide for the most common clinical conditions that will present to family physicians in Ethiopia. It is based on statistics from Arada Health Centre and topics from a seminal South African family medicine textbook, Bob Mash’s Handbook of Family Medicine.

Leadership Development

Leadership development is crucial to the growth of family medicine in Ethiopia. Current residents are being groomed to be the future faculty and leaders of the Family Medicine Program. The quality of residents in the Family Medicine program is exceptional. They have proven to be mature and dedicated group, with a high degree of professionalism and strong leadership skills. Under the supervision of the AAU family medicine leadership they have started to participate in the day-to-day management of the program in order to develop the necessary leadership, educational and managerial skills.  The residents, in particular the co-chief residents, have started to assume primary responsibilities, with supervision and guidance from the program director and expatriate faculty as appropriate. For this reason, in addition to their regular residency curriculum, faculty development and leadership development were identified as core components of this residency training program.

The role of the family physician in Ethiopia is an important topic of discussion. The current residents developed a comprehensive action plan to forward Family Medicine in Ethiopia, both at the training level and at the career level.

Annual Family Medicine Meetings

Three Annual Family Medicine meetings have been held since the inception of the program. Scheduled to coincide with the beginning of the academic year at AAU (in February), the meetings have brought together representatives from AAU, University of Toronto, University of Wisconsin, Federal Ministry of Health, and others to discuss the potential contributions of Family Medicine to the Ethiopian health system, the development of a roadmap to the integration of Family Medicine into the Ethiopian Health Care System, and the role of the family physician in Ethiopia. The annual meetings are an important forum for deliberations on the future of family medicine in Ethiopia with key stakeholders. The meetings are an opportunity for open dialogue about initiatives and collaborations between all partners.

Success to Date

Despite a persistent level of uncertainty, it is evident from years of commitment, hard work and leadership training, that family medicine in Ethiopia is wanted, needed, and supported and that the future of the discipline looks bright. The long-term impact of the development of family medicine will be exciting to follow.

Collaborations

Support from other specialties, from the community and from governments at all levels will influence how family medicine develops in Ethiopia. Collaboration with other disciplines is imperative for the TAAAC-FM program, especially as the family medicine gains recognition and acceptance in Ethiopia.  Though these are still early days, collaborations have already emerged and developed with other programs such as the Emergency department, public health, psychiatry, and others.

Next Steps & Opportunities

Current residents are being groomed to be the future faculty for the Family Medicine Program.  Residents provide the primary instruction at the Academic Half-Day under supervision, and senior residents supervise more junior residents at the community health centre.  Plans to offer more formal faculty development training in the INTAPT (Interprofessional Applied Practical Teaching and Learning in the Health Professions) program are underway.

Ethiopia’s Federal Ministry of Health (FMOH) has enthusiastically embraced family medicine as a key element of its health system and recently announced the upcoming establishment of two additional training programs in Gondar and Jimma. Traditional medical schools in Mekele and Bahir Dar are other potential future candidates as are those in Hawassa and Haramiya.  Ethiopia has established twelve new medical schools in the past two years with an innovative community-based curriculum for health care workers with prior experience.  The graduates of these programs, beginning in 2017, will be ideal candidates for training in family medicine, a community-based discipline.  The new schools may also be suitable sites for undergraduate involvement by family medicine if resources permit.

Program Contact Information

Global Health Program, Department of Family and Community Medicine
500 University Ave. 5th Floor
Toronto, ON, CANADA
dfcm.globalhealth@utoronto.ca

Grants and Publications

WONCA, Addis Ababa University, Ethiopia – Family Medicine launch. February 2013:  http://www.globalfamilydoctor.com/News/AddisAbabaUniversityFamilyMedicinelaunch.aspx

WONCA, Family Medicine in Ethiopia. March 2014: http://www.globalfamilydoctor.com/News/FamilyMedicineinEthiopia.aspx

Philpott J, Shiferaw S, Rouleau K, Cole D, Nicolle E,  Bezanson K, et al. Family Medicine needs assessment: Studying the clinical work of general practitioners in Ethiopia. Research Gate 2014

Philpott J,  Cornelson B,  Derbew M, Haq C, Kvach E, Mekasha A, Rouleau K,  et al. The Dawn of Family Medicine in Ethiopia. Family Medicine 2014; 46:9.

WONCA, Family Medicine Ethiopia Highlights. February 2015: http://www.globalfamilydoctor.com/News/FamilyMedicineEthiopiaHighlights.aspx