title: Understanding of family medicine in Africa: a qualitative study of leaders' views.
abstract: BACKGROUND
  The World Health Organization encourages comprehensive primary care within an ongoing personalised relationship, including family physicians in the primary healthcare team, but family medicine is new in Africa, with doctors mostly being hospital based. African family physicians are trying to define family medicine in Africa, however, there is little clarity on the views of African country leadership and their understanding of family medicine and its place in Africa.
  
  
  OBJECTIVE
  To understand leaders' views on family medicine in Africa.
  
  
  METHODS
  Qualitative study with in-depth interviews in nine sub-Saharan African countries.
  
  
  METHODS
  Key academic and government leaders were purposively selected. In-depth interviews were conducted using an interview guide, and thematically analysed.
  
  
  RESULTS
  Twenty-seven interviews were conducted with government and academic leaders. Responders saw considerable benefits but also had concerns regarding family medicine in Africa. The benefits mentioned were: having a clinically skilled all-rounder at the district hospital; mentoring team-based care in the community; a strong role in leadership and even management in the district healthcare system; and developing a holistic practice of medicine. The concerns were that family medicine is: unknown or poorly understood by broader leadership; poorly recognised by officials; and struggling with policy ambivalence, requiring policy advocacy championed by family medicine itself.
  
  
  CONCLUSIONS
  The strong district-level clinical and leadership expectations of family physicians are consistent with African research and consensus. However, leaders' understanding of family medicine is couched in terms of specialties and hospital care. African family physicians should be concerned by high expectations without adequate human resource and implementation policies.
authors.affiliation: Department of Family Medicine, University of Witwatersrand, Johannesburg, South Africa. shabir@drmoosa.co.za
authors.forename: Shabir
authors.initials: S
authors.lastname: Moosa
authors.forename: Raymond
authors.initials: R
authors.lastname: Downing
authors.forename: Bob
authors.initials: B
authors.lastname: Mash
authors.forename: Steve
authors.initials: S
authors.lastname: Reid
authors.forename: Stephen
authors.initials: S
authors.lastname: Pentz
authors.forename: Akye
authors.initials: A
authors.lastname: Essuman
mesh_terms: D017954:Africa South of the Sahara; D001294:Attitude to Health; D003695:Delivery of Health Care / Q000458:organization & administration; D005194:Family Practice; D006291:Health Policy; D006694:Holistic Health; D006801:Humans; D007857:Leadership
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