Dear dr. Martin Ekeke, Dear Friends at the First Regional Forum on Strengthening Health Systems for the SDGs and UHC: Healthy Systems, Healthy People in Windhoek Namibia,

We want to bring you a contribution from The Primary Health Care Family Medicine Network in Africa. The African continent suffers a very high burden of disease and only a marginal workforce of health workers available, resulting in difficult access to care, fragmented care, lack of infrastructure and technology and poor health systems. The World Health Report 2008: “Primary health care: now more than ever!” emphasizes the importance of strengthening primary care in addressing these health challenges. Evidence from WHO shows that strengthening primary health care is an important strategy to address inequities in health. In the recent report by the high-level commission on Health Employment and Economic growth: “Working for health and growth: investing in the health workforce”, the importance of investing in primary care workforce is stressed once again.

Primafamed (Primary Health Care & Family Medicine Network)( is an international network active in the field of research, service delivery and capacity building in primary health care in Africa, committed to universal health coverage and addressing the challenges described above, since its conception in 1997. The Network subscribes to the SDG. In 1997 the Department of Family Medicine and Primary Health Care of Ghent University became a partner in the “South-African Family Medicine Educational Consortium”, an interuniversity cooperation in the field of postgraduate training of family physicians. Later on a “twinning-strategy” was developed, twinning each of the 8 South-African departments of family medicine with another African country, to train family physicians.  In addition to capacity building, Primafamed incorporated a focus on service delivery and research, with the creation of the “African Journal for Primary Health Care and Family Medicine” (

In the meantime, research projects on the concept and implementation of family medicine in Africa were developed, resulting in a “Consensus Statement of on Family Medicine” (see attachment [*]). In 2012, at the 5th Primafamed workshop in Victoria Falls (Zimbabwe), a strategy was adopted to scale up family medicine and primary health care in Africa integrating education, research and services delivery, and with special emphasis on development of primary care oriented health systems (see attachment [*]). Thanks to a wide variety of funding sources over the years (Belgian VLIR-UOS- Own Initiatives 2003-2006-2009; VLIR-INC; ACP-EU-Cooperation Programme in Higher Education-Edulink; EU-FP7-HURAPRIM;…) Primafamed grew and consolidated into an international network, including institutions in Europe (Denmark, U.K,…)and Africa (South-Africa, Tanzania, Kenya, DRC, Ruanda, Uganda,…).  It is this consortium of committed partners that has often worked together in the past and have proven their scientific capacity, and their contribution to universal health coverage through concrete actions in the pedagogical field (e.g. curriculum development, improvement of training programs, appropriate skills training) and in the area of development of research capacity, as well as working at the “health system” level.

At this moment, based on the experience of the PRIMAFAMED-Network, we would like to suggest the following strategies to the First Regional Forum on Strengthening Health Systems for the SDGs and UHC: Healthy Systems, Healthy People in Namibia:

1. According to the Abuja Declaration African countries should invest 15% of the public spending in health care in order to address the actual challenges of infectious diseases and chronic conditions, especially multi-morbidity.

2. African countries should double the percentage of their public health spending, that is invested in primary health care, in order to strengthen primary health care systems, as there is clear evidence that strong primary health care systems have an essential role to play in achieving the Sustainable Development Goals and contribute to universal health coverage.

3. Actually there is an important input of resources by international donor organizations like USAID, Bill & Melinda Gates Foundation, Global Fund, Danida,… through vertical disease-oriented programs. As was already asked by the campaign “15by2015”, launched in March 2008 (see article in BMJ 8 March 2008), that donors that invest in vertical disease oriented programs (HIV/AIDS, malaria, tuberculosis,…) should invest by 2020 20% of the resources of their investment in these vertical programs, in strengthening local primary health care systems. By doing so, they put into practice the recommendation by the World Health Assembly 2009 (WHA62.12), that “… vertical disease oriented programs should be integrated and implemented in the framework of integrated primary health care systems”. By doing so, the campaign “15by2015”, could be followed-up by a campaign “20by2020”.

4. National Ministers of Health should formally recognize the discipline of family medicine operating in the primary health care system (already of lot of countries did so), and should define the role of family medicine in the framework of the primary health care team and provide financing in order to create posts for family physicians in the framework of primary health care teams. In annex, the “Consensus Statement of Family Medicine in Africa” gives a clear picture of how this could happen.

5. There is an urgent need to scale up the capacity in family medicine and primary health care in Africa. According to the “Vic Falls Declaration” (see attachment), at least 40% of the students finishing undergraduate medical training, should start a post-graduate training in family medicine in order to strengthen primary health care teams. One of the strategies to make this happen is to increase the early exposure in undergraduate curriculum of all medical students to primary health care settings and family medicine practice.

6. All stakeholders involved at national provincial and local level should invest in strengthening the primary health care team, including strengthening the cooperation between nurses, family physicians, midwifes, social workers, community health workers in the context of primary health care centers and ­ where needed ­ in the framework of district health hospitals.

7. In order to address the problem of brain-drain there should be an appeal to the receiving (Western) countries’ governments that receive health care providers who are trained in Africa and integrate them in their (Western) health system, that the receiving governments, reimburse the full cost of the training of such a health care provider in their own country, to the country where the provider has been trained. This would contribute to more equity in availability of health care providers worldwide.

The Primafamed-Network, in cooperation with other stakeholders, that may support these strategies, is willing to cooperate to these Developments. Can this document and annexes immediately be made available to the participants at the First Regional Forum in Windhoek.

Looking forward to your reaction, Prof Jan De Maeseneer Primafamed Network

Director International Centre for Primary Health Care and Family Medicine ­ Ghent University, WHO Collaborating Centre on PHC.

HIFA profile: Jan De Maeseneer is Secretary General of the Network Towards Unity for Health. The Network: TUFH is a global association of individuals, groups, institutions and organisations committed to improving and maintaining health in the communities they have a mandate to serve. The Network: TUFH is a Non-Governmental Organisation in official relationships with the World Health Organization (WHO). Jan is a working family physician (part time) in the Community Health Centre Ledeberg-Ghent (Belgium). He is Head of Department of Family Medicine and Primary Health Care of Ghent University (Belgium). He is the Chairman of the European Forum for Primary Care:         jan.demaeseneer AT

[*Note from HIFA moderator (Neil PW): Thank you Jan, I look forward to comments fro other HIFA members. The original message carried attachments but HIFA does not carry attachments. Please contact Jan for further details]