Family Medicine, The Syrian exprience
Family, the first life factory, is considered the original and most important factor in creating and reshaping individuals’ health on all aspects, and because of the critical role of the family in public health there has been some remarkable emphasis from the health authorities in the whole world to adopt the” family medicine “as the first health interface to interact with family health.
*Family medicine is a medical specialty devoted to comprehensive health care for people of all ages; the specialist is named a family physician one of his responsibilities is to provide continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body; family physicians are often primary care physicians. It is based on knowledge of the patient in the context of the family and the community, by concentration on disease prevention and health promotion.
Family Medicine Program in Syria
The Family Health Program is a modern program in Syria with a similar goal in the countries in which it is implemented which is to develop the integrated health system for the services provided according to a harmonious mechanism between the levels of health care in order to provide quality services to the largest possible number of different segments of society.
After examining the reality of the current health services, it was found that the current health system is in dire need to improve the quality of services, whether at the level of hospitals or primary health care or even at the level of linking them. It was also found that there are many problems and difficulties that may be difficult to solve some of them in a short period, especially on matters of health legislation and training curricula that need to be radically modified.
A new plan has been developed to start the project where it was agreed to select the provinces that see themselves as capable of making this qualitative leap. The progressive extension of development will take place over the next five years, resulting in a heavy burden (material, human resources and basic logistics).
- Activating the concept and mechanism of family health in all selected governorates
- Highly qualify and train specialists to provide health care services horizontally within the concept of family health in all.
- Contribute to the development of the health service sector in the Syrian Arab Republic by activating the concept of family health.
We need an effective, integrated and unified information system for all health services in the selected governorates serving full, Develop the infrastructure and organizational health services within the concept of family health gradually by 50% for the selected governorates and by 10% – 20% for other governorates. A clear vision of the concept of family health in 80% of the health staff, 50% of the community in the selected governorates, 40% of the health staff and 25% of the community in the other governorates by the end of 2015.
Current Status of Family Medicine in Syria:
– The Family Medicine Program was established in the Ministry of Health in Syria in 1990 in cooperation with the World Health Organization. It is one of the leading programs in the Arab world in terms of its coverage of all governorates and regions.
– Many governorates lack any specialists in family medicine because of their travel abroad.
– Most of the graduates are outside Syria because of the large external demand and the lack of family medicine
– The Ministry of Health ensures that family doctors work immediately after graduation, as well as the opportunity for continuous medical training.
– Syrian universities have graduated family doctors and provided them with extensive training in primary health care programs within the health facilities of the Ministry of Health.
– The reasons for the lack of affiliation with family medicine in general are due to the following two reasons:
A- Ignorance of the benefits of family medicine for both doctors and citizens and those who will benefit from this specialty
B- Expect weak financial returns for family medicine compared to some other specialties.
At least one family doctor per health center, urban or rural, by 2020
Second: Objective Purpose of Family Medicine
Family medicine specialists should provide primary health care in the Syrian Arab Republic, they should provide health insurance services in the Syrian Arab Republic, Rational and equitable use of material, human, scientific and financial resources, for the health of all citizens.
Family Policy Program at the Ministry of Health
Prioritize rehabilitation and training programs for resident physicians and family medicine specialists, prioritize primary health care programs for resident and specialized family physicians., Assigning the primary responsibility in the application of health insurance to family doctors, Acquire good knowledge, positive attitudes and appropriate skills during patient care.
Fourth: Strategies of the Family Medicine Program at the Ministry of Health:
Cooperation between the Family Medicine Program at the Ministry of Health and the bodies responsible for health insurance, especially the World Health Organization, the European Union, and family medicine programs in brotherly and friendly countries.
Cooperation with the Arab Council for Medical Specialties “Scientific Council for Family and Community Medicine Specialists”, Take advantage of all current family medicine graduates and develop their training skills in the field of family medicine. Media evangelization for family medicine as the best means of achieving primary care for the population of Syria.
- Admission of at least 10% of the total number of applicants to the preference for family medicine.
- Increase the annual admission rate by at least 3% per annum to reach 35% of the total number of applicants by 2020.
- Training 14 family physicians specialized in training skills and teaching techniques each year.
- Recognize at least one family medicine training center in each governorate by 2020.
- Cover all health training centers with at least four family doctors by 2020.
Family Medicine Program Offers:
- Increase the annual percentage of family medicine graduates compared to the total number of all specialties by 3% annually.
- Increasing the number of resident physicians taking the first and second year exams by 3% annually.
- The presence of at least one specialist physician in each governorate in the field of family medicine, who master the skills of training and teaching techniques in the specialty of family medicine
- There is at least one health training center in each governorate.
- There are at least two family doctors in each training center
- Implementation of the plan of action with the World Health Organization, which includes local and external training courses, authoring and printing books, periodicals, scientific conferences, and supervisory visits to the branches of the Family Medicine Program in the governorates.
Family medicine in other developed countries
Primary care in the UK is probably one of the best primary care systems in the world. The UK system is a publicly funded system that provides healthcare free-of-charge to the UK population through the National Healthcare Services NHS. Their primary care system is based on General Practitioners GPs who act as the primary point of contact for UK patients. The General Practitioners in the UK also act as gatekeepers who coordinate the referral of the patients from the primary level to the secondary level of care. For example, a patient with knee problem in the UK would visit his GP first and then his GP would refer him to a specialist if there is a clinical need for that. UK’s GP are reimbursed by the NHS according to the number of patients registered with them. On the other hand, the patient in the UK has the freedom of choice to register with the GP that he wants. The NHS monitors the performance of the GP through a number of metrics including the healthcare outcomes of their patients and provides incentives accordingly.
One country that is currently innovating with their primary care services is Ukraine. Ukraine has inherited a post-soviet healthcare system. They are currently adopting a system similar to the UK one. Their primary practitioners are transitioning from government employees to government contractors who are paid according to the number of patients that register with them. The patients also have the freedom to change their primary care practitioner when they wish to do so. The number of patients that each physician can have is limited and this limit differs between the UK and Ukraine. I believe that this model of financing improves competition among providers and my lead to improved quality of care. This successful model has been applied in many countries beyond the UK and Ukraine and it may be a suitable model for application in the Arab region and Syria.
Dr. Alexey Youssef
Dr. Mariana Haydar