Table 2.

Challenges to family medicine development in Ethiopia

National

• Ethiopia’s health care system is under-capacity for meeting the health care needs of the country.

• Family medicine as a specialty is not well understood by the medical community, though family medicine leaders think that the public understands and embraces the idea of family medicine specialists.

• There is a lack of established Ethiopian family medicine specialists in Ethiopia.

• Level of buy-in from GPs, other specialists, and health extension workers varies from uncertainty and ambivalence to suspicion.

• Despite vision at the highest level about what family medicine would look like, family medicine’s roles are still evolving and still not clearly defined.

Institutional

• Family medicine leaders in Ethiopia now are other specialists who have heard and/or learned about family medicine but have not had first-hand experience as family medicine specialists.

• There is a limited number of family medicine-trained faculty to teach residents.

• The current faculty are still developing ways of teaching family medicine residents.

• A system of mentorship and faculty development is still in the early stages of development.

Program

• There is competition from other residents for clinical training opportunities when residents rotate in hospitals that have residents in the specialty that they are rotating in.

• There are highly limited financial resources to pay for resident salary, for residents to attend international conferences, for research, to pay community specialists to provide training, and for a learning resource center.

• Expectations about what family medicine residents should learn and how they should be evaluated on are still under development, though there is ongoing iterative development at Addis Ababa University.

• Addis Ababa University’s family medicine program started at a large medical center and in the city, but the setting where the majority of family medicine specialists will practice will likely be different.

• Currently, there is no family medicine experience at the undergraduate level.

• Without considerable push from the Ministry of Health, recruiting medical students into family medicine to attain the goal of 50% family medicine specialists and 50% other specialists will be difficult.

Abbreviation: GP, general practitioner.