How to make primary healthcare a favourable career choice for medical students: strategies and reflections

This article was exclusively written for The European Sting by Ms. Alaa Abusufian E. Dafallah, a 6th year medical student from University of Khartoum, Sudan with 5 years of experience in the field of student advocacy and medical education development in Sudan and Africa. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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Primary healthcare is the foundation of all health systems as it is the first contact and ongoing link between people and their health providers. Yet 400 million people around the world do not have access to basic health services. After the new global commitment to primary healthcare (PHC) in Astana a few months back, PHC has never been more important. A few months back, I went on a medical mission to Kordofan, a state 12 hrs from from the capital city of Sudan. As we visited village after village, I observed the status of PHC centres. Understaffed, under resourced, and bluntly said, empty. One centre was a room, slightly larger than a classroom, with only a desk and a couch  where even a size 16 cannula could not be found. It became quite apparent to me that aside from the low resources, the notable shortage of primary health care workers is greatly affecting the provision of quality basic health care services. I silently asked myself, who would work here ? How can we make Primary Healthcare an attractive career choice for medical students who constitute the bulk of the future health workforce ? As a strong believer that education is the most powerful weapon you can use to change the world, one of the fundamental solutions is reforming of undergraduate medical education on 3 main aspects – Firstly, decentralisation of medical education such that states within a country have schools that graduate doctors who will work in the same communities they came from. In addition, medical schools must ensure their selection policies are inclusive of students from rural/underserved areas by providing financial aid whenever needed. The second aspect is to increase the longitudinal exposure and training of students in PHC settings. It it has been documented that undergraduate training largely influences career choices of medical students however, in most schools, 90% of clinical training is in tertiary health institutions and in the 4 main disciplines of medicine. What if PHC or family medicine would be the 5th ? The final aspect is to promote social accountability amongst medical students by creating opportunities whether core or elective within the curriculum that allow for students to engage with and feel accountable to their communities. Another approach would be to address postgraduate training. Most students feel there is no room for career growth within PHC especially in rural areas, hence it is essential to create a strong and compelling continuous professional development and training programme for physicians working in PHC settings. Finally, addressing working conditions is integral. It is paramount to bridge the payment gap between specialists and PHC physicians by increasing the funding for PHC in general. This, coupled by appropriate working hours, well resourced centres and adjunct benefits like insurance and housing will help reduce the perceived imbalance between specialists and PHC physicians. In conclusion, the shortage of primary health care workers is an complex issue, which will require a combination of strategies to solve. It is important to involve youth in the continuous assessment of the situation and the implementation of innovative ideas to address this challenge. Health is for all, by all. About the author Ms. Alaa Abusufian E. Dafallah is a 6th year medical student from University of Khartoum, Sudan with 5 years of experience in the field of student advocacy and medical education development in Sudan and Africa. She is currently the Regional co-ordinator of Medical education for Africa at the International Federation for Medical Students Association (IFMSA). Alaa recently founded MHSL (Model Health system Leaders ) a novel initiative that aims to promote youth understanding & reforming of health systems. She aspires to pursue a career in Health systems and health workforce planning.