Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Anne-Charolotte Tulinius

Second Supervisor/Advisor

Riaz Ratansi

Third Supervisor/Advisor

Robert Armstrong


Family Medicine (East Africa)


Primary health care was identified as the ideal model of health care delivery during the Alma Atta conference in USSR in 1978. The World Health Organization urged member countries to adopt it as a model of health care service delivery to their people. Since then many countries have adopted a primary health care model including Tanzania. In countries such as Cuba and Costa Rica where primary health care has successfully been implemented, access to affordable and quality health care service to all has resulted in lowered morbidity, mortality, improved quality and longevity of life. The success story behind primary health care implementation in these countries has been attributed to family physicians taking a leading role. In 2008 the World Health Organization (WHO) challenged all countries to train more family physicians and emphasized the need to fully implement the primary health care model. Despite this call, there has been a decline in the number of doctors applying for family medicine residency programmes especially in developed countries and in Africa many countries are yet to start the training of family physicians.

In Tanzania the Aga Khan University has been offering family medicine residency for more than five years. The number of local applicants to this program has remained low. To explore the reasons as to why this is the case, a qualitative study was designed. The study question was “what are the undergraduate medical students’ perceptions towards family medicine?”

Methodology: This was a qualitative study carried out in two universities; Muhimbili University of Health and Allied Sciences (public) and the Hubert Kairuki Memorial University (private) among final year undergraduate medical students. A self-administered open-ended questionnaire was constructed, validated and used as the study tool to collect the data. The questionnaire was administered to all 212 final year undergraduate medical students in both institutions and the return rate was 84.5%. The questionnaires were administered by a research assistant at each institution. The final year class in each institution had four clinical rotation groups to which the questionnaire was administered and collected at different times. The answers of the open-ended questionnaire were treated as qualitative data (texts) and were analyzed through a data-led four-step method of analysis as described by Giorgi’s methods of analysis (1985). Themes were identified through the analysis and further validated through researcher triangulation.

The study was approved by the Aga Khan University Ethics and Research Committee, Muhimbili University Research and Publication Committee and the Tanzania National Institute for Medical Research.

Results: The gender distribution was 67% males and 33% females. 47% of the respondents had heard of family medicine while 53% had not. 36% of those who had heard of family medicine reported that they had had an exposure to a family physician. The exposures were through friends, family or at a private hospital. 40% of the females who had heard of family medicine said they would consider family medicine as a future career choice while only 17% of their male counterparts said they would consider family medicine. No significant difference in level of awareness was noted between the two universities.

Among those respondents who had an awareness of family medicine two themes could be described. The first theme illustrates a profound lack of understanding of the role of family physician, described in three sections: The holistic doctor, the family doctor as serving special families only, and family medicine in the medical hierarchy and as a strategy for the health care system. Most of the students did not understand the concept of family medicine, for example some thought a family physician was a doctor for specific families/ special families, others thought (s)he dealt with family planning and hereditary diseases that run in families. Some did not understand how a family doctor differed from a medical officer. The second theme described that Personal competences and community needs are perceived as the main determinants of future career specialization. This theme is described in two sections showing that the professional and community needs come first, and that role modeling, professional status and accessibility are important determinants: Community needs, personal interest, personal skills, subject performance and role models were factors reported to influence how the students made future career decisions.

Conclusion: The results show a general misinterpretation of the concept of family medicine, which is likely to influence the career choice among these future doctors. If family medicine is to be successfully introduced in Tanzania there will need to be interventions aimed at raising awareness of the role of family medicine within the health care system. Aga Khan University will need to increase awareness among medical students of the programme they offer. At the same time it will be important that other medical schools be encouraged to start family medicine programmes. Working with government to influence policy related to family medicine is also suggested as an important strategy for the future.