Training doctors for family practice in primary health care work in Sri Lanka

Over one-third of the doctors in Sri Lanka are involved in the delivery of PHC. They form one of seven categories of PHC workers--others being the ayurveda physician, the assistant medical practitioner, nurse, midwife, traditional healer and unqualified practitioner. PHC workers function either in the government or private sector. Their functions in the PHC system are not defined and are dependent on state health policies and people's expectations of health care. The secondary and tertiary levels of the health system are managed by the government through a network of hospitals. These hospitals provide Western type health care facilities free to the people. Government PHC workers have access to referral facilities and back up services provided through this hospital system. Doctors functioning within the PHC system had neither undergraduate nor postgraduate training in PHC. Private general practitioners were the first to realise the need for training doctors in PHC. They sought and got government and university approval for postgraduate training in family practice. The family practice training programme is conducted by the Postgraduate Institute of Medicine of the University of Colombo. The course consists of educational and clinical components which could be completed in a minimum of 1 year or maximum of 4 years. Nine private general practitioners and 19 government medical officers registered for the course. Fifteen completed the course in 1 year. Family practice trained doctors will function in a PHC system in which the services provided are not coordinated. Changes in the PHC system are being considered. Government is proposing to establish health centres manned by doctors with sub-centres manned by lesser trained health workers. The medical profession has suggested a unified PHC system and a national health insurance scheme. The exact role of the family practice trained doctor in the country's PHC system cannot be defined. Family practice training should influence and be influenced by changes in the PHC system in Sri Lanka.