Role of Family Physician in Improving Healthcare Equality

Role of Family Physician

It is important for us to understand the role of a family physician before we begin our discussion on the importance of family physicians in any health care system of the community. Many reforms have been made in the health care systems of various communities all over the world. Almost all of these reforms lay their focus on the prevention as well as the treatment of any disease along with the promotion of health and management of conditions that have become a chronic problem for the patients. All of these areas are the center of the family physicians and therefore family medicine has a huge role to play in here.

In this paper, we shall look at the current health care system in Libya and see how the government and other organizations like WHO are playing their role to improve the health care system in the country as they lay emphasis on the role of family physicians. Moreover, we shall also shed light on the general perception that the people have about family physicians and how they are important in the provision of better health facilities to the public.

Health care system in Libya

In Libya, all citizens are provided with the health care facilities. All the regulations in training, health, education, rehabilitation, family issues, housing, old age benefits and disability are made in the country according to "Decision No. 11" of the General People's Committee that has been formed on the Promulgation of the By-Law Enforcement Law No. 20 that was based on Social Care Fund of 1998. It should be noted however, that the health care system is not solely run by the state and there are many small private hospitals in different areas of the country. Moreover, when we compare the statistics of Libya with those of other countries of the Middle East, we find out that the average health of the people in Libya is above average, which is not the case elsewhere in the Middle East. Childhood immunization is taken special care of and all the new born children are vaccinated. One of the reasons that have led to this improved state of health in the country is the improvement in sanitation and provision of clean water for drinking. The two main hospitals of the country are Benghazi and Tripoli (Libya: Health, 2011).

When we look at the statistics, we find out that number of dentists and doctors increased by almost sevenfold between the years 1970 and 1985. This means that there is one doctor for every 673 citizens, which is not a very bad average. In the year 1985, almost one third of the doctors in Libya were born in Libya, meanwhile the rest were foreigners. Moreover, the number of hospital beds also increased during the same years. In decade of 1970s, it has been reported that the major endemics that the country was challenged with were that of paratyphoid, typhoid, leishmaniasis, infectious hepatitis, meningitis, rabies, schistosomiasis and venereal diseases. Malaria had been eradicated by then and efforts were being made to eradicate leprosy and trachoma. In the year 1985, the infant mortality rate was recorded to be 84 deaths per every 1000 children. As for the year 2004, this mortality rate dropped to 25.7 per 1000 children. There have been other reports on this that reveal that the infant mortality came down to 20 per 1000. There were about 7000 estimated cases of HIV. These cases were derived mainly because of the intravenous drug abuse. It was also recorded that many people had developed multi-resistance to tuberculosis in many areas of the country where these drugs were being used (Libya country profile, 2005).

Re-building the Libyan health care system

The Ministry of Health of Libya has been taken a lot of significant steps for the betterment of the country's health care system. Towards the end of the year 2011, the Ministry asked WHO to help the country revitalize their declining health care system so that the people can get access to quality health care services and so that all the citizens are provided with the same amount of services, irrespective of their financial status.

One of the critical problems that were identified in the provision of primary health care facilities was that there were no concrete concept of a family physician and there were not many district hospitals and local clinics in the country. The total population of Libya is 6.5 million for which there are only 1,500 local clinics. Therefore, the people are unable to get routine checkups and they have to wait for hours outside the national hospitals to get themselves an appointment with a specialist. Moreover, since there are no family physicians, there is no one to guide these people as to how to go about the treatment protocol.

In some places of the country, these facilities were actually very rare to find. On the other hand, the places that had these facilities, they were in very bad condition. The matters were made worse by the fact that when there was a conflict in Libya in the year 2011, most of the foreigners who were working there as medical personnel, fled to their native lands. This further created an increased demand for nurses and doctors and especially in the rural areas.

After the conflict, the health needs of the people have also changed and demands have increased. Adel Mohamed Abushoffa, who was the Deputy Minister of Health of Libya, was reported as saying that there are many critical areas that need special attention now. He pointed out at the psychosocial support and mental health after the conflict. He said that as the conflict took place, there are many people who need help to get over the whole trauma of the conflict. He also said that we do not have many psychiatrists in the country and it was actually shocking to find out when he said that there were only 14 of them in the whole country.

As the needs have changed, there is and has always been a constant need for the improvement in services that are provided to pregnant women so that childbirth is made a safer process and so that the newborn child is given the appropriate conditions for a healthy life. Apart from this, there is also a need for improvement in the emergency health services.

Since the health care system is damaged in the country, not just the health of the people is suffering, but also the government has to pay millions of dollars per day when the people of Libya have to go abroad to get these services that are not available in their own country.

Actions that are being taken to reform the Libyan health system

As a first step that was taken for rebuilding the health care system in Libya in collaboration with WHO, a senior delegation from the country visited the headquarters of WHO in Geneva, where the two parties decided to work together to improve the conditions of the health care system in the country. It was decided in this meeting that the team will be focusing on the six main areas that need improvement. The first area would be the improvement in the provision of primary health care to the people. The second area is the improvement in the main aspects of health service organization. The third area is to make the laboratory services stronger along with improving the management and supply pertaining to drugs and finally there needs to be an increase in the number of trained nurses in the country.

Some of the preliminary ideas were jotted down what the basic plan of what needs to be done and what should the action plan to cover all the six areas that have been mentioned above. The next stage of these reforms was to discuss the action plan and the ideas with the other people involved in the health care system in the country.

The WHO Representative in Libya, Dr. Samir Ben Yahmedsaid that this will be an important platform that will bring the stakeholders of the health care system, consumers as well the as the health authorities who would be selected through questionnaires after meetings that would be held across Libya so that they all come together and reconcile in a way that would be acceptable to all, regarding the re-building of the health care system in the country.

On the other hand, the Assistant Director-General for Health Systems and Services at the WHO, Dr. Carissa Etienne said that it is a major challenge to re-build the whole health care system in Libya and that is also an opportunity. It is an opportunity for the country to make a fresh start so that such a system is created that provides quality and equality in the health care services. Moreover, he said that such a system should be constructed so that expectations and needs of the people are catered.

The challenge would not be that big for WHO as it is for the government of Libya. This is because WHO has had this role in the past, for example in Iraq after so many years of conflict in the year after which WHO took the charge and responsibility of the health care system and that is when the vaccines for Heamophilus influenza type B and rotavirus were made available at all the health care centers as part of the Good Governance of Medicines in Iraq (WHO, 2012).

Primary health care and family physicians

The key to primary health care renewal and the backbone of all the health care systems all over the world are family physicians. One of the medical workers who have worked really hard in the field of primary health care is Dr. Barbara Starfield, who has probed into the importance of family physicians in primary health care and has concluded that if a primary care system needs to be made strong, there is a need that there should be better communication between the people who provide the health care services and those who receive them (Starfield, 2003). As the system of health care has evolved over the years, there has been a demand by the consumers that they should not just be treated but they should be treated in a way that does not only cure their illness, but also makes them feel satisfied. As we all know that the patients always the view the health systems through the eyes of their family physicians and that is how they evaluate the strength of any health care system. This is one of the reasons why it is important for people to have family physicians so that they are guided in the right way regarding the whole situation that is there in the health care system of a particular area or society. The central role of the family physicians also needs identification here. The main role of the family physician is to coordinate care for the patients, making proper arrangements whenever the patient demands and to sustain the continuity of the health care services so that it is made sure that the health care that is being provided to them is comprehensive. Moreover, it is the duty of the family physician to make sure that the patients are accepting the treatment protocol that they are getting and that they are satisfied with it.

The important of primary health care lies in the fact that it is the only part that forms the whole of the health care system. At the same time, primary health care also forms a part of the integrated system that has been devised to provide the health care services to the patients when they first need it. It should be noted that although family physicians have an extremely important and crucial role to play in the provision of primary health care to the patients, they have to encompass all levels of health care that includes primary as well secondary and tertiary.

It is very unfortunate, when we talk for the world in general and Libya in particular that most of the patients do not have any access to the health care services beyond the primary level. This is when the role of the family physician is further highlighted. It is thus the duties of the family physicians to make sure that the patients have access to the secondary and tertiary health care services and those they get them when they need them. However, primary health care system includes more than just what has to be done to prevent or cure the disease. It includes educating the patients as to what is to be done if the find themselves in a similar situation in the future and it also includes educating the people that they have to the right to justice in the provision of the health care services. Therefore, family physicians need to consider primary care more than just providing their patients with health care but they should also consider expanding what encompasses primary health care. This also makes it the responsibility of the family physicians to acquire knowledge and gain expertise in the field of advocating for preventive measures that are to be taken for a certain disease and also for advising their patients. The recognition of this need among the family physicians has implications for many aspects of the primary health care that includes the development and establishment of advisory boards on community health along with interdisciplinary teams.

People's perception of family physicians

In this part of the paper, we shall be discussing the results of a study that was carried out in order to find out what the people perceive about the role of their family physicians. The limitations of this study have also been mentioned in this discussion. Since this is a study that was conducted in a part of the world and not Libya, the results can be contradictory to what they could have been had the study been conducted in Libya.

The participants of this study were selected randomly and there were particular criteria for the selection of the participants, and there were only a limited number of people who were interviewed for this study. This is one of the limitations of the study. Another limitation of this study was the fact that the hospital that was chosen for this study was a teaching hospital. This implies that there could be an element of bias in the answers that were given by the participants of this study. However, irrespective of the weaknesses of this study, we were able to conclude the results as to what the people perceive the role of their family physician is and what is there idea of visiting a specialist physician.

According to the results of this study, 56% of the people who participated in this study would first consider contacting their family physician in case of a chest pain for example; meanwhile forty four percent of them would directly consult a specialist physician. This means that there is a significant number of people who do not put their trust in their family physician or maybe because they have not had a very good experience consulting their family physician during a health conflict. Studies have also concluded that the people who do not trust their family physicians are normally the ones who complain that the practitioners are not concerned about providing the patients with adequate health care services. Therefore, it can rightly be concluded that there has to be a trusting relationship between the patient and the physician in order for the patient to get satisfied with the medical treatment that he is receiving. (Marshall, 1998)

Since there are only limited resources available in a hospital setting or where a specialist physician practices, this approach of the patients leads to wastage of these resources because most of the chest pains are not experienced because of any underlying heart diseases and under such circumstances the family physician can guide the patient well. It has also been concluded by many studies that a huge amount of patient suffering is because of the failure of the health care system to deliver, meaning the visit of the patient directly to a specialist without seeing or consulting the family physician (Thom et al., 2004).

Out of the people who participated in this study, 62% of them were of the view that there was no such thing as health care delivery system without the family physicians being a part of it. On the other hand, 80% of these people were of the view that the system of health care delivery would totally collapse if specialist physicians would not be considered a part of it. These statistics, yet again, reaffirm the idea that patients rely greatly on the specialist physicians for the delivery of the health care services. Another reason for such statistics could be that idea of family medicine is not an established one in many parts of the world, especially the developing world and Libya is also a part of the developing world. Therefore, it should be noted that until the area of family medicine is not established in a way that it should be, the health care delivery system would not be able to work to its full potential. (Qidwai, 2004)

At many occasions, it has been noted that there is a difference in the approaches that are adopted towards the same medical problem by the family physicians and the specialist physicians. Many of the respondents of this study also referred to these differences in their responses. The important part here is that these differences should be realized by the family physicians as well as by the specialist physicians and the ones that satisfy the patients better should be adopted by both (Rosser, 1996).