Physician tracking in sub-Saharan Africa: current initiatives and opportunities.

BACKGROUND: Physician tracking systems are critical for health workforce planning as well as for activities to ensure quality health care - such as physician regulation, education, and emergency response. However, information on current systems for physician tracking in sub-Saharan Africa is limited. The objective of this study is to provide information on the current state of physician tracking systems in the region, highlighting emerging themes and innovative practices. METHODS: This study included a review of the literature, an online search for physician licensing systems, and a document review of publicly available physician registration forms for sub-Saharan African countries. Primary data on physician tracking activities was collected as part of the Medical Education Partnership Initiative (MEPI) - through two rounds over two years of annual surveys to 13 medical schools in 12 sub-Saharan countries. Two innovations were identified during two MEPI school site visits in Uganda and Ghana. RESULTS: Out of twelve countries, nine had existing frameworks for physician tracking through licensing requirements. Most countries collected basic demographic information: name, address, date of birth, nationality/citizenship, and training institution. Practice information was less frequently collected. The most frequently collected practice fields were specialty/degree and current title/position. Location of employment and name and sector of current employer were less frequently collected. Many medical schools are taking steps to implement graduate tracking systems. We also highlight two innovative practices: mobile technology access to physician registries in Uganda and MDNet, a public-private partnership providing free mobile-to-mobile voice and text messages to all doctors registered with the Ghana Medical Association. CONCLUSION: While physician tracking systems vary widely between countries and a number of challenges remain, there appears to be increasing interest in developing these systems and many innovative developments in the area. Opportunities exist to expand these systems in a more coordinated manner that will ultimately lead to better workforce planning, implementation of the workforce, and better health.

Medical schools in sub-Saharan Africa.

Small numbers of graduates from few medical schools, and emigration of graduates to other countries, contribute to low physician presence in sub-Saharan Africa. The Sub-Saharan African Medical School Study examined the challenges, innovations, and emerging trends in medical education in the region. We identified 168 medical schools; of the 146 surveyed, 105 (72%) responded. Findings from the study showed that countries are prioritising medical education scale-up as part of health-system strengthening, and we identified many innovations in premedical preparation, team-based education, and creative use of scarce research support. The study also drew attention to ubiquitous faculty shortages in basic and clinical sciences, weak physical infrastructure, and little use of external accreditation. Patterns recorded include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development. Ten recommendations provide guidance for efforts to strengthen medical education in sub-Saharan Africa.

A longitudinal study of occlusal caries among schoolchildren in Dar es Salaam, Tanzania.

OBJECTIVES: To describe the clinical caries status and the radiographic progression of occlusal caries lesions in permanent first and second molars among primary schoolchildren in Dar es Salaam over a 3-year period. METHODS: Clinical and radiographic diagnosis of caries in first and second permanent molars in 223 children aged 8-16 years were carried out annually from 1994 to 1997. The drop-out rates from the baseline in 1994 to the follow-up examinations in 1995, 1996 and 1997 were 16.6%, 22.0% and 35.4%, respectively. Twenty-one percent of the dropouts were picked up during the study. RESULTS: Less that 5% of all occlusal surfaces that were sound at the beginning of the study developed new clinical caries lesions over the 3-year study period. The highest rate of new lesions was found in second molars. The mandibular second molars were most frequently affected by new caries lesions followed by the mandibular first molars. Progression of lesions was generally slow. After 1, 2 and 3 years, 30.0%, 47.9% and 52.8% of lesions in occlusal surfaces of first molars had progressed, compared to 47.9%, 71.3% and 100.0% of lesions in second molars. CONCLUSIONS: Dental caries prevalence was low. New occlusal lesions were more likely to appear in mandibular second molars. Carious lesions were progressing slowly, especially in the first molars. Fissure abrasion may play a role in minimizing the risk of developing new occlusal lesions as well as progression of existing lesions.