Integrating clinical care and public health: The Malian rural doctors experience

PURPOSE: To describe the experience of Malian rural doctors in the integration of public health and individual health care.

INFORMATION USED: This presentation is based on an article written for a special issue of Education for Health, which advocates for integrated health care.

METHODS: The Malian rural doctors experience is analyzed from the point of view of the "Towards Unity of Health" strategy, emphasizing the integration of medicine and public health

RESULTS: Human resource shortage is a major problem in rural Sub Saharan Africa. The experience of rural doctors in Mali, supported by Faculty members and the NGO Santé Sud, demonstrates that rural medical practice can be attractive and rewarding. After 15 years of experience, about 90 doctors grouped in the Rural Doctors Association provide clinical care and community health in rural settings. This practice introduces novel professional roles ; a training scheme specifically oriented to these new needs of rural primary care practitioners was developed. Factors which favored the development of this rural doctors' movement include: increased numbers of medical doctors trained, strong community demands, NGO support with installation, professional support through the Rural Doctors Association, reasonable financial incentives, and quality mechanisms developed in partnership between academics, professionals and the NGO.

POLICY IMPLICATIONS: The increased production of doctors leads, in some countries, to the emergence of rural first line medical practice. If adequately supported and canalized to serve the interests of the public, this represents a unique opportunity to revitalize primary health care and strengthen health care systems.