Family doctors, often known as general practitioners, play a central role in improving population health and delivering personal, comprehensive, and continuous health care to patients.
We spoke to two family doctors from central Asia, who explained what their role entails and why it is such a crucial part of community health care. We also looked at some of the challenges they face. Dr Indra Tezekova is a family doctor working at a health centre in the Chüy region of Kyrgyzstan.
“I look after all members of a family, so I have a good idea of their medical problems and ways to solve them. As their doctor, I can take into account any hereditary conditions, experiences of previous diseases, and identify priorities for treatment. Having a complete account of a patient’s medical history, as I do, is often key to making a successful diagnosis and choosing the right treatment paths.”
Like Dr Tezekova, Dr Munirakhon Sodikova, director of the Training and Clinical Centre for Family Medicine in the Sughd region of Tajikistan, is also keen to stress the advantages of having a comprehensive overview of her patients’ health:
“As family doctors, we provide an integrated service, with continuity of care for patients from birth to old age. We know each family and each family member, and we can provide psychological, social and, if necessary, palliative care.”
The importance of trust in health care
Both doctors agreed that building trust with their patients was vital for understanding their health needs and for encouraging them to reach out for support when needed. Each doctor had their own view on how this is achieved.
“Trust is built through good communication and demonstration of my professional skills and knowledge,” thinks Dr Sodikova. “When I can answer my patients’ questions, explain their conditions, deal with their concerns, and provide clear recommendations and instructions, they have more confidence in me. Showing tact, patience and understanding is also important.”
Dr Tezekova, on the other hand, believes that trust is mainly earned after a patient has received effective treatment:
“As a family doctor, I build trust by identifying a range of conditions early on and then prescribing treatments that make a difference. In our country, there is also a lot of internal migration, so I work closely with the local government and health authorities to better understand the health needs of migrants and to ensure that they can access the care that we can provide.”
Health beyond health centres
However, the role of many family doctors extends beyond simply seeing patients. Providing education and going out into their local communities plays an important role in preventing people from becoming ill in the first place, as Dr Tezekova explains:
“As a family doctor, I participate in vaccination tours, give lectures in schools on preventable diseases such as Type 2 diabetes and hepatitis, or those caused by smoking. I also give presentations to pregnant women on staying healthy and any danger signs to look out for.”
Not working in isolation
Primary health-care provision is not just about family doctors; it also includes a significant contribution from nurses and the collaboration of multidisciplinary teams, including in the local community, as Dr Tezekova is keen to stress:
“I would like to emphasize the role of community health teams in assisting health centres in addressing the determinants of health at community level through their own initiatives. This leads to an increase in medical and environmental understanding, which often, in turn, encourages positive behaviour change, such as taking up healthier diets and lifestyles.”
Healthy planet, healthy people
Working in Kyrgyzstan, Dr Tezekova recognizes the connection between environment and health, and the central role family doctors play for the overall well-being of patients. She is working to address a number of these issues:
“In our country, smog, caused by the burning of inappropriate fuels, is common. This leads to respiratory health problems in the population. As part of my role, I educate my patients about the importance of clean air and give advice on what is and what is not safe to burn. In remote areas, access to safe water and good sanitation can also be a challenge, so I regularly give advice on this, in addition to emphasizing the importance of hand hygiene for preventing infectious diseases.”
Dr Sodikova, too, believes that family doctors can be agents for encouraging healthy choices that benefit the environment:
“The family physician is a good ally in making healthy lifestyle choices, ideally placed to give information about environmental risk factors and ways to mitigate them, be it from polluted air, water, or smoking, and to promote the health benefits of walking over driving, among other things.”
A ticking timebomb
Like many other countries in the WHO European Region, the Central Asian Countries, which comprise Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan, are seeing a shortage of family doctors and other health workers, with an ageing working population threatening to further increase these shortages in the future. Indeed, according to a 2020 study, 30% of family doctors in Kyrgyzstan are already of retirement age. Nurses often step up to compensate for family doctor shortages, but placing the extra burden on them is neither fair nor sustainable.
This health workforce crisis is far from unique to central Asia, as WHO/Europe warns of the regional consequences of this crisis in its report titled “Health and care workforce in Europe: time to act”. WHO/Europe has since developed a framework for action that has been endorsed by all 53 Member States of the Region.
Challenges and measures to address family doctor shortages
As part of their health reforms, many central Asian countries have introduced family medicine in their medical education and primary health-care systems. However, these countries are still facing challenges in getting family medicine recognized and respected by their populations, due to a tradition of patients seeking diagnoses and treatments through specialist care professionals.
This problem is exacerbated by the fact that many of these countries are facing difficulties in attracting sufficient numbers of medical students to become family doctors. This is felt most acutely in rural, remote and mountainous regions, where doctor shortages are making it hard for patients to access and receive proper care. To address these shortages, some central Asian countries have implemented regulations allowing medical graduates with 6 years of medical education to take up positions equivalent to family doctors.
Strengthening family doctors in central Asia
The WHO European Regional Office is providing technical support to the countries of central Asia to ensure that their primary health-care systems are geared up to meet the changing health needs of their populations.
This includes preliminary assessments of primary care systems and the health workforce to identify and shape the nature of WHO support for improving the accessibility and quality of health services at primary health-care level. The quantity and distribution of health workers with the right competences are an essential part of this, with family doctors recognized as having a pivotal role in reducing the burden of ill-health on communities and economies.
In addition, in 2022, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan adopted the WHO Roadmap for Health and Well-being in Central Asia (2022–2025) – the first roadmap of its kind in the central Asian subregion, which serves as the foundation to “deliver as one” on resource mobilization and investment opportunities for health.
To further support the strengthening of family medicine in central Asia, WHO/Europe will also be convening a technical workshop in Kazakhstan to present family medicine models across the region and to highlight regional experiences with the introduction of mandatory general or family medicine specialization and multidisciplinary primary health-care teams.