Healthcare in Africa involves families and communities: training of professionals should reflect this

The training of healthcare professionals shapes the way they relate to their patients, patients’ families and the communities they serve. But what if that training doesn’t fit the circumstances the professionals work in? I’ve been working in higher education in South Africa and internationally for over 20 years. During this time, my colleagues and I have introduced our students in various health and social care professions to training modules that are based on theory, models and frameworks from the global north. For example the curriculum has a strong focus on an individual’s performance. As a result, health professionals will look for those same behaviours in their colleagues, and unconsciously expect patients and communities to engage in that same individualistic way. It often felt that we were lagging behind in our training. We asked ourselves why our students were not actively participating in group work or team discussions during clinical training. Over time, however, our team of educators began to wonder whether the students in African countries had a different approach to how they worked with people. In a recently published paper we looked into this question. We concluded from our findings that some training and education models for health professionals in Africa are misplaced. That’s because health decisions in many communities across the continent are frequently made within families. Elders need to be consulted. Care is understood as a shared, communal undertaking rather than a private negotiation between one health professional and one patient. Based on these findings we looked at how international training frameworks could be strengthened by including a set of skills and abilities that better align with students from African countries. We built this approach around the concept of ubuntu. This is an African philosophical idea often summed up in the phrase “I am because we are”. We argue that this approach would result in healthcare provision that sees patients not simply as individuals with a diagnosis, but as people whose health is shaped by their families, communities and relationships. We believe that this approach could lead to better care, stronger trust in healthcare teams and better health outcomes. What’s wrong with current frameworks Interprofessional competency frameworks are guidelines setting out the skills, knowledge and attitudes that health and social care workers need to work effectively as a team. The world’s dominant interprofessional competency frameworks for healthcare workers have done a great deal to improve teamwork, communication and role clarity in health professions education. These include the Interprofessional Education Collaborative in the US and the Canadian Interprofessional Health Collaborative. But these frameworks make assumptions about what professionalism and communication look like. Collaborative patient care is expected to involve characteristics such as: assertive verbal contribution direct eye contact quick responsiveness and informal, easy interaction with authority figures. This leaves out a lot of what collaboration actually looks like in many African health contexts. In our work we found that a number of essential skills that African students possess aren’t recognised in frameworks. These included: attentiveness to what colleagues are saying collective responsibility for patient care shared accountability for patient outcomes. Reality on the ground Our proposal grew out of years of teaching and researching interprofessional education and collaborative practice for students and healthcare workers in South Africa and internationally. We examined the world’s leading competency frameworks for healthcare teamwork alongside African scholarship on ubuntu. The question we asked was whether these global models fully reflected how collaboration is understood and practised in African contexts. Our analysis identified three key observations. Firstly, that international competency frameworks privilege western assumptions about how collaboration is demonstrated and assessed. Secondly, that collaborative behaviours embedded in African cultures are often overlooked or undervalued. These include collective responsibility, where everyone shares accountability for the outcome. And relational decision-making, where decisions are reached through discussion and mutual respect rather than by one person acting alone. Thirdly, that ubuntu provides a robust philosophical foundation for reframing interprofessional competencies in ways that complement existing frameworks. And that they reflect African realities while offering lessons for healthcare systems globally. What a new model would look like We mapped five ways that ubuntu could inform existing interprofessional competency guidelines: Understanding that patients are part of families and communities, not isolated individuals. “Person-centred care” is care that is developed with the patient, their family, community and healthcare professionals, rather than being decided by healthcare providers alone. Treating accountability for health outcomes as shared among professionals, patients, families and caregivers, rather than resting on one provider or one hierarchy. Valuing attentive listening as a communicative skill in its own right. Recognising that rigid role boundaries can give way to more adaptive, overlapping ways of working that better fit complex, changing care needs. Treating leadership as something shared, built on trust. We don’t call for existing ways of working across the health professions to be thrown out. Rather, we argue that they should be expanded. The next step is to turn this idea into a workable competency framework. It must be tested and refined through pilot programmes in African health professions education. Gérard Charl Filies does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Healthcare in Africa involves families and communities: training of professionals should reflect this

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