Collaboration between family medicine and emergency medicine for integrated care in Pakistan.

The primary healthcare (PHC) Declaration of Alma-Ata, the first international action on advocacy of the importance of primary healthcare (PHC) stated PHC as the most important strategy for achieving “Health For All”.1 Thirty five years down the road, PHC is still not well established in its true spirit even in many of developed countries.2 With an ever increasing disease burden and rapid globalization, there is a significant stress on all the countries, developed and developing alike. The poorly performing health systems across the globe pose huge challenge on the healthcare providers, urging the imperative need to improve health system, which must respond to the need of the masses in a better way and at a faster pace. There is cumulative international evidence that PHC is the way forwards- “to meet the challenges of a changing world”.2 The PHC is the core of the healthcare system and provides care for the individuals and families in the community. It not only caters for acute health problems, but also caters for individuals with ongoing chronic conditions. This aims at health promotion and disease prevention and at the same time provides supportive and rehabilitative care.3 The evidence supports that it is the foundation of healthcare system and results in better health outcomes.4 Emergency Medicine and Family Medicine are the two major entities of the PHC. Both are now recognized specialties at undergraduate and postgraduate level in Pakistan.5-7 The training programs in both the specialties prepare physicians to provide broad-based healthcare. However, history of the two specialties is not very old. College of Physicians and Surgeons Pakistan (CPSP), keeping in view the need of these important disciplines, started postgraduate training i.e. Fellowship of College of Physicians and Surgeons Pakistan (FCPS). The FCPS program in Family Medicine was started in 1993, and since the start has produced 69 FCPS trained Family Physicians. For various reasons, 20 years since start of the program there are only 3 medical institutes with recognized Family Medicine residency programs. Only 6 medical colleges have undergraduate curriculum in Family Medicine. There is parallel MCPS program in Family Medicine with a total of 608 MCPS trained doctors to-date. On the other hand, FCPS in Emergency Medicine was introduced in 2011. The training in Emergency Medicine is in the initial phase and there are only two institutions offering training in Emergency Medicine in Pakistan. The discipline of Emergency Medicine is facing lot of challenges in Pakistan among which lack of trained Emergency Medicine faculty is the important one. In Pakistan, more than 125,000 medical practitioners have been registered with the Pakistan Medical and Dental Council to-date, 8 providing primary healthcare to the community in various capacities. Despite this, there is a huge gap between the health needs of the communities and basic healthcare provision as there is no structured training of these doctors and there is poor coordination and collaboration at various levels of healthcare systems.