COMMENTARIES

More than medicine: The Department of Family Medicine's journey to embed care and learning in the heart of the community

O A Adeleke^I; K Mfenyana^II; P Yogeswaran^III; B Cawe^IV

^IMMed (Farn Med), FCFP (SA), MPhil; Department of Family Medicine and Rural Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa
^IIMPraxMed, MA; Department of Family Medicine and Rural Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa
^IIIMSc, MFamMed, FCFP (SA); Department of Family Medicine and Rural Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa
^IVMPhil, MFamMed; Department of Family Medicine and Rural Health, Faculty of Medicine and Health Sciences, Walter Sisulu University, Mthatha, South Africa

Correspondence

The Department of Family and Community Medicine at the University of Transkei (now Walter Sisulu University) was formally established in January 1989. The founding Head of Department's leadership laid the foundation for an integrated approach to community-based medical education. At the end of 1989, the Department of Family and Community Medicine was officially split into two independent entities: the Department of Family Medicine and the Department of Community Medicine.

From its inception, the Department of Family Medicine assumed a multifaceted role. It was entrusted with overseeing the Department of Family Practice and Emergency Medicine. It also served as the academic and clinical interface between the university and Mthatha General Hospital (MGH), which was then known as Umtata General Hospital and served as the teaching hospital. Its clinical operations began in earnest in January 1989, laying the groundwork for a comprehensive, community-based model of care that would influence healthcare delivery across the region.

From its inception, the Department of Family Medicine recognised the limitations of hospital-based healthcare, especially in a region where primary healthcare was urgently needed. The department advocated for a community-integrated approach, emphasising direct engagement with clinics and frontline facilities. As a result, doctors from the department began outreach efforts to clinics in and around Mthatha.

These efforts soon revealed significant systemic challenges: many clinics were under-resourced and structurally inadequate for safe and effective patient care, raising serious public health concerns. As a result, MGH bore the brunt of the region's healthcare demands, receiving patients with a wide range of needs, from basic primary care to complex tertiary-level cases. This situation highlighted the urgent need for a decentralised, community-based healthcare model.

During this period, the University of Transkei (Unitra) Community Health Partnership Project (UCHPP) was launched - an innovative initiative to integrate community engagement into health professions education. Between 1991 and 1996, the UCHPP facilitated the establishment of four community health centres in the greater Mthatha area: Mbekweni, Baziya, Mhlakulo and Ngangelizwe. In a remarkable show of local collaboration, traditional leaders in the rural areas of Mbekweni, Baziya and Mhlakulo donated land at no cost. At the same time, in the urban township of Ngangelizwe, a dedicated facility was constructed adjacent to an existing clinic. Community members also played a key role in safeguarding these centres, voluntarily providing security services. Once operational, the centres became active hubs for clinical learning and service delivery, with students and healthcare professionals regularly visiting to provide care and deepen their understanding of community-based practice.

In May 1997, the Department of Family Medicine relocated its services from the tertiary hospital to four community health centres established under the UCHPP. The local community welcomed this strategic shift, as it improved access to primary healthcare in underserved areas and reduced the patient load at MGH. The transition marked a significant milestone in integrating clinical education with community-based healthcare delivery, addressing the region's educational and healthcare needs.

The establishment of Nelson Mandela Academic Hospital in April 2004 led to the transition of all specialist departments, marking a change in the region's healthcare infrastructure. The Department of Family Medicine took over MGH, a 350-bed facility that became a key referral centre for clinics and community health centres. This change underscored the department's role in improving primary healthcare service delivery while integrating clinical education with community care.

The department initiated a postgraduate training programme in Family Medicine, enrolling candidates through the Medical University of Southern Africa (Medunsa), with joint faculty from Medunsa and Unitra. In 1992, Unitra began its Master's programme, graduating its first student in 1996. Undergraduate students start formal training in Family Medicine in their second year, continuing to their final year. The Department of Family Medicine was the hub for the community-based education component of medical training. It co-ordinated the Community-Based Education and Service (COBES) programme, promoting a model that views the community as a classroom. COBES combined service learning with academic goals, allowing students to engage with underserved populations and address health disparities. Faculty from various clinical departments instructed students, exemplifying interdepartmental collaboration in South African (SA) medical education and fostering a holistic approach to healthcare training.

Building on this foundation, the department also led the implementation of the Integrated Longitudinal Community Clerkship (ILCC) for fifth-year MB ChB students. This innovative educational model immersed students in extended, community-based clinical placements. Through COBES and the ILCC, the Department of Family Medicine positioned itself at the forefront of transformative medical education, aligning academic training with social accountability and primary healthcare principles.

The Department of Family Medicine's involvement in the decentralised teaching platform is a key strength of the faculty. It consistently places clinical students in diverse primary healthcare settings such as clinics, community health centres and old-age homes. This broad range of training environments allows students to experience real-world healthcare delivery, enhancing their clinical competence and understanding of social determinants of health and patient-centred care, especially in underserved communities.

Following the formal recognition of Family Medicine as a speciality in SA in 2010, the Department of Family Medicine began its registrar training programme at MGH. The programme adopted a decentralised model, expanding to Cecilia Makiwane Hospital in East London, Dora Nginza Hospital in Gqeberha, and three district hospitals, allowing registrars to gain diverse clinical experience while ensuring consistent academic training. Utilising the university's online platform, the programme offered structured teaching and innovative assessments, including electronic portfolios and digital-based evaluations such as multiple-choice and modified-essay questions. This technology-enabled approach ensured a high standard of postgraduate training while responding to the geographical and service realities of the Eastern Cape.

The Department of Family Medicine continues to play a pivotal role in strengthening the clinical capacity of the District Health System (DHS) in the Eastern Cape. Through targeted training initiatives, the department equips medical officers working within the DHS to pursue the Diploma in HIV Management, thereby enhancing the quality and consistency of HIV care across communities. In addition to formal training, the department provides ongoing support to district-based healthcare professionals, offering clinical guidance, mentorship and administrative advice. This collaborative engagement builds local capacity and contributes to more effective, responsive and sustainable healthcare delivery within the district system.

The Department of Family Medicine at Walter Sisulu University has become a nationally recognised model of integrated medical education and community-based healthcare. Its sustained impact on the training of future healthcare professionals and the strengthening of primary health systems reflects visionary leadership, enduring partnerships, and an unwavering commitment to social accountability. Today, its legacy is not only measured in academic achievements and service delivery milestones, but in the healthier, more empowered communities it continues to serve.

Correspondence:
O A Adeleke
oadeleke@wsu.ac.za

Received 11 April 2025
Accepted 11 August 2025