​​Kenyan family physician Dr Gulnaz Mohamoud is a trailblazer in her field. In 2009 she was the first woman in East Africa to obtain a Master's degree in Family Medicine. This month she will become the first family physician in East Africa with a PhD in Family Medicine when she graduates at Stellenbosch University.

It is the achievement of a long-held ambition. “It is my joy and pride," says Mohamoud, a private practitioner in Kenya's capital, Nairobi, and a senior lecturer in the Department of Family Medicine at the Aga Khan University, a private tertiary care and teaching hospital.

She attributes her success to “perseverance, discipline and a stoic belief that I could do it despite the challenges of being a mother and a full-time physician". But her latest accomplishment extends far beyond merely being a personal achievement.

“I am thrilled with the thought that my PhD will motivate other family physicians to reconsider the belief that completing their Master's in Family Medicine is the end of their study ambitions," says Mohamoud. “I hope to contribute towards a paradigm shift that will bring about greater awareness that life-long learning is an essential component of life."

Her career certainly bears testimony to this. She graduated from the Dow University of Health Sciences in Karachi, Pakistan, in 1987 and subsequently acquired accreditations in Ultrasonography, Geriatric Medicine, HIV/TB/sexually transmitted diseases, Rehabilitation in Family Medicine and Clinical Ethics.

Family Medicine – which addresses holistic medical care – has clearly long been at the centre of her professional life. She has continued to further the development and understanding of Family Medicine in Kenya through various publications and active participation in the Kenya Association of Family Physicians as an executive member.

Her PhD was a logical step in expanding her expertise in the field. “My study was the first ever to focus on measuring the quality of service delivery in primary care in the private healthcare sector in Nairobi," explains Mohamoud. “My PhD was based on the need to measure the performance of primary healthcare in low and middle-income countries, where 'macro data' is often absent.

“Therefore, the study not only shed light on the gaps and gave recommendations on how to improve the quality of service delivery in private sector facilities, but also brought into focus the various methods, changes and adapted tools that could be used to measure this in the broader African context."

The significance of her research cannot be overemphasised: “As is the case in most developing countries, the primary care system in the private sector is diverse and fragmented. As a result, reliable and meaningful data on the quality of healthcare being provided is grossly lacking.

“The private healthcare sector in Kenya caters for more than 50 percent of the medical care being provided to the Kenyan population, hence its significance in the service delivery of healthcare. Also, the proportion of services provided by private organisations is increasing exponentially."

Her supervisor Prof Bob Mash, Executive Head of Stellenbosch University's Department of Family and Emergency Medicine, elaborates: “Her work focused on the key ingredients of high-quality primary healthcare as identified by the World Health Organisation and the Primary Health Care Performance Initiative – how accessible is care, how comprehensive are the services, to what extent is there ongoing care within a trusted doctor-patient relationship, how well is primary care coordinated with hospital care, and to what extent is care person-centred."

Mash notes: “Gulnaz demonstrated how data can be collected at the local level to give information on the quality of service delivery that managers can act on. In addition, she adapted and validated the Primary Care Assessment Tool for the whole country. This tool can now be used by researchers or managers at the local level throughout Kenya to measure the quality of service delivery."

He adds: “Having more established researchers such as Gulnaz should improve the quality of training and supervision. We hope Gulnaz can continue her research interests in collaboration with colleagues in Kenya and East Africa to build research capacity and improve the quality of service delivery."

Mohamoud is alive to these challenges. “Conversations around the implementation of universal health coverage have commenced in Kenya and have been prioritised as a goal," she says. “However, this goal cannot be achieved without incorporating the key elements of high-quality primary care such as accessibility, continuity, coordination, comprehensiveness and person-centredness."

She believes family physicians can play a major role in this regard: “They will also, in turn, reduce the present over-reliance on specialists for chronic care. Studying the key elements of high-quality primary care in service delivery therefore became the soul of my PhD journey."

Mohamoud is eager to build on her work in Family Medicine, but realises this will not be without difficulty. “As a married professional with multiple jobs and life's responsibilities, the challenges are numerous," she says.

“But my resolve and inner strength helped to shape the trajectory of my career and goals. I realise that the human mind can accomplish incredible feats with a clear vision and stubborn determination. As the great Sufi philosopher Rumi said, 'You have wings, learn to use them and fly.' "

Caption: Prof Bob Mash (PhD supervisor), Dr Gulnaz Mohamoud and her husband Merali Mohamoud.

Photo credit: Stefan Els