The Hashemite Kingdom of Jordan is situated south of Syria and northwest of the Kingdom of Saudi Arabia. The constitutional monarchy of Jordan has a total area of 91,000 km² and a population of 5.3 million inhabitants, with Amman as its capital. The official language of Jordan is Arabic, although English is widely spoken. The language of medical instruction is English. The population growth rate is 2.8 per cent per annum, and it is projected that the population of the country will double by the year 2030. The population is 92% Sunni Muslim, while the remaining 8 per cent practice the Christian faith.
Jordan's constitution
proclaims "health is for all," clarifying that it is the responsibility
of the government to ensure the availability of health care to all the Kingdom's
citizens.
Health Care Systems in Jordan
Prior to the accreditation of Family Medicine as a specialty in Jordan, primary health care was provided by general practitioners and various medical specialists. The bulk of those providing primary health care to the population in Jordan remain general practitioners. Currently, a variety of medical systems exist in Jordan, and they fall under three distinct categories: the private sector, the public (governmental) sector and the non-governmental (NGO) sector.
The public sector comprises the Ministry of Health (MOH), the Royal Medical Services (RMS), the University of Jordan and the Social Security Organization. The MOH is the principal health care provider, running an extensive network of public health centers and serving over 95.5 per cent of the community, with 86.1 per cent of the population able to reach these centers in less than 30 minutes.
Development of Family Medicine in Jordan
In 1981, in response to the perceived need for comprehensive and cost effective medical services, the RMS began its first three-year, postgraduate, residency program in combined Family Medicine and Emergency Medicine, which was accredited in 1985. This was followed by the first Board Examination in Family Medicine in 1986. In 1989, the MOH started its first residency program in Family Medicine.
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| Jordanian
Family Medicine Residents. Front row seated from left to right: A secretary , Dr. Nagham Abu Shakra, Dr. Farihan Al-Barghouty (Head of the Department), Dr. Sajeda Al Shaltoni, Dr. Iman Al-Jabi. Back row standing from left to right: Dr. Jinan Al Rossan, Dr. Safa' Al Kawsi, Dr Leila Ayoub, a secretary and Dr. Hiyam Quqa. |
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| Second
International Conference of the Jordanian Society of Family Medicine, 1998 Front row seated from left to right: Dr. Ma'moun Bawab, a secretary, Dr. Nagham Abu Shakra, Dr. Hana Halabi (Associate professor at Jordan University). Back row standing from left to right: Dr. Faisal Al Nasser (from Bahrain), Dr. Farihan Barghouty, Dr. Rula Barghouty, a visiting doctor from the UK, Professor Vincent Hunt, Dr. Mazen Al Bashir (Associate Professor in the Department), Dr. Shawqi Amin (from Bahrain) and Dr. Doa'a Al Hammouri. |
This was followed in 1995 by the initiation of a three year long Family Medicine training program in both of Jordan's medical schools: Jordan University (JU) and the Jordan University of Science and Technology (JUST). In July of the same year, the Jordan Medical Council (JMC) modified the length of the Family Medicine training program to four years, standardizing the content of the training programs and establishing a 'Specialist' in Family Medicine.
Training in Family Medicine in Jordan takes place primarily in the hospital setting for the first three years, with a minority of time spent in the outpatient clinics. The fourth and final year is spent entirely in the outpatient clinic. Evaluation of the trainees is through a combination of case logbooks, ongoing evaluations by proctors, mock examinations and end-of-year written examinations.
The goals of the Family Residency training programs are to produce graduates who are prepared to treat patients and families and provide preventive services regardless of age, sex, stage of life or type of illness, across a variety of clinical settings, including the inpatient setting. Issues of cost effectiveness and coordinated care are also critical in the training of future Family Physicians.
The Jordanian Medical Council (JMC) defines a 'Specialist' in Family Medicine as a physician who meets at least one of the following criteria:
The JMC Accreditation and Training Committee is responsible for accrediting training programs, training centers and hospitals. It develops and updates the educational plan of the program, as well as coordination between programs. It arranges and supervises workshops, training courses and lectures for trainees. Finally, it co-operates with, and maintains communication with the Arab Medical Council.
The JMC Examination Committee develops and rules and regulations of the examinations, and conducts the first two parts of the Board exam. Moreover, it develops a plan of co-operation with the Exam Board of the Arab Medical Council - the Arab Board of Family Medicine - a degree granted by the Arab Board of Medical Specialties.
As of 2003, 34 family medicine residents are in residency training programs and 37 residents are eligible to take their Jordanian Medical Boards in family medicine. As of the end of 2002, 176 board certified Family Medicine Specialists are practicing in the various sectors of the Jordanian health system.
International Contributions
Brown University, through a United States Agency for International Developmement (USAID) sponsored project, provided support to programs at JU and JUST for the first four years. This project was spearheaded by Dr Vincent Hunt. The Public Health Care Project initiated by USAID provided support for the MOH program by establishing a reference library, a study tour for specialists, ad-hoc consultations, and physical support to the Health Academy (Furniture, library, training rooms).
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| Dr Iman Al-Jabi |
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| Dr. Mohammed Tarawneh |
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| Dr. Laeth Nasir, MBBS |
The World Health Organization (WHO) financially supported the MOH to run six training courses in community medicine for the Family Medicine residents. In addition, the WHO provided financial coverage for the training of 19 trainers at the American University of Beirut, and provided logistic support to the Training Center.
Looking to the Future
Family Medicine in Jordan faces a number of unique challenges and opportunities. The relatively late arrival of the specialty of family medicine into a medical system traditionally dominated by subspecialists is beginning to lead to a restructuring of the primary care's role in the country. It is hoped that this shift will result in an increased emphasis on primary care in the medical system.
Improvements in the quality of care provided by Family Physicians are likely to result in increased requirements of material and manpower at the primary care level. This, in turn, will require new administrative structures to monitor and ensure provision of adequate resources in these settings. It will also require a shifting of existing resources and referral patterns to the outpatient setting. Patient acceptance of this specialty is also important, and will require efforts on the part of family medicine to educate patients on its roles and responsibilities within the system.
Dr Iman Al-Jabi MD,
MRCGP
Part-time Associate Professor
University of Jordan Faculty of Medicine
Family Medicine and Community Department
Private Clinic
Dr. Mohammed Tarawneh
MBBC, JMB
Director of Training and Education
Chief of Family Physicians
Jordan Ministry of Health
Dr. Laeth Nasir, MBBS
Associate Professor of Family Medicine,
University of Nebraska Medical Center
Currently Visiting Fulbright Scholar,
University of Jordan Faculty of Medicine