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Our world is facing an environmental crisis with major consequences for health. From a health perspective, the choice between development and the environment is a false dichotomy. Humanity can only flourish between a solid social foundation and an ecological ceiling. We are struggling with both objectives. Renewed commitment to the primary health care approach is one sign of hope and the emergence of both Planetary Health and One Health. We need a stronger health voice in the conversation, alongside others, such as our youth and faith communities. The sustainable development goals need inner development goals across the whole of society.

BackgroundAfrica is the last region to incorporate family physicians into its health systems. They are still a relatively new concept in many countries, small in numbers and deployed in a variety of ways. There is a need for more evidence on their contribution to African health systems to guide policymakers.AimThe aim of this study was to review the special collection of short reports on the contribution of family physicians to African health systems, published in the African Primary Health Care and Family Medicine Journal in 2021.MethodSeventeen short reports from eight countries were qualitatively and thematically analysed in ATLAS.ti. Codes, which were derived inductively, were organised into categories according to the World Health Organization’s primary health care monitoring framework.ResultsIn the domain of health system determinants, family physicians made little contribution to governance, adjustment to population health needs or financing. They did, however, contribute substantially to the capacity of the health workforce, supply of equipment, functioning of the health information system and use of digital technologies. In the domain of service delivery, they strengthened the model of care and championed systems for improving the quality of care. This translated into improved availability and utilisation of services, core functions of primary care, quality of care and patient safety.ConclusionFamily physicians described their important contribution to service delivery in district hospitals and primary health care. This should lead to improvements in outcomes and impact for the health system. Their contribution to the concept of resilient facilities and health services needs further exploration.

Currently most clinical trial units focus on specific diseases or groups in an approach that mirrors the specialist hospital environment and a verticalised fragmented health system. No Action 1 Strengthen local leadership and national support for sustained infrastructure and funding 2 Enhance engagement with patients, communities and the public in trial life cycle 3 Address barriers to clinical trials in under-represented populations 4 Ensure trials are well designed including adoption of innovative designs and digital technologies 5 Accelerate access to fit-for-purpose training packages for clinical trials 6 Improve coordination and streamlining regulatory and ethics review 7 Engage clinical practitioners to integrate clinical trials into health systems and practices 8 Step up the use of trial registries for research outcome reporting 9 Expand international health research and clinical trial collaboration 10 Identify exemplar trials to monitor how reforms can accelerate generation of quality evidence Primary care has developed many practice-based research networks that could fulfil such a function if adequately resourced and capacitated.8 Such networks have, as a premise, the integration of research into clinical practice and health services. First WHO Global Clinical Trials Forum puts forward a global vision for sustainable clinical research infrastructure [homepage on the Internet].

To explore the interventions for change in oral health behaviour that are effective in improving oral health behaviours in 8 to 18-year-old children during oral health promotion. The Joanna Briggs Institute framework of evidence synthesis for conducting a scoping review was implemented for the methodology. Included studies related to the objective, measured clinical or non-clinical outcomes, were in English, 2011-2023, and were experimental, observational or reviews. PUBMED, Science-Direct, Scopus and Sabinet were systematically searched with predetermined search strings. Studies were selected by appraisal of the title, abstract and full text. Data were extracted using a standardised template and the key questions were addressed via a qualitative analysis. Searches yielded 407 articles from electronic databases. Of these, 290 articles were excluded, and 47 full-text studies were assessed for eligibility, with 23 studies and two systematic reviews finalised for inclusion. In addition, a PEARL search was conducted from the reference lists of other studies. Most studies (91.3%) focused on educating children directly; 8.7% indirectly influenced parents, guardians, and teachers. Interventions focused largely on traditional oral health education presented in diverse forms and via different platforms. Studies differentiated clinical outcomes (indices) from non-clinical outcomes (knowledge, behaviour). All included RCTs were of different quality regarding selection, performance and detection bias. But all studies indicated a low risk of bias in attrition and Reporting bias. Seventeen of the 25 studies (68%) were not based on any behaviour change theory. Oral health interventions based on motivational interviewing and the social cognitive theory have been shown to be to be effective. Interventions could also include practical tooth brushing activities, gamification, audio-visual components, as well as reinforcement and repetition in the longer term. Future oral health promotion in children should be designed to include these elements. There is a need for higher quality studies in this field, with future research being urged to provide detailed intervention descriptions and incorporate longer follow-up periods.

Family medicine should ‘stop talking to ourselves’ and boldly present its ‘value proposition’ to policymakers in the African region. This is the advice of Prof. Nelson Sewankambo at the Primary Care and Family Medicine (PRIMAFAMED) network meeting in Lusaka, June 2025. The African Journal of Primary Health Care and Family Medicine recently published a special collection to reflect on the lessons learnt regarding advocacy for family medicine in sub-Saharan Africa.

No abstract available.No abstract available.

The achievement of the World Health Organization's END TB goals will depend on the successful implementation of strategies for early diagnosis and retention of patients on effective therapy until cure. An estimated 150,000 cases are missed annually in South Africa. It is necessary to look at means for identifying these missed cases. This requires the implementation of active surveillance for TB, a policy adopted by the National Department of Health. To explore the views of managers of the TB program on the implementation of active surveillance for TB in the resource constrained setting of the Eastern Cape, South Africa. A descriptive, explorative, thematically analysed qualitative study based on 10 semi-structured interviews of managers of the TB program. Interviews were transcribed verbatim and analysed using the framework method and Atlas-ti. Active case finding of people attending health facilities was the dominant approach, although screening by community health workers (CHWs) was available. Both government and non-government organisations employed CHWs to screen door to door and sometimes as part of campaigns or community events. Some CHWs focused only on contact tracing or people that were non-adherent to TB treatment. Challenges for CHWs included poor coordination and duplication of services, failure to investigate those identified in the community, lack of transport and supportive supervision as well as security issues. Successes included expanding coverage by government CHW teams, innovations to improve screening, strategies to improve CHW capability and attention to social determinants. A multifaceted facility- and community-based approach was seen as ideal for active surveillance. More resources should be targeted at strengthening teams of CHWs, for whom this would be part of a comprehensive and integrated service in a community-orientated primary care framework, and community engagement to strengthen community level interventions.

Most health care in South Africa takes place in the district health system. In the public sector, this includes primary health care and district hospitals. Although there have been improvements in health and health care, there are still inequities, many instances of poor quality, and weakness regarding community engagement and multisectoral action. Service delivery is currently challenged by budget cuts and loss of resources. Ongoing reforms are needed to improve performance and accommodate the introduction of national health insurance. The deployment of family physicians is an overlooked reform that can improve the model of care, quality, and resilience.

Political will and support is pivotal and will enable the discipline to create the critical mass to place family medicine at the forefront, to reach universal health coverage and contribute to the achievement of the sustainable development goals in sub-Saharan Africa. 1 Family physicians are found in many countries of sub-Saharan Africa, but the numbers can vary from just a handful, as in Zimbabwe, 2 to more than a thousand in South Africa. 3 Their location in the health system can also vary. Some countries, such as South Africa, have seen a competency gap at small and often rural district hospitals that family physicians can fill. 4 Their role in the health system may be that of a clinician and consultant, a capacity builder and clinical trainer or as a leader of clinical governance to improve the quality of care and patient safety. 5 There is some evidence that they have an impact in all these roles, more so than medical officers, and it may be greater in district hospitals. 6 , 7 However, as the scoping review concluded, we need more evidence of their unique contribution to African health systems. What is their contribution to creating high-performing primary healthcare systems and district health services that can lead the way to universal health coverage and the known benefits in terms of health status, responsiveness, equity, resilience and efficiency?

Since the declaration of Alma Ata, community participation in health services has been promoted in making services responsive to the needs of the people. This requires effective community engagement approaches. Community dialogues have been used to engage communities in design, implementation and evaluation of health activities and interventions. This study evaluated the implementation outcomes of a community dialogue intervention that was intended to improve primary care performance in a health sub-district in rural Uganda. This was a mixed methods study using purposively selected key informants and a data collection form. The key informant interviews were conducted in English using a semi-structured interview guide, audio-taped and transcribed verbatim. Qualitative data was analysed using Atlas ti using a framework approach. Quantitative data was entered into an Excel spreadsheet and analysed into frequencies and percentages. Overall, 196 community dialogues were conducted by all 16 primary care facilities, and the average attendance was 32 (range 16-46). They were found to be appropriate, acceptable and affordable and, therefore, adopted. They were feasible and implemented with fidelity, encountered minimal contextual barriers and were thought to be sustainable. Thirteen context factors enabled implementation (e.g. prior existence of regular outreach activities at each health facility), while two were barriers (e.g. community members' expectations of incentives). The intervention reached all the health facilities within the health sub-district at no direct incremental cost. Community dialogues can be implemented through integration at no direct incremental cost and with significant reach to the population served with favourable outcomes.