Jordan has been committed to achieving UHC for over thirty years. As the cornerstone of UHC, Primary Health Care (PHC) should be the first level of contact that people have with the health system. This is where individuals, families, and communities receive most of their health care including promotion, prevention, treatment, rehabilitation and palliative care as close as possible to where they live and work. At its heart, PHC is about caring for people and helping them improve their health or maintain their well-being, rather than just treating a single disease or condition. It is for this reason that the Ministry of Health in Jordan decided to strengthen the role of family doctors.

Challenges facing Jordan’s health sector

A 2015 census revealed that 55% of the whole population is covered by health insurance, rising to 68% among Jordanian citizens. However, public expenditure on primary health care is only 16% of total public expenditure on health.

Jordan’s health system faces increasing pressure as a result of the conflict in neighbouring Syria and an influx of displaced persons. The already limited resources are severely strained; health facilities are overloaded; health workers are insufficient in number; and the health sector infrastructure cannot cope with increasing demand.

Family doctors, or general practitioners GPs) are fundamental to deliver primary health care to communities to promote healthy lifestyles and provide treatment. Yet the number of doctors per 10,000 people has fallen from 28.5 before the Syrian crisis, to 22.6 in 2017. Another significant burden on the health system is the increasing rate of non-communicable diseases within the population.

At its heart, PHC is about caring for people and helping them improve their health or maintain their well-being, rather than just treating a single disease or condition.

Family Medicine Online Diploma

In order to achieve UHC by 2030, Jordan needs to invest in a good number of family doctors that will delivery quality and safe services to communities and take primary health care to a higher level. In April 2019, the Ministry of Health (MoH) in Jordan, in cooperation with WHO, launched the Family Medicine Online Diploma which aims to train GPs to deliver better primary health care services.

"Training GPs is very important to provide quality, evidence-based updated services. It will resolve many of the health issues that the MoH faces like overcrowded clinics, shortage of preventive services, overcrowded secondary and tertiary care clinics. Also the training will improve health awareness of community members through increasing their knowledge about GPs,” said a Family Medicine programme coordinator at Jordan’s MOH.

"One of the major health issues that MOH face is the increasing burden of non-communicable diseases, which needs the cooperation of all parties to manage and prevent them. Having GPs equipped with evidence-based knowledge will also add a lot to the NCD programme,” said a Family Medicine programme coordinator at Jordan’s MoH.

A national multi-stakeholder team comprising experts from the Ministry of Health, academia and the private sector initially developed a six-month course and following a review, decided to extend the course to 12 months. The programme consists of a hybrid of online and face-to-face training to improve the knowledge, attitudes and practice of GPs. The GPs have two face-to-face on-the-job trainings per month, four online skype meetings per month, and one quarterly meeting. The GPs must also read about two topics each week. A key part of the training is to support GPs to establish a family health team including nurses to provide a coherent approach to primary health care delivery.

Impact of training

Several evaluation tools were developed to monitor the training’s impact over time and to evaluate the changes in GPs’ knowledge, attitude and practice. Preliminary data analyses showed positive changes in all these areas, and in many health indicators. For example, the percentage of referrals has fallen and antibiotic prescriptions have declined. A test to assess GPs’ knowledge showed an 85% success rate, compared with about 45% in the initial baseline evaluation. The assessment of on-the-job training for the development of communication and counselling skills showed a 20% improvement. GP attendance rate of online sessions reached 95%, showing the extent of their commitment to the training.

"The diploma training has changed a lot in our outlook to the patients and disease. We have become more patientcentred and are more capable of prescribing drugs and offer counselling to patients. I feel more confident to make a follow-up of chronic diseases, and I know more about psychological disease and psychosomatic disorders,” said a General Practitioner in Jordan.

"Doctors look more confident and have more precision in decision making. They are more patient-centred in their practice, instead of disease-centred,” said Dr. Amjad AlShdaifat, Assistant Professor College of Medicine, Hashemite University, Jordan.

Through supporting GPs to improve their practice at primary healthcare facilities, the Ministry of Health is taking steps to achieve UHC. Although much more needs to be done, it is an indication of the MoH’s commitment to health for all, and to solidarity and action for UHC.