Appropriateness and acceptability of family medicine service in a locality of Karachi, Parkistan

Family physicians, who are well trained generalists could help to integrate the currently fragmented levels of the health care system. However, there is limited information available about the acceptability, viability and appropriateness of Family Medicine practice by the people of Pakistan. Utilizing the scientific skills of field-base epidemiology, we conducted a random survey proportionate to population density in an urban community of Karachi to explore the current health seeking patterns and attitude towards a Family Medicine program. A total of 456 households encompassing a population of 2731 were surveyed from January to February, 1994. Out of 250 persons (9%) who were ill at the time of survey, 213 (85%) suffered from diseases of more than 6 weeks duration. Of those who were ill 126 (50%) went to private outpatient clinic, out of which 50 (40%) went to a general practitioner and 63 (50%) to a specialist. The mean consulting fee for an acute illness (<6 weeks duration) per visit was Rs. 232 and that for a chronic illness (>6 weeks duration) was Rs 500. Among the 456 interviewed households, 433 (95%) showed a willingness to utilize the Family Medicine Service while 273 (60%) agreed to Rs 75-100 being the appropriate fee for a visit. Four most important services, in order of priority, desired by the residents from the Family Medicine program were 24 hours curative care, laboratory investigations like urine testing, treatment for infectious diseases and immunization for children less than five years. We conclude that in the absence of integrated health care at Garden, a service like Family Medicine will be acceptable and appropriate to its needs and envision its economic sustainability.