Search

Background: Basic palliative care teaching should be included in training curricula for health care providers (HCPs) at all levels of the health service to ensure that the goal set by the South African (SA) National Policy Framework and Strategy for Palliative Care, to have an adequate number of appropriately trained HCPs in South Africa, is achieved. Furthermore, palliative learning objectives for nurses and doctors should be standardised. Many SA medical schools have integrated elements of Palliative Medicine (PM) teaching into undergraduate medical training programmes for doctors; however, the degree of integration varies widely, and consensus and standardisation of the content, structure and delivery of such PM training programmes are not yet a reality. Aim: This joint position paper aims to describe the current state of undergraduate medical PM teaching in South Africa and define the PM competencies required for an SA generalist doctor. Setting: Palliative Medicine programme leads and teachers from eight medical schools in South Africa. Methods: A survey exploring the structure, organisation and content of the respective medical undergraduate PM programmes was distributed to PM programme leads and teachers. Results: Responses were received from seven medical schools. Through a process of iterative review, competencies were defined and further grouped according to suitability for the pre-clinical and clinical components of the curriculum. Conclusion: Through mapping out these competencies in a spiralled medical curriculum, the authors hope to provide guidance to medical curriculum designers to effectively integrate PM teaching and learning into current curricula in line with the goals of the SA National Policy Framework and Strategy on Palliative Care (NPFSPC).

Introduction. Influenza-like illness (ILI), Acute Respiratory Infections (ARI), and Severe Acute Respiratory Infections (SARI) are the most common infectious diseases globally, causing severe forms annually, especially in at-risk groups. The aim of this paper is to analyse the epidemiological and virological data on ILI, ARI, and SARI in the Republic of Moldova during the 2014/2015 to 2022/2023 epidemic seasons. Material and methods. The descriptive-retrospective epidemiological study analysed morbidity due to ILI, ARI, and SARI, as well as laboratory results for the presence of influenza viruses during the 2014/2015 to 2022/2023 epidemic seasons. Results. ILI has been of low to medium intensity except for two seasons, while ARI has been of very high intensity in one season. ILI, ARI, and SARI primarily affected children aged 0-14 years. During the nine seasons (except 2020/2021), influenza virus types A(H1N1) pdm09, A(H3N2), and B have been identified, with the percentage of positives decreasing considerably in the last two seasons. During the period under review, each influenza virus type dominated, and in three seasons, two to three virus types co-dominated. Genetic characterization of the identified strains demonstrated that influenza viruses fully fit the phylogenetic tree constructed for the nominated period, do not differ antigenically from strains identified in other regions of the northern hemisphere, and are susceptible to antivirals. Conclusions. The national surveillance system for ILI, ARI, and SARI makes it possible to monitor the evolution of the epidemic process in real-time and geographic space, facilitating prompt intervention with control and response measures.

Introduction. The transition from childhood to adulthood significantly impacts overall health and requires adequate nutrition to facilitate physical and cognitive development. Managing children’s weight and fostering an environment that promotes healthy eating habits are significantly influenced by parents’ knowledge, attitudes, and practices. Material and methods. In February – March 2023, a quantitative study was conducted, involving 472 parents of school-aged children. The questionnaire, developed according to the Knowledge, Attitudes, and Practices methodology, was completed both online, in electronic format, and on paper. Results. The results of the KAP study regarding the nutrition of school-aged children show that parents have a significant level of knowledge (76.9±19.07%) about their children’s nutrition. Regarding attitude, the score is moderate (59.99±10.7%), indicating that parents may not prioritize healthy eating habits for their children or may not be sufficiently motivated to act. However, there is a low level of practice: 45.43±16.6%. Statistical analysis indicates significant correlations between: gender and knowledge (τ=0.175, p

Background: Medicine is a self-regulating profession. Doctors must learn how to self-regulate to keep up-to-date with evolving health care needs. This is challenging for those working at District Hospitals (DHs) in rural settings, where limited resources and understaffing may compound a poor approach and understanding of how to become a self-directed learner. Aim: To explore perspectives of doctors working in rural DHs, regarding their understanding of learning and learning needs. Setting: This study was conducted in Bethesda and Mseleni DHs, in rural KwaZulu-Natal. Methods: This was a qualitative study. Data was collected through 16 semi-structured interviews and non-participatory observations. Results: Four major themes emerged: “Why I learn,” “What I need to learn,” “How I learn,” and our learning environment.” This paper focussed on the first three themes. Doctors’ learning is influenced by various factors, including their engagement with clinical practice, personal motivation, and their learning process. Deliberate practice and engagement in reflective practice as key principles for workplace learning became evident. Conclusion: In rural DHs, doctors need to take a proactive self-regulated approach to their learning due to difficulties they encounter. They must build competence, autonomy, a sense of connection in their learning process, thus recognizing the need for continuous learning, motivating themselves, and understanding where they lack knowledge, all essential for achieving success. Contribution: This article contributes towards strengthening medical education in African rural context, by empowering medical educators and facility managers to meet the learning needs of doctors, thus contributing to the provision of quality health care.

Workplace-based assessment has become increasingly crucial in the postgraduate training of specialists in South Africa, particularly for family physicians. The development of a Portfolio of Learning (PoL) has been a central focus within the discipline of family medicine for over a decade. Initially, a paper-based portfolio was adopted to collect evidence of learning for 50 out of 85 agreed exit-level outcomes. Stellenbosch University led the conversion of this portfolio into an electronic format, known as e-PoL, utilising Scorion software. The e-PoL was successfully implemented in the Western and Eastern Cape regions and was subsequently adopted nationally under the coordination of the South African Academy of Family Physicians. In 2023, the e-PoL underwent a redesign to gather evidence of learning for 22 entrustable professional activities (EPAs). Key insights from this development process underscore the importance of the PoL in supporting assessment-for-learning rather than merely assessment-of-learning. This necessitates features for feedback and interaction, ensuring that the PoL functions beyond a mere repository of forms. Additionally, the e-PoL should facilitate triangulation, aggregation, and saturation of data points to effectively measure EPAs. Furthermore, the PoL has not only documented learning but has also played a pivotal role in guiding the development of clinical training by explicitly outlining expectations for both registrars and supervisors. While the initial design and development costs are significant, operational costs become affordable when shared across all training programmes.

Workplace-based evaluation is one of the most important, but challenging aspects of medical education. The aim was to improve the assessment of the rural community-based clinical training for undergraduate 3rd and 4th year family medicine students at the University of Namibia (UNAM) and implement a paperless process. An online module was developed on the Moodle platform to include a study guide, an electronic portfolio, and electronic resources (e-books and apps) to replace the current paper version of the logbook. We explored local resources by engaging with students and clinical trainers on how to best conduct the initial implementation. Engagement also entailed motivating students to actively participate in the implementation process. All 3rd and 4th year community-based education end service (COBES) students are now submitting proof of clinical learning electronically with the use of their phones in their online portfolio and using online resources. In addition, students in the practical family medicine module that has been introduced in the 6th year since 2023 are now also using an electronic portfolio and these assessment tools. Contribution: Overall feedback from students and supervisors indicates a positive atmosphere of learning and constructive feedback on performance from all team members, hopefully improving work-based assessments and ultimately patient care. More members of the primary health care team were involved and the carbon footprint has also been decreased.

Introduction. Intersectoral collaboration in public health represents a huge potential for optimizing the three fundamental public health actions: disease prevention, health protection, and healthcare awareness. The COVID-19 pandemic has significantly impacted the engagement of the parties particularly interested in disease prevention and control. Material and methods. A mixed qualitative and quantitative research (in-depth interviews/questionnaire survey) was carried out in this paper. Results. Most of the respondents assessed the intersectoral cooperation as unsatisfactory and consider that the latest reform of the Public Health Service had a negative impact on it. The pandemic alert caused by the COVID-19 infection served as a catalyst to improve cooperation. The main barriers to collaboration are considered the lack of staff and insufficient communication, various viewpoints and lack of public health knowledge, an overlying complex legal framework, and lack of motivation, which often requires central authority involvement. Conclusions. Some barriers to cooperation can be overcome without any systemic changes and centralized involvement, while more easily achievable measures such as joint training are sufficient. Thus, understanding these aspects can greatly improve the interaction between services.

# Purpose Flammer syndrome (FS), a clinical entity characterized by primary vascular dysregulation of blood flow together with various signs and symptoms, has been reported in both healthy individuals and those with certain diseases. Adequate management of FS requires personalized treatment and preventive measures. In the field of aesthetic medicine, proper regulation of blood flow is crucial for optimal wound healing. This study aims to investigate the prevalence of FS signs and symptoms among individuals seeking aesthetic intervention. # Methods A total of 207 patients seeking aesthetic intervention at the Beauty2Go clinic in Lucerne answered a standardized questionnaire consisting of 15 signs and symptoms of FS. # Results Overall, 189 (91.3%) patients were female and 18 (8.7%) were male. The mean age was 36.0 years (standard deviation \[SD\] 12.1) and the median age was 35.0 years (interquartile range \[IQR\]: 14.0−67.0). Several signs and symptoms of FS were present among patients undergoing aesthetic surgery. Compared to a control group patients showed a higher tendency towards cold hands (25.1% \[95% confidence interval \[CI\]: 19.5--31.7\]), feeling cold (21.7% \[95% CI: 16.4--28.1\]) and low blood pressure (27.3% \[95% CI: 21.0--34.7\]). Other signs and symptoms included Increased response to certain drugs (8.4% \[95% CI: 4.8--14.3\]) a low Body Mass Index (BMI) (58.0% \[95% CI: 50.9--64.7\]), Reversible skin blotches (7.2% \[95% CI: 4.3--11.9\]) and a tendency towards perfectionism (53.6% \[95% CI: 46.6--60.5\]). Accompanying symptoms of migraines were lower in the patient group (5.0% \[95% CI: 2.2--10.4\]) than in the control group. # Conclusions The prevalence of FS is notable among individuals seeking aesthetic interventions. Acknowledging this fact not only enables the treatment of FS in patients but also empowers the field of aesthetic medicine to devise proactive strategies for enhancing blood flow regulation through personalized treatment in this population. This research paper emphasizes the significance of identifying FS in the context of aesthetic procedures and highlights the potential benefits of personalized preventive treatments.

Introduction. Sugar consumed in reasonable quantities plays a beneficial role for the human body. In recent decades, however, it has been found that increased sugar consumption has negative effects on the health of the population. Material and methods. The paper presents a synthesis of official international and national documents and bibliographic sources on the occurrence of certain non-communicable diseases (NCDs) as a result of excessive sugar consumption. A focused search of literature sources was conducted using the Google Scholar search engine, PubMed, Research for Life, and Medline databases. The criteria for selecting the items included health problems caused by excessive sugar consumption. Results. Excessive sugar consumption contributes to the emergence of various NBTs such as circulatory system diseases, type 2 diabetes and a. Excessive sugar consumption has a major contribution to the phenomenon of overweight and obesity with its consequences. Excess sugar in the daily diet is one of the main causes of tooth decay. According to WHO recommendations, complex, multi-sectoral interventions are needed to reduce sugar consumption. Conclusions. In order to prevent NCDs associated with the nutritional factor, especially with excessive sugar consumption, in the Republic of Moldova, it is important to implement cost-effective interventions both socially and economically.

Introduction. The risk factors for multiple sclerosis (MS) and cancer overlap to a large extent. The objective of our study was to estimate the prevalence and risk ratios (RR) of cancers in patients with MS and to identify which types of cancer have the lowest frequency. Materials and methods. We carried out research of the literature in the PubMed, Medline, and Google Academic databases, with the aim of identifying large-scale studies addressing the link between different cancers and MS. From 411 relevant articles, we selected 13 scientific papers for further analysis, comprising 109,276 patients diagnosed with MS from different countries. Results. Of all MS patients, 5.1% were diagnosed with a certain type of cancer compared to 5.5% in the general population; the cancers with the lowest incidence were respiratory, digestive, and blood cancers. Conclusions. The results of our analysis suggested that MS patients are less exposed to respiratory, digestive, and blood cancers, but more research is needed to understand if some disease-modifying therapies play a role in this regard.

Introduction. Antimicrobial resistance (AMR) is a major problem with a negative impact on animal health and public health worldwide. Actions to reduce this phenomen are of major importance and require collective management in the context of "one health". Material and methods. The research material constituted the legislative acts that regulate the activity of the veterinary sanitary service within the National Agency for Food Safety, statistical data regarding the use of antimicrobial in the animal population from the republic. Results. The analysis of the data presented in the paper is focused on the legal acts of activity of the veterinary service in order to reduce the effect of RAM at the national level with the involvement of the authorities in the field of human and animal health, as well as environmental protection. Conclusions. The reduction of AMR at the national level can be achieved by creating an institutional framework responsible for intersectoral coordination and collaboration as well as the effective implementation of control of the release of animal medicaments only on the basis of veterinary prescriptions.

Background: Community health worker (CHW) programmes, when adequately integrated into mainstream health systems, can provide a viable, affordable and sustainable path to strengthened health systems that better meets demands for improved child health, especially in resource-constrained settings. However, studies that report on how CHW programmes are integrated into respective health systems in sub-Saharan Africa (SSA) are missing. Aim: This review presents evidence on CHW programmes’ integration into National Health Systems for improved health outcomes in SSA. Setting: Sub-Saharan Africa. Method: Six CHW programmes representing three sub-Saharan regions (West, East, and Southern Africa) were purposively selected based on their deemed integration into respective National Health Systems. A database search of literature limited to the identified programmes was then conducted. Screening and literature selection was guided a scoping review framework. Abstracted data were synthesised and presented in a narrative form. Results: A total of 42 publications met the inclusion criteria. Reviewed papers had an even focus on all six CHW programmes integration components. Although some similarities were observed, evidence of integration on most CHW programme integration components varied across countries. The linkage of CHW programmes to respective health systems runs across all reviewed countries. Some CHW programme components such as CHW recruitment, education and certification, service delivery, supervision, information management, and equipment and supplies are integrated into the health systems differently across the region. Conclusion: Different approaches to the integration of all the components depict complexity in the field of CHW programme integration in the region. Contribution: The study presents synthesized evidence on CHW programmes integration into national health systems in SSA.

Background: In resource limited-settings, timely tuberculosis (TB) diagnosis depends upon referral of sputum samples from non-diagnostic to diagnostic facilities for examination. The TB programme data for 2018 suggested losses in Mpongwe District’s sputum referral cascade. Aim: This study aimed to identify the referral cascade stage where loss of sputum specimen occurred. Setting: Primary health care facilities in Mpongwe District, Copperbelt Province, Zambia. Methods: Data were retrospectively collected from one central laboratory and six referring health facilities between January and June 2019, using a paper-based tracking sheet. Descriptive statistics were generated in SPSS version 22. Results: Of the 328 presumptive pulmonary TB patients found in presumptive TB registers at referring facilities, 311 (94.8%) submitted sputum samples and were referred to the diagnostic facilities. Of these, 290 (93.2%) were received at the laboratory, and 275 (94.8%) were examined. The remaining 15 (5.2%) were rejected for reasons such as ‘insufficient sample’. Results for all examined samples were sent back and received at referring facilities. Referral cascade completion rate was 88.4%. Median turnaround time was six days (IQR = 1.8). Conclusion: Losses in the sputum referral cascade for Mpongwe District mainly occurred between dispatch of sputum samples and receipt at diagnostic facility. Mpongwe District Health Office needs to establish a system to monitor and evaluate the movement of sputum samples along the referral cascade to minimize losses and ensure timely TB diagnosis. Contribution: This study has highlighted, at primary health care level for resource limited settings, the stage in the sputum sample referral cascade where losses mainly occur.

Introduction. According to the European Association of Urology guidelines, flexible ureterorenoscopy is one of the treatment modalities for kidney stones less than 2 cm. Disposable flexible ureterorenoscopes are superior to reusable ones in terms of scope performance deterioration, damage repair costs and special gas-sterilization equipment. Despite the undeniable progress of disposable flexible ureterorenoscopes in everyday urological practice, the literature lacks a rich database on their technological design and clinical effectiveness. The objective of this paper is to present our experience in the management of kidney stones by a flexible disposable ureteroscope – WiScopeTM. Material and methods. Between the 1st of January 2020 –the 1st of January 2021, 76 patients with kidney stones were treated in our centre by flexible ureteroscopy and laser lithotripsy. The evaluation of demographics, efficacy and safety of the procedure was performed. Results. A successful procedure was recorded in 94.7% (72/76) of the patients. We evaluated the total stone-free rate 8 weeks after the intervention, which was 94.4% (70/72). The complications rate was 13.1% (10/76). No serious adverse events were observed. Conclusions. The use of flexible disposable ureteroscopes has proven a good efficacy and safety. WiScopeТМ is a comparable option among all available flexible disposable ureteroscopes, in terms of all basic characteristics.

The ongoing pandemic of COVID-19 is causing more health, economic and social issues worldwide. As of July 5, 2021, the world registered more than 184 million cases across 222 countries; more than 4 million have died from the deadly infection. The SARS-CoV-2 continues spreading globally; new variants emerge randomly due to errors in the virus' gRNAs replication process. The present paper treats the new delta variant of concern, also known as B.1.617.2 lineage. The study highlights transmissibility, vaccine effectiveness, pathogenicity, and the likelihood of hospital admission related to delta variant infection based on a literature review of 10 indexed databases. The findings indicate high transmissibility of the B.1.617.2 lineage, approving it to be the dominant strain worldwide. Also, reduced vaccine effectiveness is confirmed. However, approved vaccines for emergency use remain valuable against COVID-19's delta variant. Finally, the risk of hospitalization seems to be twice in the case of delta variant infection. A combined approach of vaccination and nonpharmaceutical interventions is the leading way to contain the ongoing pandemic of COVID-19.

Considered as signum of poisoning by treatises on poisons written in Western Late Medieval Europe, colour takes also place among the skills that help preserving from poisoning because some stones are seen as able to reveal the presence of poison by changing or losing its colour when they are put on table, near-by plates or glasses. From several specialized texts and books of natural philosophy, this paper aims to know how the authors explained chromatic changes of stones in front of poison, if they believed in it and if their advices were heard and followed in late medieval courts.

In the present paper we focus on the comparison between medical language present in the narrative of some Italian writers: Antonio Tabucchi, Umberto Eco, Oriana Fallaci, Elena Ferrante, Dino Buzzati and fragments of medical reports that deal with the respective medical problems observed in the analysed novels/short stories: Il tempo invecchia in fretta, La misteriosa fiamma della regina Loana, Il cappello pieno di ciliege, La storia del nuovo cognome, Sette piani. With the comparative analysis of stylistically distant passages, we intend to indicate common points in the use of the Italian medical language both in the scientific and literary fields, as well as identify divergent linguistic aspects in the representations of this reality. We also intend to demonstrate the need to understand various narrative modes at different levels of specialized language. Despite different narrative modes, the essence of the phenomenon itself is not lost. There is also a common space in which meet various representations of the subjective truth that exists regardless of the language.

This paper examines how different institutions (medicine, family, state) govern the bodies of children with variations in sex development. In the continuity of the work on governmentality and the government of bodies, sexualized bodies are apprehended as a site of the exercise of power through the regulation, surveillance and control to which they are subjected. Issues of consent and individualized self-constraint that have become central to the practice of governing bodies are absent from contemporary modes of governing variations in children’s sex development. The article shows how medicine exerts a strong external constraint on the bodies of children with variations in sex development, and how parents occupy an intermediary place at once dominated by the medical institution but dominant vis-à-vis their child whom they represent and in whose place they decide.

Background: The family planning service requires a routine health information system (RHIS) that can produce quality data that will be used for making decisions. However, the quality of data generated is not always of a good standard. Its usefulness in making data-driven decisions in family planning service is questionable. Aim: The study intended to assess the quality of family planning data and determine healthcare providers’ (HCPs’) views on factors influencing data quality in Tshwane district. Setting: The study was carried out in 13 healthcare institutions in Tshwane district, Gauteng province, South Africa. Methods: This paper reports on the quantitative strand of a mixed methods study. A sample of 111 HCPs was selected through a stratified random sampling technique, and six months of monthly reports from 13 institutions were reviewed for data quality. A self-administered questionnaire and a tick sheet were utilised to collect data from the HCPs and to review monthly reports for data quality, respectively. The Statistical Package for the Social Sciences (SPSS) programme for Windows version 24.0.0 was used to analyse the data. Results: Data quality, mainly accuracy and timeliness, was a challenge. Many HCPs were not trained in the RHIS. They viewed several issues relating to organisational, behavioural and technical factors as barriers to data quality. Conclusion: The low quality of family planning data has a negative impact on policy development and decision-making. Contribution: There is a need for capacity building through training and supportive supervision, provision of adequate human and technical resources to enhance data quality and use of information for decision-making.

Background: The coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane’s Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response. Aim: To describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal. Setting: Three community-based COSUP sites in Mamelodi (Tshwane, South Africa). Methods: A retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data. Results: Of the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eight (26%) people participated, amongst whom most were male (n = 55, 95%). Participants’ median age was 32 years. Most participants injected heroin (n = 36, 62.1%). Most participants experienced at least one side effect (n = 47, 81%) with 37 (64%) experiencing two or more side effects from tramadol. Insomnia occurred most frequently (n = 26, 45%). One person without a history of seizures experienced a seizure. Opioid withdrawal symptoms were experienced by 54 participants (93%) whilst taking tramadol. Over half (n = 38, 66%) reported using less heroin whilst on tramadol. Conclusion: Tramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists. Contribution: This research contributes to the limited data around short-acting tramadol for opioid withdrawal management in the African context, with specific focus on the need for increased access to opioid agonists for those who need them, in primary care settings.

Background: Although there is evidence of the key role played by focusing on local knowledge in designing appropriate interventions regarding modifiable risk behaviours among patients living with diabetes and hypertension in Mangochi (and Malawi), little is known about local salient beliefs. Aim: With a focus on the theory of planned behaviour as a theoretical lens, this study aimed to identify salient beliefs about modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, south-eastern Malawi. Specifically, the objectives were to identify advantages and disadvantages (behavioural salient beliefs), people who approve or disapprove (normative salient beliefs) and enablers and barriers (control salient beliefs) for measures to change modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, Malawi. Setting: A hypertension diabetes clinic at Mangochi District Hospital, south-eastern Malawi. Methods: A formative qualitative study of a quasi-experimental trial was conducted among 25 patients, purposefully sampled, who were living with diabetes, hypertension or both at Mangochi District Hospital in February 2019. Researchers conducted in-depth interviews with patients using an interview guide informed by the theory of planned behaviour’s elicitation interview guide. Thematic content analysis was used to identify emerging themes. Results: A total of 25 participants were recruited, of which 12 (48%) were living with diabetes. Five thematic areas emerged from this analysis: physical and psychological fitness, social disconnection, perceived support systems, perceived enablers and perceived barriers to change. Conclusion: Appropriate words for each salient belief were identified. Future researchers should use the identified salient beliefs when designing interventions based on the theory of planned behaviour in diabetes and hypertension. Contribution: The paper adds to the body of knowledge informing the use of theory of planned behavior in addressing modifiable risk factors among practitioners, specialists and academics in primary care and Family Medicine in the field of noncommunicable diseases in Mangochi Malawi and beyond.

Reports of women giving birth to a baby together with an animal (toad, mouse, bird, etc.), are documented in Europe from the 1100s onwards: the most important traditions of which are the frater Salernitanorum and the sooterkin. Throughout the centuries, authors have typically attempted to explain monstrous animal siblings in the light of contemporary medical knowledge. The present paper compares the medieval frater Salernitanorum with the later sooterkin and investigates both in historico-folklore terms. It argues that it is important to understand monstrous birth traditions not only in the light of medical history, but as beliefs and narratives actively shared through acts of communication. In so doing, this article is informed by both the history of medicine and folklore studies.

The first-line physicians’ practice in Kisangani city in Democratic Republic of Congo: Towards a typology. Background: In the Democratic Republic of the Congo (DRC), for a number of years, there has been a spontaneous and growing phenomenon of physicians operating at the front line of the health system, while this role is traditionally devolved to nurse-practitioners. This phenomenon does not align with the current health policy. Aim: The aim of this paper is to develop and discuss the main types of frontline physicians in the city of Kisangani. Setting: We conducted a descriptive cross-sectional study in two urban districts in the city of Kisangani. Methods: The study population consisted of all first-line health facilities that employed at least one physician. The construction of a typology of first-line physicians consisted of three stages: identification and definition of relevant dimensions of analysis; grouping cases based on empirical data; and analysis of significant relationships and establishment of the typology itself. Results: An involvement of physicians in healthcare delivery at the first line was observed in 60% of all first line facilities in the two urban districts. Two main types of first-line physicians were identified: firstly, and by large the most prevalent one (96% of cases), the ‘hospital-like physician’, and secondly, the much less frequent type of the ‘supervision physician’. Conclusion: The involvement of physicians in first line healthcare is today a growing phenomenon in the DRC, especially in urban areas. The most dominant expression of this phenomenon is a transposition of the hospital-based physician model to the first line healthcare services, which thereby jeopardizing the specificity of first line healthcare.