Globally there is a need for well-trained primary health care physicians at the district level. Physicians who focus on ambulatory care will be in greater demand in addressing the global burden of chronic disease and multi-morbidity, which are on the increase in Africa. Not surprisingly, family medicine has grown stronger on the African continent in the past decades.1,2,3 In Rwanda, education of health professionals has recently undergone several changes. Postgraduate training in medical and surgical specialties has been further developed in a constructive and inclusive way with support of American universities.4 Although postgraduate training in family and community medicine has been temporarily halted, the need to develop and enhance undergraduate training in social and community medicine was identified and efforts have since commenced. This raises the question whether postgraduate training was developed too early, at a time when undergraduate training did not yet embrace the concept of primary health care.

Rwanda is a small, landlocked, low-income country in central East Africa and the most densely populated country on the continent.5 The majority of the population live in rural areas. The 2010 Demographic Health Survey showed dramatic gains in life expectancy, although infectious diseases were still the leading cause of death.6 Chronic non-communicable diseases are on the rise and presently constitute 25% of Rwanda's burden of disease, which makes the need for chronic care urgent.7

At present Rwanda has four national referral hospitals, over 40 district hospitals and about 450 health centres. In addition, approximately 45 000 community health workers provide health promotion activities as well as preventive and curative care to rural communities.8,9 Faced with a similar shortage of health workers as in other African countries, Rwanda has successfully embarked on pre-service and in-service training programmes at all levels of care delivery.