Sub-Saharan Africa has the highest global burden of disease and the lowest number of health workers per population. In a resource-constrained environment like this, a focus on primary healthcare (PHC) is most likely to impact on the health of the population and to be cost-effective. Medical generalists have the competences needed in the multidisciplinary team to build a strong PHC system. However, in many African countries, PHC is the weakest part of the healthcare system, which often focuses on a limited number of priority conditions that are addressed through fragmented vertical programmes offered by health workers with limited training, skills and support.