Sub-Saharan Africa is probably the region with the worst health indices in the region. Although health problems in this region are largely preventable through a good primary health care system, efforts to implement such a system have not been so successful and neither have reforms suggested by the World Bank. However, there are new efforts to improve delivery of health care by introducing family medicine in the region through decentralized health care systems. Uganda is at the forefront of these efforts, and ways to integrate family physicians into the health system are still being debated. This paper reviews the potential role of family medicine/general practice in the health care systems of sub-Saharan Africa and in Uganda in particular and offers suggestions based on successes made in other countries.