The perceived impact of family physicians on the district health system in South Africa: a cross-sectional survey

Abstract

BackgroundEvidence from first world contexts support the notion that strong primary health care teams contain family physicians (FPs). African leaders are looking for evidence from their own context. The roles and scope of practice of FPs are also contextually defined. The South African family medicine discipline has agreed on six roles. These roles were incorporated into a family physician impact assessment tool, previously validated in the Western Cape Province.MethodsA cross-sectional study design was used to assess the perceived impact of family physicians across seven South African provinces. All FPs working in the district health system (DHS) of these seven provinces were invited to participate. Sixteen respondents (including the FP) per enrolled FP were asked to complete the validated 360-degree assessment tool.ResultsA total number of 52 FPs enrolled for the survey (a response rate of 56.5%) with a total number of 542 respondents. The mean number of respondents per FP was 10.4 (SD = 3.9). The perceived impact made by FPs was high for five of the six roles. Co-workers rated their FP’s impact across all six roles as higher, compared to the other doctors at the same facility. The perceived beneficial impact was experienced equally across the whole study setting, with no significant differences when comparing location (rural vs. metropolitan), facility type or training model (graduation before and ≥ 2011).ConclusionsThe findings support the need to increase the deployment of family physicians in the DHS and to increase the number being trained as per the national position paper.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0710-0) contains supplementary material, which is available to authorized users.

Reflections on family medicine and primary healthcare in sub-Saharan Africa

“…In Nigeria, however, it appears that family physicians are deployed at all levels of the healthcare system, including tertiary and referral hospitals. Despite this apparent confusion, there is a consensus on the role of family medicine in Africa and evidence of their early impact 23 24. Family physicians though remain a scarce resource and there are few academic departments, which mainly focus on training and have little research output.…”

A scoping review on family medicine in sub-Saharan Africa: practice, positioning and impact in African health care systems

“…There is a clear perception among co-workers that FPs in South Africa are making an impact on quality of care and population health status [62]. In instances where FPs have functioned well, the PHC team has begun to function more coherently [62].…”

“…There is a clear perception among co-workers that FPs in South Africa are making an impact on quality of care and population health status [62]. In instances where FPs have functioned well, the PHC team has begun to function more coherently [62]. Reflections from district managers suggest that FPs make a significant impact on the quality of clinical processes and health system performance [63].…”

Improving the quality of clinical training in the workplace: implementing formative assessment visits

“…Family physicians, with additional postgraduate training to become specialists in family medicine, can improve the quality of primary and district level care, when they are part of healthcare teams. 2,3 Family physicians accomplish this through their roles as clinicians, consultants, capacity builders, clinical trainers, leaders of clinical governance and supporters of community-orientated primary care. 4 The medium-term goal is to have a family physician at every district hospital, community health centre and sub-district in South Africa.…”