The views of family physicians on National Health Insurance in Gauteng Province, South Africa

Abstract

Background Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI. Methods This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling. Results Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level. Conclusion Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level. Contribution This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level.

The exceptional potential in extending primary care exposure for South African medical interns

“…Family physicians are vital in working with stakeholders to strengthen working conditions and governance in South Africa's healthcare system to retain these highly skilled professionals post-internship, especially with the national commitment to universal health coverage. 9,10 This message resonates with the interns' call for further research and improvement of the internship model to 'prepare us sufficiently for community health service, strengthen our health system and ultimately achieve health for all those we serve in our communities'. 2…”