Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa

Abstract

Background: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS) of the Western Cape.Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method.Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, non-communicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers.Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.Evaluation de l'impact des médecins de famille dans le système de santé du district du Western Cape, en Afrique du Sud.Contexte: En 2007, l'Afrique du Sud a institué une nouvelle spécialité, la médecine de famille. Les médecins de famille qui se sont spécialisés dans cette nouvelle discipline sont employés dans le système de santé de district depuis 2011. L'objet de cette étude était d‘étudier les perceptions des gestionnaires de district sur l'impact que les des médecins de famille avaient sur les processus cliniques, la performance du système de santé et les résultats des systèmes de santé des districts (DHS) du Western Cape.Méthodes: On a effectué neuf entrevues approfondies: sept avec les gestionnaires de district et deux avec les directeurs principaux du DHS rural et métropolitain. On a enregistré, transcrit et analysé les entrevues en utilisant ATLAS-ti et la méthode de structure.Résultats: Il y a eu un effet positif sur les processus cliniques du VIH et/ou du SIDA, la Tuberculose, le traumatisme, les maladies chroniques non-contagieuses, la santé mentale, et la santé de la mère et de l'enfant. La performance du système de santé a été positivement affectée en termes d'accès, coordination, exhaustivité et efficacité. On s'attendait à un impact sur les résultats en matière de santé. L'impact n’était pas uniforme dans toute...

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