The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study

Pressentin, Klaus B. von; Mash, Robert; Baldwin-Ragaven, Laurel; Botha, Roelf Petrus Gerhardus; Govender, Indiran; Steinberg, Wilhelm Johannes; Esterhuizen, Tonya

doi:10.1370/afm.2133

Cited by 21 publications

(25 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This article re-analyses data that were collected for a cross-sectional analytical observational study that compared the performance of facilities with and without family physicians in seven of the nine provinces in South Africa. 19 The previous study, however, did not analyse or report on all the available PCAT data to give an overall picture of primary care performance. The aim of this study, therefore, was to use the existing data to report on the performance of primary care in South Africa.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the performance of South African primary care: a cross-sectional descriptive survey

Bresick

Pressentin

Mash

2019

South African Family Practice

View full text Add to dashboard Cite

In 2018 governments reaffirmed their commitment to implementing primary health care (PHC) in the Astana Declaration. South Africa has introduced a number of health reforms to strengthen PHC and enable universal health coverage (UHC). UHC requires access to quality primary care and progress needs to be measured. This study aimed to evaluate the quality of South African primary care using the Primary Care Assessment Tool (PCAT). Methods: A descriptive cross-sectional survey used data derived from a previous analytical observational study. Data from 413 patients, 136 health workers and 55 managers were analysed from 30 community health centres across four provinces of South Africa. Scores were obtained for 10 key domains and an overall primary care score. Scores were compared in terms of respondents, provinces and monthly headcount. Results: Patients rated first contact accessibility, ongoing care and community orientation as the poorest performing elements (< 50% scoring as 'acceptable to good'); first contact utilisation, informational coordination and family-centredness as weaker elements (< 66% scoring as 'acceptable to good'); and comprehensiveness, coordination, cultural competency and availability of the PHC team as stronger aspects of primary care (≥ 66% or more scoring as 'acceptable or good'). Managers and providers were generally much more positive about the performance of PHC. Conclusion: Gaps exist between PHC users' experience of care and what PHC staff believe they provide. Priorities to strengthen South African primary care include improving access, informational and relational continuity of care, and ensuring the implementation of community-orientated primary care. The PCAT is a useful tool to measure quality of primary care and progress with UHC.

show abstract

Section: Introductionmentioning

confidence: 99%

Evaluating the performance of South African primary care: a cross-sectional descriptive survey

Bresick

Pressentin

Mash

2019

South African Family Practice

View full text Add to dashboard Cite

show abstract

“…They also have been able to broaden the scope of practice as they received a comprehensive training, covering biomedical, psychological and social issues. As a result of the improved quality and scope of practice, FPs may have impacted on referral rates and enabled more patients to be managed in the district, saving money at other levels [31]. This also saved patients time and money, as previously people would have had to travel to a referral hospital [39].…”

Section: Key Question 2: What Evidence Exists For the Effectiveness Amentioning

confidence: 99%

“…As clinical trainers, they provided training and supervision to the resident FPs, interns and medical students. As leaders of clinical governance, they led the 5 Roles and competencies expected of a family physician in South Africa [31] teams in improving quality of care and patient safety, while as champions in COPC they supported the PHC teams in engaging with local communities to improve population health [15,39,71]. In West Africa, FM roles included PHC that could be in the home or primary care facility, with a focus on family-oriented primary care as well as in secondary or tertiary care hospitals [40,72].…”

Section: Key Question 5: What Roles Do Family Physicians Play In Sub-mentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

Background: Family medicine (FM) is a relatively new discipline in sub-Saharan Africa (SSA), still struggling to find its place in the African health systems. The aim of this review was to describe the current status of FM in SSA and to map existing evidence of its strengths, weaknesses, effectiveness and impact, and to identify knowledge gaps. Methods: A scoping review was conducted by systematically searching a wide variety of databases to map the existing evidence. Articles exploring FM as a concept/philosophy, a discipline, and clinical practice in SSA, published in peer-reviewed journals from 2000 onwards and in English language, were included. Included articles were entered in a matrix and then analysed for themes. Findings were presented and validated at a Primafamed network meeting, Gauteng 2018. Results: A total of 73 articles matching the criteria were included. FM was first established in South Africa and Nigeria, followed by Ghana, several East African countries and more recently additional Southern African countries. In 2009, the Rustenburg statement of consensus described FM in SSA. Implementation of the discipline and the roles and responsibilities of family physicians (FPs) varied between and within countries depending on the needs in the health system structure and the local situation. Most FPs were deployed in district hospitals and levels of the health system, other than primary care. The positioning of FPs in SSA health systems is probably due to their scarcity and the broader mal-distribution of physicians. Strengths such as being an "allround specialist", providing mentorship and supervision, as well as weaknesses such as unclear responsibilities and positioning in the health system were identified. Several studies showed positive perceptions of the impact of FM, although only a few health impact studies were done, with mixed results. Conclusions: FM is a developing discipline in SSA. Stronger evidence on the impact of FM on the health of populations requires a critical mass of FPs and shared clarity of their position in the health system. As FM continues to grow in SSA, we suggest improved government support so that its added value and impact on health systems in terms of health equity and universal health coverage can be meaningfully explored.

show abstract

“…Family medicine is making a valuable contribution to strengthening district health services in several countries in sub-Saharan Africa and has published a consensus statement on the role of the family physician. 1 , 2 , 3 , 4 , 5 , 6 Although the roles of the family physician differ between countries and are still debated, it is clear that in Africa, the family physician often works at the district hospital as well as in primary care teams. 7 , 8 , 9 Their roles are often different from that of family physicians in more highly resourced countries and they are seldom the first point of contact, which is usually with a nurse or clinical officer.…”

Section: Introductionmentioning

confidence: 99%

The state of family medicine training programmes within the Primary Care and Family Medicine Education network

Pressentin

Besigye

Mash

et al. 2020

African Journal of Primary Health Care & Family Medicine

Self Cite

View full text Add to dashboard Cite

The 2019 Primary Care and Family Medicine Education network (Primafamed) meeting in Kampala, Uganda, included a workshop that aimed to assess the state of postgraduate family medicine training programmes in the Primafamed network. Forty-six people from 14 African and five other countries were present. The evaluation of programmes or countries according to the stages of change model was compared to a previous assessment made 5 years ago. Most countries have remained at the same stage of change. Two countries appeared to have reversed their readiness to change as Rwanda moved from relapse to pre-contemplation and Mozambique moved from action to contemplation. Malawi, Zambia and Zimbabwe increased their readiness to change and moved from contemplation to action. Countries in the region remain quite diverse in terms of their commitment to family medicine training. Within Primafamed, it is possible for countries with a more advanced stage of change to assist countries with an earlier stage. Primafamed is also supported by a variety of partners outside of Africa. Five years after the previous country-level assessment, family medicine in Africa continues to span across all levels of the stages of change model. Stage-matched interventions aligned with the needs of individual countries should follow. Consequently, this workshop report will serve as a mandate and compass for Primafamed’s actions over the next few years, aimed at designing and delivering these interventions. As reiterated in the 2019 Kampala commitment, we should continue developing the discipline of family medicine (the medical ‘specialty’ of primary care), through alignment of our training programmes to the health needs in the African region.

show abstract

The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study

Cited by 21 publications

References 45 publications

Evaluating the performance of South African primary care: a cross-sectional descriptive survey

Evaluating the performance of South African primary care: a cross-sectional descriptive survey

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

The state of family medicine training programmes within the Primary Care and Family Medicine Education network

Contact Info

Product

Resources

About