The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system

Abstract

BackgroundIntegrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being only fully registered as a full specialty in South Africa in 2008. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues.MethodsThis was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposively selected leaders using an interview guide. Thematic content analysis was based on the framework method.ResultsWhilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and ‘specialist’ status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance/quality improvement; and providing support to community-oriented care. Respondents’ urged family physicians to consolidate the development and training of family physicians, and shape human resource policy to include family physicians.ConclusionsFamily physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care - a tall order, requiring strong teamwork. Innovative team-based service delivery is possible despite human resource challenges, but requires family physicians to proactively develop team-based models of care, reform education and advocate for clearer policy, based on the views of these respondents.

Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians

“…4,12 Lastly, physicians must also mentor, supervise, and serve as consultants to NPCs and other midlevel health workers on complex clinical cases. 2,4,20,30,31 In several sub-Saharan countries and for multiple types of surgery, for instance, NPCs perform as well as qualified surgeons within the limited scope of their training or skill level, but only with strong mentoring and supervision by physicians. 3,12 Task-shifting to NPCs enables health systems to function with fewer physicians, but it also creates non-clinical tasks for physicians.…”

Emerging role of family medicine in South Africa

“…Yet, this is arguably short sighted. Senior African government officials and academics engaged in a recent study on family medicine in Africa see a strong leadership role for family physicians in primary health care, although principally based at district hospitals 17–19. Their leadership is expected mainly through managing clinical referrals from juniors and clinical governance (including training and supporting the primary healthcare team in the district, including clinics) 17–19.…”

A Web-Based Survey of Residents’ Views on Advocating with Patients for a Healthy Built Environment in Canada

“…Improving medical education to address this discordance between advocacy endorsement and lack of engagement may encourage physicians to increase their involvement in meaningful and effective advocacy activities related to this determinant of health. Social responsibility (e.g., advocating for clearer policy) is an important component of community-oriented primary care and seen to be a key role for family physicians [ 22 ]. Despite the fact that the role of physicians as health advocate has been long and profusely discussed [ 14 , 23 – 25 ], it is not easy to define this role, which may contribute to residents' perceptions of their responsibility to educate patients about and advocate for a healthy built environment.…”