@article{27135e62269b4eb48b65ac7e638dbadc,
title = "The bird{\textquoteright}s-eye perspective: How do district health managers experience the impact of family physicians within the South African district health system? A qualitative study",
abstract = "Background: Health policy-makers in Africa are looking for local solutions to strengthen primary care teams. A South African national position paper (2015) described six aspirational roles of family physicians (FPs) working within the district health system. However, the actual contributions of FPs are unclear at present, and evidence is required as to how this cadre may be able to strengthen health systems. Methods: Using semi-structured interviews, this study sought to obtain the views of South African district health managers regarding the impact made by FPs within their districts on health system performance, clinical processes and health outcomes. Results: A number of benefits of FPs to the health system in South Africa were confirmed, including: their ability to enhance the functionality of the local health system by increasing access to a more comprehensive and coordinated health service, and by improving clinical services delivered through clinical care, capacitating the local health team and facilitating clinical governance activities. Conclusions: District managers confirmed the importance of all six roles of the FP and expressed both direct and indirect ways in which FPs contribute to strengthening health systems{\textquoteright} performance and clinical outcomes. FPs were seen as important clinical leaders within the district healthcare team. Managers recognised the need to support newly appointed FPs to clarify their roles within the healthcare team and to mature across all their roles. This study supports the employment of FPs at scale within the South African district health system according to the national position paper on family medicine.",
keywords = "Family physicians, Healthcare system, Healthcare team, Leadership, Primary health care",
author = "{Von Pressentin}, {K. B.} and Mash, {R. J.} and L. Baldwin-Ragaven and Botha, {R. P.G.} and I. Govender and Steinberg, {W. J.}",
note = "Funding Information: This study was conducted with the financial assistance of the European Union. The contents of this document are the sole responsibility of the authors and can under no circumstances be regarded as reflecting the position of the European Union. Additional funding was received from the Discovery Foundation (South Africa) and the Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. Funding Information: This study was approved by the Human Research Ethics Committee (Medical), Stellenbosch University (reference S15/01/003), as well as by each partner institution. The seven provincial health authorities and research committees also gave permission to access the study setting (the full list is available as a supplementary file). Funding Information: AIDS : acquired immune deficiency syndrome CHC: community health centre COPC: community-oriented primary care COREQ : consolidated criteria for reporting qualitative research DCSTs: district clinical specialist teams DH : district hospital DHS: district health system DMs : district managers FPs : family physicians HIV : human immunodeficiency virus MOs : medical officers MOU : midwife obstetrics unit NCDs: non-communicable diseases NDOH : South African National Department of Health NHI : National Health Insurance PHC : primary health care STIs : sexually transmitted illnesses WBOTs : ward-based outreach teams WHO : World Health Organization Acknowledgements – The authors wish to thank the district managers for agreeing to participate in the study. The authors also wish to thank the members of the research team for their help with conducting the interviews: Dr L Campbell (University of KwaZulu-Natal), Mr B Mashaba (Sefako Makgatho Health Sciences University), Sr G Mathebula and Dr P van Niekerk (University of Pretoria), and Ms T Rwafa (University of the Witwatersrand). In addition, the authors would also like to thank Ms S Munshi (University of the Witwatersrand) for her help during the initial planning phase of the study. This study was conducted with the financial assistance of the European Union. The contents of this document are the sole responsibility of the authors and can under no circumstances be regarded as reflecting the position of the European Union. Additional funding was received from the Discovery Foundation (South Africa) and the Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. Publisher Copyright: {\textcopyright} 2017 The Author(s).",
year = "2018",
doi = "10.1080/20786190.2017.1348047",
language = "English",
volume = "60",
pages = "13--20",
journal = "South African Family Practice",
issn = "2078-6190",
publisher = "Taylor and Francis Ltd.",
number = "1",
}