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’ 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.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2018; DOI: 10.1080/20786190.2017.1348047
Highlights
Health policy-makers in Africa are looking for local solutions to strengthen primary care teams
family physicians (FPs) were seen as important clinical leaders within the district healthcare team
This study aimed to evaluate the impact of FPs within the District Health System (DHS) of South Africa from the perspective of the district managers in the following three domains: health system performance, clinical processes and health outcomes
Summary
Health policy-makers in Africa are looking for local solutions to strengthen primary care teams. One of the strategies to strengthen PHC is to review the composition and deployment of the primary care workforce.[5] Health policy-makers in South Africa are faced with a quadruple burden of disease: HIV/AIDS and tuberculosis; maternal and child health; injuries and violence; and non-communicable chronic diseases.[6] Internationally, there is increasing support for PHC services that are provided by multidisciplinary teams led by doctors with postgraduate training in family medicine.[2,7,8,9,10,11] Paradoxically (and in line with the inverse care law), PHC teams on the African continent lack this cadre of specialist-trained family physicians (FPs).[7,12] The majority of primary care doctors working in both private and public sectors do not have a postgraduate qualification in family medicine.[7,8,13,14]
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