The impact of family physician supply on district health system performance, clinical processes and clinical outcomes in the Western Cape Province, South Africa (2011-2014).

Rekai L Chinhoyi,Klaus B Von Pressentin,Moleen Zunza

doi:10.4102/phcfm.v10i1.1442

Rekai L Chinhoyi, Klaus B Von Pressentin + Show 1 more

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https://doi.org/10.4102/phcfm.v10i1.1442

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Abstract

BackgroundA revised family physician (FP) training programme was introduced in South Africa in 2007. A baseline assessment (2011) of the impact of FP supply on district health system performance was performed within the Western Cape Province, South Africa. The impact of an increased FP supply within this province required re-evaluation.AimTo assess the impact of FP supply on indicators of district health system performance, clinical processes and clinical outcomes in the Western Cape Province. The objectives were to determine the impact of FPs, nurses, medical officers (MOs) and other specialists.SettingThe study sample included all five rural districts and eight urban subdistricts of the Western Cape Province.MethodsA secondary analysis was performed on routinely collected data from the Western Cape Department of Health from 01 March 2011 until 30 April 2014.ResultsThe FP supply did not significantly impact the indicators analysed. The supply of nurses and MOs had an impact on some of the indicators analysed.ConclusionThis study did not replicate the positive associations between an increase in FP supply and improved health indicators, as described previously for high-income country settings. The impact of FP supply on clinical processes, health system performance and outcome indicators in the Western Cape Province was not statistically significant. Future re-evaluation is recommended to allow for more time and an increase in FP supply.

Highlights

The World Health Organization (WHO) defines primary health care (PHC) as ‘essential health care’ that is based on scientifically sound and socially acceptable methods and technology
The South African PHC system is not exempt from these challenges as it is besieged by a quadruple burden of disease consisting of human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS), tuberculosis (TB), non-communicable diseases (NCDs), high maternal and child mortality rates and high levels of violence and injuries.[3]
Shi et al found that populations residing in regions with well-developed PHC systems have better health outcomes, lower health care costs, less specialist involvement per episode of care, more visits with primary care physicians and fewer hospital days in intensive care compared to regions with weak PHC systems.[4]

Summary

Introduction

The World Health Organization (WHO) defines primary health care (PHC) as ‘essential health care’ that is based on scientifically sound and socially acceptable methods and technology. Primary health care is an aspect of health care that facilitates population access to health services through universal health care coverage of individuals, families and communities.[1]. Medicine is a comprehensive specialty that strives to ensure equitable access, continuity of care, coordination of care and comprehensiveness of care in PHC and district health services (DHS). To improve PHC, the principles of family medicine and primary care should be embraced by the entire PHC team,[5] which includes clinical nurse practitioners, professional nurses, midwives, community health workers, doctors without postgraduate training in family medicine and allied http://www.phcfm.org. A revised family physician (FP) training programme was introduced in South Africa in 2007. A baseline assessment (2011) of the impact of FP supply on district health system performance was performed within the Western Cape Province, South Africa. The impact of an increased FP supply within this province required re-evaluation

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