Quality Of Healthcare Services Research Articles

Patients’ satisfaction with the quality healthcare services

<p>The quality of health services has become a priority in the modern health system, defined as a service that meets professional and patient needs by efficiently using resources and minimizing risks. The quality of health care implies the best possible outcomes, timely service, rational use of resources and application of appropriate procedures. Quality measurement includes dimensions such as availability, safety, continuity, effectiveness and interpersonal relationships, key to patient trust and satisfaction.<br />This literature review analyzes instruments for measuring the quality of health services and their importance for improving the system. <br />Satisfaction is not a sufficient indicator of quality, because patients are often unaware of their real needs and may demand inadequate treatments. Quality also includes economy and compliance with legal, ethical and contractual obligations of the healthcare institution. Major satisfaction factors include healthcare, communication, waiting time and patient education. Patient satisfaction should be measured regularly and used for continuous improvement of services.<br />The quality of health care is a continuous process that requires constant monitoring, evaluation and improvement to ensure the best possible outcome for patients.</p>

Sustainable Young Nursing Business Manager Leadership Competency: The Philippines Experience

The global shortage of qualified nurse managers, particularly evident in the Philippines, is rooted in the absence of training programs for transitioning nurses into management roles. Recent studies highlight this gap, leading to the promotion of inexperienced nurses to leadership positions and resulting in ineffective management practices and compromised care quality. Recognizing the importance of sustainable leadership competency for the long-term viability of healthcare services, a study in Metro Manila seeks to address these issues. The research focuses on gathering insights from nursing business experts regarding essential skills for sustainable leadership among young nursing business managers. The study aims to not only explore these perspectives but also assess the competency levels of young nurse managers using a newly developed survey tool. The objectives encompass determining expert views on necessary skills, profiling participants based on demographic factors, assessing competency levels, and drawing recommendations from the mixed-methods study results. Employing a mixed-method approach, the study initially conducted interviews with nursing business leaders in Manila. The themes derived from these interviews were then utilized in formulating the questionnaire. The findings revealed demographic variations among participants, influencing their responses. Five major themes emerged, reflecting participant perspectives on the competency of young nurse business managers: professional conduct, educational competency, individual assessment, trans-cultural competency, and informatics tech competency. In conclusion, the study emphasizes the diverse skills and competencies required by young nurse business leaders for effective functioning in occupational and professional settings. These competencies, spanning professional conduct, individual assessment, cultural competence, and technological proficiency, are deemed critical components in assessing and evaluating the effectiveness and efficiency of young nursing leaders, as emphasized in the existing literature. The study underscores the imperative for comprehensive training programs to enhance the competency of young nursing leaders, contributing to the overall quality and sustainability of healthcare services. Keywords: Nursing, leadership, Management, Concepts Investigated: professional conduct, individual assessment, culturally-inclined competency, informatics tech competency, educational competencies, Exploratory sequential Mixed-method , purposive sampling , The Philippines, South East Asia

The effect of trans-provincial immediate reimbursement for healthcare expenses on inequity in the utilization of healthcare services for migrants

BackgroundImproving the accessibility of public services for migrants is an important endeavor to promote equity in economic and social development. As a response to the large-scale movement of migrants and the fragmentation of China’s health insurance system, the Chinese Government has launched a policy of trans-provincial immediate reimbursement for healthcare expenses. The present study hopes to examine the effect of immediate reimbursement policy on the utilization of healthcare services for migrants in China.MethodsThis study used two waves of data from the China Migrants Dynamic Survey (CMDS) collected in 2013 and 2017, with the sample comprising 13,540 individuals. We constructed a difference-in-differences (DID) model to investigate the impact of the policy on the utilization of healthcare services for migrants. Meanwhile, we also analyzed the heterogeneity of the policy effect by grouping the samples by industry, gender, income, and education level.ResultsThe results found that the trans-provincial immediate reimbursement significantly promoted the probability of migrants’ utilization of quality healthcare services (average treatment effect on the treated = 0.072, p < 0.05). Heterogeneity analyses revealed that the policy effect was more pronounced among higher-income and better-educated migrants. In addition, the policy effect was more significant for female migrants, and the benefits were more marked for migrants in high-risk industries.ConclusionsThe trans-provincial immediate reimbursement policy has improved the inequity of healthcare services utilization among migrants as a whole; however, within the migrants, inequity still exists. More attention should also be paid to low-income or low-education groups in future policy design.

The Effect of Accreditation in Health Care Services: Case Study at HMO- Health Maintenance Organization in Israel

The healthcare sector is a critical component of a well-functioning society that formed any society, we can depend on it and is responsible for maintaining the health of the people, and to offer them the services they need. The nature of healthcare is such that it is a service on which the health of human beings depends and helps them to live a healthy life without suffering. Quality is something that is universally desired by individuals in every kind of product or service. However, there is no aspect of society in which quality is as essential as in healthcare because if the person has a good health he will do his best to serve his society and he will be a benefit citizen to his society and country. Poor quality of services in healthcare can be the cause of physical harm or even death for a patient. As such, the ramifications of quality are nowhere as serious as in the particular domain of medicine and healthcare.

Effect of work stress on service delivery of health workers in University of Benin Teaching Hospital, Benin City Nigeria

The study examined work stress and service delivery among health workers in University of Benin Teaching Hospital Benin City. The study adopted descriptive research method. Data were collected through questionnaire, focus group discussion guide, in depth interview and secondary sources. The study revealed that work overload has nexus with service delivery of the health workers of University of Benin Teaching Hospital. The study recommended among other things that University of Benin Teaching Hospital (UBTH) should deploy more student doctors in their residency programmes who would be closely supervised by their superiors in order to reduce the workload on existing doctors in their provision of health services. The work schedule for medical and health workers at the University of Benin Teaching Hospital (UBTH), should be made more flexible to accommodate the peculiarities in female medical personnel, especially married women, nursing mothers and those that are pregnant. The government should do better in the disbursement and payment of hazard allowances to medical and health workers in order to encourage their selfless services to God and humanity through the provision of quality healthcare services.

Efektivitas Penggunaan Rekam Medis Elektronik Terhadap Peningkatan Kualitas Pelayanan Pasien di Rumah Sakit

This research aims to explore the benefits and challenges of EMR implementation and its implications for medical practices and healthcare services in Indonesia. The research design utilizes a Literature Review. Sources used in searching for literature in this research include Google Scholar, ScienceDirect, DOAJ, and Scopus. Furthermore, in conducting literature selection, the researcher uses the PRISMA method. This study identifies the benefits of EMR in accelerating patient information access, enhancing coordination among medical teams, and reducing the risk of errors in medical data recording. However, challenges such as data security and staff training are also faced in EMR implementation. In conclusion, the implementation of EMR in Indonesian hospitals promises significant benefits in improving the efficiency, accuracy, and quality of healthcare services, although it still faces some obstacles that need to be addressed.

Health equity in Somalia? An evaluation of the progress made from 2006 to 2019 in reducing inequities in maternal and newborn health

BackgroundEvery human being has the right to affordable, high-quality health services. However, mothers and children in wealthier households worldwide have better access to healthcare and lower mortality rates than those in lower-income ones. Despite Somalia’s fragile health system and the under-5 mortality rate being among the highest worldwide, it has made progress in increasing reproductive, maternal, and child health care coverage. However, evidence suggests that not all groups have benefited equally. We analysed secondary 2006 and 2018–19 data to monitor disparities in reproductive, maternal, and child health care in Somalia.MethodsThe study’s variables of interest are the percentage of contraceptive prevalence through modern methods, adolescent fertility rate, prenatal care, the rate of births attended by midwives, the rate of births in a health care facility, the rate of early initiation of breastfeeding, stunting and wasting prevalence and care-seeking for children under-five. As the outcome variable, we analysed the under-five mortality rate. Using reliable data from secondary sources, we calculated the difference and ratio of the best and worst-performing groups for 2006 and 2018–19 in Somalia and measured the changes between the two.ResultsBetween 2006 and 2018–19, An increase in the difference between women with high and low incomes was noticed in terms of attended labours. Little change was noted regarding socioeconomic inequities in breastfeeding. The difference in the stunting prevalence between the highest and lowest income children decreased by 20.5 points, and the difference in the wasting prevalence of the highest and the lowest income children decreased by 9% points. Care-seeking increased by 31.1% points. Finally, although under-five mortality rates have decreased in the study period, a marked income slope remains.ConclusionsThe study's findings indicate that Somalia achieved significant progress in reducing malnutrition inequalities in children, a positive development that may have also contributed to the decrease in under-five mortality rate inequities also reported in this study. However, an increase in inequalities related to access to contraception and healthcare for mothers is shown, as well as for care-seeking for sick children under the age of five. To ensure that all mothers and children have equal access to healthcare, it is crucial to enhance efforts in providing essential quality healthcare services and distributing them fairly and equitably across Somalia.

Professional difficulties of a nursing worker in the department of obstetrics and gynecology

With the continuous improvement of living standards, most patients have increasingly high demands on the quality of health care services. As for nursing, the high-quality nursing care model has gradually replaced the traditional nursing model and has been recognized by many patients. Throughout the entire period of the formation of medicine, all kinds of measures have been taken to improve the provision of therapeutic and preventive care to pregnant women, women in labor, women in childbirth, newborns and gynecological patients, since this type of care has certain specifics, differing from general medical practice. One of the possible tools to improve the quality of work of nursing professionals is to study the problems of the work process and timely elimination of difficulties faced by midwives and nurses in the course of their professional activities.

UHI based Healthcare Management System through Digital Transformation

The Unified Health Interface (UHI) represents a pivotal initiative within the Indian healthcare landscape, offering an open and interoperable IT ecosystem tailored for modern and innovative health service delivery. In response to the challenges posed by the COVID-19 pandemic, UHI emerges as a strategic solution aimed at ensuring enhanced accessibility and quality of healthcare services. Through its seamless interface, UHI facilitates various functionalities including online search, lab test bookings, virtual medical consultations via video, voice, or chat, digital transfer of health records, and secure digital payments. This paper explores the transformative potential of UHI in addressing the evolving needs of healthcare delivery in India. By fostering ease of application and improving access to quality healthcare services, UHI stands as a cornerstone in the nation's healthcare infrastructure. The emergence of enterprise- and national-level healthcare systems underscores the growing demand for comprehensive and cost-effective public healthcare solutions. Leveraging classic telecommunications and internet services such as presence, voice, video, and messaging, along with service composition solutions and enterprise networks, UHI lays the groundwork for unified health applications. This research delves into the implications of UHI in driving healthcare accessibility, affordability, and efficiency, while also examining its role in shaping the future trajectory of healthcare delivery in India. By elucidating the integration of UHI within existing healthcare frameworks, this paper provides valuable insights into the transformative potential of digital technologies in revolutionizing public health services.

The Greek economic crisis and its impact on the national health system

Abstract The Greek economic crisis produced severe economic and social outcomes. A massive rescue package was conditional on implementing a Memorandum of Economic and Financial Policies agreed upon between the Greek government and the EU, European Central Bank, and the International Monetary Fund. The extremely austere fiscal consolidation and the structural reforms accompanying the Greek Economic Adjustment Programmes reduced the country’s GDP. Implementing the austerity policies on the Greek National Health System, which was already facing structural problems, reduced the quality and availability of public health care services. This paper investigates the impact of the GDP change on public healthcare expenditures (HCE) from 2000 to 2018. The empirical analysis reveals a statistically significant positive correlation between the GDP per capita and public healthcare expenditure (HCE) from 2000 to 2014 while the effect of GDP on HCE after the 2015 remains unchanged. This paper contributes to the field’s literature since it determines the impact of GDP on public HCE, specifically matched with empirical results to derive conclusive answers.

Enrichment of microscopic photographs by utilizing CNN regarding soil-transmitted helminths identification

Soil-transmitted helminth (STH) infection remains a significant global health challenge, affecting millions of people, particularly in developing countries. A convolutional neural network (CNN) approach to optimize the detection of STH infections in microscopic images. The study aims to assess the effectiveness of the CNN model in identifying and classifying STH worm eggs accurately. The research employs MATLAB as the primary tool for conducting experiments and validation tests. By implementing image preprocessing techniques to enhance image quality and applying precise segmentation methods, the CNN model is trained on a dataset of microscopic images to learn and classify STH infections effectively. The validation test results demonstrate that the CNN model achieved a high accuracy rate of 92.31% in classifying STH infections. This accuracy surpasses traditional methods, which are time-consuming and susceptible to human errors. This study underscores the importance of integrating artificial intelligence, particularly CNN, into the healthcare domain to support detecting and diagnosing diseases requiring specialized expertise, such as STH infections. The findings of this research can serve as a valuable reference for researchers, medical practitioners, and data scientists in leveraging artificial intelligence to enhance the quality of healthcare services, leading to positive impacts on society worldwide.

How Norwegian homecare managers tackled COVID‐19 and displayed resilience‐in‐action: Multiple perspectives of frontline‐staff

AbstractA resilient healthcare system is key to responding to sudden crises, such as the coronavirus disease 2019 (COVID‐19) pandemic. Homecare services have been an important platform of healthcare delivery during the pandemic, and healthcare staff on the frontlines of homecare have been confronted with major challenges requiring adaptation to sustain high quality healthcare services. Managers' capacities to adapt to disruptions and challenges are important for an adequate response to challenges on the frontlines. To explore healthcare staff's perspectives on managers at different managerial levels (meso‐level) handling of the COVID‐19 pandemic in Norwegian homecare services. A qualitative multiple case study was designed including four cases. A case was defined as a homecare service within a Norwegian municipality (public organization). Data were collected through 16 interviews with healthcare staff. Interviews were conducted by using a semi‐structured interview guide. Healthcare staff reported their managers as proactive, prepared and responded quickly. Present and supportive managers that provided effective and targeted information, and involved staff in decision‐making were key to handling the pandemic in Norwegian homecare services. Our results underscore the interaction between healthcare staff and managers at different managerial levels as essential for quickly react, adapt, and resiliently respond to disruptions like the COVID‐19 pandemic. Organizations need to have the flexibility to interact across levels and encourage managers to apply strategies for collaboration and staff involvement, especially during a crisis.

Maintaining altruism among nursing professionals

The demanding hospital work environment has increased the need for organizational citizenship behaviour (OCB). It’s essential to maintain the altruistic behaviour of nursing professionals towards each other to enhance the patient experience and provide quality healthcare service to patients efficiently. This quantitative study explored the relationships between OCB constructs based on social identity theory (SIT) and system justification theory (SJT). This study is empirical and cross-sectional in nature; structural equation modeling is performed on two hundred twenty-two nursing professional responses, using IBM AMOS V.22 to test the hypothesized model. Conscientiousness has a mediating effect on the relationship between civic virtue and altruism (Indirect effect=0.19, Boot SE=.057, lower-level confidence interval (LLCI)=.0940, upper-level confidence interval (ULCI)=.3144). Moreover, sportsmanship had a mediating effect on the relationship between civic virtue and altruism with an Indirect effect=-0.06, Boot SE=.023, LLCI=-0.1159, ULCI=-0.0222). The results supported the hypothesis that civic virtue and altruism are directly related and found that conscientiousness and sportsmanship mediate the relationship between civic virtue and altruism. The findings suggest that employees with higher sportsmanship tend to reduce their altruistic behavior in the long run.

Telehealth Consultation for Malaysian Citizens' Willingness to Pay Assessed by the Double-Bounded Dichotomous Choice Method.

Re-envisioning healthcare in technology tools includes robust utilisation of telehealth, improvement in access, quality, care efficiencies and cost-effectiveness of healthcare services. In reality, the technology's potential to transform healthcare may be limited by the ability to pay for it. This study aims to estimate Malaysian citizens' willingness to pay (WTP) for telehealth consultations and determine the factors contributing to it. This is vital to inform decision-making about expansion, preferences and deployment of a pricing strategy for telehealth services. A random sample of 220 adult Malaysians was surveyed using social network services (SNS). Three different WTP bid arrays were identified and each respondent received a randomly drawn bid price. The WTP fee for using the telehealth consultation for 30 min was measured and estimated using a Double-Bounded Dichotomous Choice (DBDC) and the Random Utility Logit Model. The median WTP was estimated to be RM58 (JPY2,198), RM78 (JPY2,956) for 132 respondents' willingness to use telehealth consultation and RM26 (JPY985) for 51 respondents who were unwilling. Further analysis found that WTP is correlated with the perception and willingness of the respondents to use it. Despite most respondents being willing to pay for telehealth consultations, sociodemographic characteristics and affordability influenced the process of making decisions about WTP for telehealth consultation. This finding suggests that the private sector can play a crucial role in the deployment of telehealth. However, there may be a need to consider affordability and how to increase access and use of telehealth services.

Utilization of repeat services in the outpatient department of Dewi Sartika general hospital, Kendari City, 2023

The reutilization of services in outpatient clinics of hospitals plays a crucial role in enhancing the quality and effectiveness of healthcare services. This study aims to analyze the factors associated with service reutilization in hospital outpatient clinics using a cross-sectional design and quantitative approach. Data were collected through questionnaires from 100 respondents at Dewi Sartika General Hospital in Kendari, Southeast Sulawesi, during October-November 2023, using accidental sampling techniques. The analysis results indicate that factors such as service quality, family encouragement, facilities, location, and patient attitudes are significantly associated with service reutilization in outpatient clinics. Univariate analysis was used to describe sample and variable characteristics, while bivariate analysis involved correlation testing to evaluate the relationships among variables. The conclusion of this study highlights the importance of enhancing communication, education, and family support in influencing patient decisions to reuse the same services at the hospital. The development of family support programs, patient empowerment, family-friendly policies, and periodic program evaluations are crucial steps in improving patient experiences and healthcare outcomes. Recommendations include critical steps such as enhancing communication, education, and family support, as well as developing structured family support programs, empowering patients, implementing family-friendly policies, and conducting regular program evaluations. It is expected that the implementation of these recommendations will improve patient experience, enhance adherence to treatment, and overall improve healthcare outcomes.

Healthcare managerial challenges in rural and underserved areas: A Review

This paper reviews the managerial challenges and strategies for improving healthcare in rural and underserved areas. It explores healthcare managers' unique obstacles, including resource allocation, staffing, infrastructure development, technology integration, policy compliance, and community engagement. Through a comprehensive literature review, the paper identifies effective strategies such as innovative human resource management, financial sustainability models, operational efficiencies, technological advancements, policy reforms, and community-based approaches. The analysis emphasizes the importance of adaptability, local context consideration, and stakeholder involvement in implementing these strategies. The paper concludes with a call to action for continued research, policy reform, and collaborative efforts to address the systemic challenges in rural healthcare management, aiming to enhance access, quality, and equity in healthcare services for rural and underserved populations.

Shared medical appointments and quality of life for children with HIV-AIDS

Background The human immunodeficiency virus (HIV) infects immune cells and weakens the immune system. There are 36.9 million HIV sufferers worldwide, with 1.8 million of them being children. Children with HIV and their parents may benefit from focus group discussions, also known as shared medical appointments (SMAs). SMAs represent an educational method capable of enhancing the quality of healthcare services. However, this method remains relatively under-researched in HIV/AIDS patients.&#x0D; Objective To assess the impact of SMA on the quality of life of children with HIV-AIDS.&#x0D; Methods This quasi-experimental study with a cross-sectional approach was carried out for 2 months. Subjects participated in SMAs, accompanied by a pediatrician as facilitator. Subjects filled three Pediatric Quality of Life (PedsQL) questionnaires (Inventory 4.0, General Well-Being Scale 3.0, and Healthcare Satisfaction 3.0), before and after attending SMAs. We compared the results.&#x0D; Results There were 12 respondents, with the majority aged 5-10 years (50%), and a higher proportion of male than female (33.3%). The majority of boys had stage 3 HIV, while most girls had stage 2 HIV. According to the PedsQL Inventory module, the average quality of life for the physical aspect was the highest (83), while the lowest was observed in the school aspect (45). In the General Well-being module, the average emotional health scores were 84 before and 93 after SMAs, which were higher than the overall health scores (68 and 77 before and after SMAs, respectively). In the Healthcare Satisfaction module, the lowest average scores were in family satisfaction (52 before and 64 after SMAs), whereas the highest were in satisfaction with healthcare provider treatment (87 and 81 before and after SMAs, respectively). There was a significant increase before and after the SMAs in emotional health (P=0.009).&#x0D; Conclusion An improvement in emotional health was observed based on the General Well-being module of the PedsQL before and after SMAs intervention. Thus, SMAs may potentially improve the quality of life for children with HIV-AIDS.

Associated Factors in Patient Satisfaction among Older Persons Attending Primary Health Facilities in Sepang, Malaysia.

With Malaysia's ageing population, the utilisation of primary healthcare services by older individuals with comorbidities is expected to increase. Patient satisfaction serves as a key indicator for assessing the quality of healthcare services. Thus, the aim of this study is to evaluate patient satisfaction among older persons attending public primary healthcare facilities and to identify associated factors. A cross-sectional survey was conducted from October 2017 to January 2018, involving face-to-face interviews with older outpatients in primary health clinics. Minimum 300 participants were required and systematic random sampling were used. The measurement included sociodemographic variables, patient comorbidity and patient satisfaction using the Short-Form Patient Satisfaction Questionnaire (PSQ-18). A total of 317 participants enrolled in this study, resulting in a response rate of 95.6%. The findings indicated that 35.7% of participants reported high satisfaction, while 64.3% reported moderate satisfaction. Participants with at least secondary education (OR = 3.12) were more likely to experience satisfaction compared to those without formal education. Participants with monthly incomes above RM2,000 (OR = 0.40) and RM1,000-RM1,999 (OR = 0.53) were less likely to be satisfied compared to those earning less than RM999. Moreover, participants with two or more comorbidities were less likely to be satisfied compared to those with one comorbidity. Gender, marital status, employment status and living arrangements were not significant factors. This study highlights the need for healthcare authorities to examine factors such as patients' education level, income level and comorbidity status that are associated with healthcare satisfaction to enhance overall patient satisfaction.

Patient satisfaction and their determinants in outpatient department of a tertiary public hospital in Nepal: a cross-sectional study

BackgroundPatient satisfaction is a vital metric for assessing healthcare quality and delivering patient-centered care. It can predict service utilization patterns by determining healthcare users’ contentment with their providers. Consequently, evaluating patient satisfaction and its underlying factors is crucial to maintaining the quality of healthcare services. The present study aimed to assess patient satisfaction and its determinants in a tertiary care public hospital in Nepal. In this research, a cross-sectional design was employed to examine patient satisfaction within the Outpatient Department of Mental Hospital Lagankhel, Nepal. The study adopted a systematic random sampling approach for respondent selection, and stringent measures were implemented to uphold the validity and reliability of the collected data. To assess patient satisfaction comprehensively, the Patient Satisfaction Questionnaire-III (PSQ-III), developed by the RAND Corporation, was employed in conjunction with relevant sociodemographic variables. Utilizing mean scores and percentages, we calculated satisfaction levels across various dimensions. Additionally, a multinomial logistic regression analysis was conducted to investigate the relationships between patient satisfaction dimensions and sociodemographic characteristics.ResultsThis study encompassed perspective of 206 participants, with 57.3% representing patient relatives and 51% being male, median age of 32 years (standard deviation: 12.53). Notably, patients reported higher levels of satisfaction, particularly within the interpersonal relationship dimension, while the technical quality domain received comparatively lower satisfaction ratings. Multinomial logistic regression analysis underscored the significance of sociodemographic factors in shaping patient satisfaction, with age (p = 0.008), type of residence (p = 0.001), occupation (p = 0.0019), income status (p = 0.014), time to reach the healthcare facility (p = 0.013), and insurance enrollment status (p = 0.017) all demonstrating significant associations. These findings illuminate the intricate qualities of patient satisfaction within our healthcare context, offering actionable insights for enhancement and guiding the trajectory of future research endeavors.ConclusionsOverall patient expressed satisfaction with service provided by tertiary care hospital, however continuous improvement remains essential. Conducting large-scale, nationwide studies across hospital tiers is vital. This data-driven approach empowers policymakers to allocate resources effectively, inform decision-making, and enact policies that exceed patient expectations, fostering a healthcare system of unparalleled excellence.

The views of family physicians on National Health Insurance in Gauteng Province, South Africa.

Universal health coverage (UHC) improves national health outcomes while addressing social inequalities in access to quality healthcare services. The district health system (DHS) is critical to the success of UHC in South Africa through the National Health Insurance (NHI) scheme. Family physicians (FPs), as champions of primary care, are central to the DHS operation and implementation of NHI. This was a qualitative exploratory study that used semi-structured interviews to explore FPs views and engagement on NHI policy and implementation in their districts. Ten FPs were included through purposive sampling. Most of the FPs interviewed were not engaged in either policy formulation or strategic planning. The NHI bill was seen as a theoretical ideology that lacked any clear plan. Family physicians expressed several concerns around corruption in governmental structures that could play out in NHI implementation. Family physicians felt unsupported within their district structures and disempowered to engage in rollout strategies. The FPs were able to provide useful solutions to health system challenges because of the design of their training programmes, as well as their experience at the primary care level. Healthcare governance in South Africa remains located in national and provincial structures. Devolution of governance to the DHS is required if NHI implementation is to succeed. The FPs need to be engaged in NHI strategies, to translate plans into actionable objectives at the primary care level.Contribution:This study highlights the need to involve FPs as key actors in implementing NHI strategies at a decentralised DHS governance level.