In South Africa, district (generalist) hospitals with family physicians have better clinical processes and health system performance, while community health centers with family physicians have lower scores in those domains. In a study across seven South African provinces, district hospitals with family physicians had higher availability of essential services, such as pediatric and emergency care, and better child and neonatal health. In contrast, community health centers with family physicians generally had lower scores for health system performance and clinical care and were associated with significantly lower scores for continuity and coordination of care. These findings differ from a large body of literature which finds that family physicians enhance continuity and coordination. The authors hypothesize that the differences might be due to the areas in which family physicians were deployed (areas of greatest need and workload, which were predisposed to perform more poorly) and/or to differing levels of physician influence (hospital teams were led by doctors, community health center teams were led by nurses). As South Africa moves toward a system of universal health coverage, the authors call for training programs that have sufficient focus on community health settings and further exploration of family physicians' roles in community health centers.
The Influence of Family Physicians Within the South African District Health System
Klaus B. von Pressentin, MMed, FCFP, PhD, et al
Stellenbosch University, Cape Town, South Africa