scholarly journals Assessment of the impact of family physicians in the district health system of the Western Cape, South Africa

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Meyer Swanepoel ◽  
Bob Mash ◽  
Tracey Naledi
Keyword(s):  
South Africa ◽  
Health Outcomes ◽  
Health System ◽  
System Performance ◽  
Positive Impact ◽  
Family Physicians ◽  
Health System Performance ◽  
District Health ◽  
District Health System ◽  
The Impact

Background: In 2007, South Africa made family medicine a new speciality. Family physicians that have trained for this new speciality have been employed in the district health system since 2011. The aim of the present study was to explore the perceptions of district managers on the impact of family physicians on clinical processes, health system performance and health outcomes in the district health system (DHS) of the Western Cape.Methods: Nine in-depth interviews were performed: seven with district managers and two with the chief directors of the metropolitan and rural DHS. Interviews were recorded, transcribed and analysed using the ATLAS-ti and the framework method.Results: There was a positive impact on clinical processes for HIV/AIDS, TB, trauma, noncommunicable chronic diseases, mental health, maternal and child health. Health system performance was positively impacted in terms of access, coordination, comprehensiveness and efficiency. An impact on health outcomes was anticipated. The impact was not uniform throughout the province due to different numbers of family physicians and different abilities to function optimally. There was also a perception that the positive impact attributed to family physicians was in the early stages of development. Unanticipated effects included concerns with their roles in management and training of students, as well as tensions with career medical officers.Conclusion: Early feedback from district managers suggests that where family physicians are employed and able to function optimally, they are making a significant impact on health system performance and the quality of clinical processes. In the longer term, this is likely to impact on health outcomes.

scholarly journals 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)

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Rekai L. Chinhoyi ◽  
Moleen Zunza ◽  
Klaus B. Von Pressentin
Keyword(s):  
South Africa ◽  
Health System ◽  
Family Physician ◽  
System Performance ◽  
Health System Performance ◽  
Western Cape ◽  
Western Cape Province ◽  
District Health ◽  
District Health System ◽  
The Impact

Background: 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.Aim: To 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.Setting: The study sample included all five rural districts and eight urban subdistricts of the Western Cape Province.Methods: A secondary analysis was performed on routinely collected data from the Western Cape Department of Health from 01 March 2011 until 30 April 2014.Results: The FP supply did not significantly impact the indicators analysed. The supply of nurses and MOs had an impact on some of the indicators analysed.Conclusion: This 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.

scholarly journals How far does family physician supply correlate with district health system performance?

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Robin E. Dyers ◽  
Robert Mash ◽  
Tracey Naledi
Keyword(s):  
Health System ◽  
Family Physician ◽  
System Performance ◽  
Family Physicians ◽  
Health System Performance ◽  
Western Cape ◽  
Physician Supply ◽  
District Health ◽  
District Health System ◽  
The Impact

Background: Since 2011, a new cadre of family physicians, with 4 years of postgraduate training, was deployed in the district health services of the Western Cape, and tasked witha considerable range of duties aimed at a general improvement in care and health outcomes. There is a need to evaluate the contribution of these family physicians to the district health system.Aim: To develop a methodology for describing the correlation between family physician supply and district health system performance, clinical processes and outcomes, and to measure this correlation at baseline.Method: A cross-sectional study was undertaken that analysed data at an ecological level for the period of 01 April 2011 to 31 March 2012. This was a pilot project analysing data from the first year of a 4-year project. The correlations between family physician supply and 18 health system indicators were assessed within a logic model. The supplies of other categories of staff were also measured.Results: Although most of the correlations with family physicians were positive, the study was unable to demonstrate any strong or statistically significant correlations at baseline. There were significant correlations with other categories of staff.Conclusions: This study developed a methodology for monitoring the relationship between family physician supply using routinely collected indicators of health system performance, clinical processes and outcomes over time. Additional research will also be needed to investigate the impact of family physicians and triangulate findings as this methodology has many limitations and potential confounding factors.

scholarly journals Improving the Measurement of Health System Performance across the Rural-Urban Continuum

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Naushaba Degani ◽  
Sharon Gushue ◽  
Alex Yurkiewich ◽  
Emmalin Buajitti ◽  
Matthew Kumar ◽  
...  
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Health System ◽  
Performance Indicators ◽  
System Performance ◽  
Working Group ◽  
Geographic Location ◽  
Key Performance Indicators ◽  
Health System Performance ◽  
The Impact

IntroductionWe report on key performance indicators to highlight quality and variation in health care. Given Ontario’s diverse geography, we have prioritized improving measurement across the rural-urban continuum. This will improve our ability to discern the impact of geography on health care and health status to inform planning and decision making. Objectives and ApproachBuilding on previous work to advance measurement of equity in health care, we struck a technical working group of experts to review methods for stratifying health system performance data by geographic location in the Ontario context. These methods were applied to a set of key performance indicators. The working group’s review of the results of this analysis will lead to recommendations for the best method to refine and standardize how geographic location is measured and stratified. This will improve our ability to discern the impact of geography on health system performance and health status for our suite of public-reporting products. ResultsThe technical working group identified three methodologies for consideration that used linked postal code data: Population Centre (POPCTR), Statistical Area Classification (SAC) and a hybrid POPCTR/SAC methodology. These methods were tested against a set of key performance indicators across dimensions of quality including timeliness, effectiveness, population health and health outcomes. The results show that, in the health system performance dimensions of effectiveness and timeliness, as well as for a subset of health outcomes, there is variation in performance across the urban-rural continuum, though not always in a linear way. This may reflect differences in health care access, health risk factors, sociodemographic or socioeconomic characteristics across the urban-rural continuum. More definitive conclusions and recommendations will be available when the working group meets to review the results. Conclusion/ImplicationsIdentifying a robust methodology for measuring performance across geographic locations will improve our ability to discern the impact of geography on health care including where geography may impact access and effectiveness of services as well as health outcomes. This information will enable better health system planning and decision-making.

scholarly journals The perceived impact of family physicians on the district health system in South Africa: a cross-sectional survey

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Klaus B. von Pressentin ◽  
Robert J. Mash ◽  
Laurel Baldwin-Ragaven ◽  
Roelf Petrus Gerhardus Botha ◽  
Indiran Govender ◽  
...  
Keyword(s):  
South Africa ◽  
Health System ◽  
Family Physicians ◽  
Cross Sectional Survey ◽  
District Health ◽  
Cross Sectional ◽  
District Health System ◽  
Perceived Impact

scholarly journals The bird’s-eye perspective: how do district health managers experience the impact of family physicians within the South African district health system? A qualitative study

2018 ◽  
Vol 60 (1) ◽  
pp. 46
Author(s):  
Klaus B Von Pressentin ◽  
Robert J Mash ◽  
L Baldwin-Ragaven ◽  
R P G Botha ◽  
I Govender ◽  
...  
Keyword(s):  
Health System ◽  
South African ◽  
Health Systems ◽  
Family Physicians ◽  
Position Paper ◽  
Healthcare Team ◽  
Local Health ◽  
District Health ◽  
District Health System ◽  
The Impact

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

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