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
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.