PURPOSE : Evidence of the influence of family physicians on health care is
required to assist managers and policy makers with human resource planning
in Africa. The international argument for family physicians derives mainly from
research in high-income countries, so this study aimed to evaluate the influence
of family physicians on the South African district health system.
METHODS : We conducted a cross-sectional observational study in 7 South African provinces, comparing 15 district hospitals and 15 community health centers (primary
care facilities) with family physicians and the same numbers without family
physicians. Facilities with and without family physicians were matched on factors
such as province, setting, and size.
RESULTS : Among district hospitals, those with family physicians generally scored
better on indicators of health system performance and clinical processes, and they
had significantly fewer modifiable factors associated with pediatric mortality (mean,
2.2 vs 4.7, P = .049). In contrast, among community health centers, those with family
physicians generally scored more poorly on indicators of health system performance
and clinical processes, with significantly poorer mean scores for continuity of
care (2.79 vs 3.03; P = .03) and coordination of care (3.05 vs 3.51; P = .02).
CONCLUSIONS : In this study, having family physicians on staff was associated with
better indicators of performance and processes in district hospitals but not in
community health centers. The latter was surprising and is inconsistent with the
global literature, suggesting that further research is needed on the influence of
family physicians at the primary care level.