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

Publisher: AOSIS Publishing Country of Publication: South Africa NLM ID: 9701104 Publication Model: Electronic Cited Medium: Internet ISSN: 2078-6204 (Electronic) Linking ISSN: 20786190 NLM ISO Abbreviation: S Afr Fam Pract (2004) Subsets: MEDLINE

Publication: 2020- : [Durbanville, Cape Town] : AOSIS Publishing
Original Publication: Cramerview : The Academy, [1994-

Physicians, Family* ; National Health Programs*; Humans ; South Africa ; Health Policy ; Delivery of Health Care

Background:  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.
Methods:  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.
Results:  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.
Conclusion:  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.

Niger Med J. 2014 Nov;55(6):512-6. (PMID: 25538373)
Health Syst Reform. 2019;5(1):48-58. (PMID: 30924745)
BMJ Glob Health. 2018 May 12;3(Suppl 3):e000662. (PMID: 29765778)
Lancet. 2015 Mar 28;385(9974):1230-47. (PMID: 25458725)
BMC Fam Pract. 2014 Jun 25;15:125. (PMID: 24961449)
Lancet Glob Health. 2022 May;10(5):e715-e772. (PMID: 35390342)
BMC Health Serv Res. 2016 Oct 7;16(1):558. (PMID: 27717353)
BMJ Glob Health. 2018 Sep 6;3(Suppl 3):e000736. (PMID: 30233837)
BMC Health Serv Res. 2021 Sep 15;21(1):969. (PMID: 34521399)
Afr J Prim Health Care Fam Med. 2016 Jun 15;8(1):e1-6. (PMID: 27380785)
S Afr Fam Pract (2004). 2021 Mar 10;63(1):e1-e5. (PMID: 33764146)
BMC Med Res Methodol. 2018 Nov 21;18(1):148. (PMID: 30463515)
PLoS One. 2021 Oct 22;16(10):e0258955. (PMID: 34679111)
Afr J Prim Health Care Fam Med. 2019 Oct 17;11(1):e1-e10. (PMID: 31714120)
Risk Manag Healthc Policy. 2020 Oct 02;13:1879-1904. (PMID: 33061721)
Afr J Prim Health Care Fam Med. 2019 Jun 24;11(1):e1-e7. (PMID: 31296018)
S Afr Fam Pract (2004). 2020 Sep 03;62(1):e1-e15. (PMID: 32896142)
J Health Organ Manag. 2017 May 15;31(3):270-285. (PMID: 28686135)

Keywords: DHS; District Health System; NHI; National Health Insurance; UHC; Universal Health Coverage; family physician; governance

Date Created: 20240404 Date Completed: 20240405 Latest Revision: 20240425

20240425

PMC11019033

10.4102/safp.v66i1.5831

38572875