Jozi Family Medicine Team to present at Wits Research Day

The team from Jozi Family Medicine will be giving three different presentations at the Wits Research Day on the 17^th of September.

Shabir Moosa will be talking about the views of key leaders in South Africa on implementation of family medicine, and the critical role in the district health system.

Stephen Pentz will be presenting on ethical challenges in Primary Healthcare Re-engineering

And Shehnaz Munshi has a poster looking at the inclusion of allied health professionals in integrated primary care teams

Go here to find out more about Wits Research Day

See abstracts for the presentations below:

Ethical challenges in Primary Healthcare Re-Engineering

Primary health care (PHC) re-engineering in South Africa is seen as crucial to reforming and strengthening the current health system and represents a change is thinking from poorly co-ordinated, verticalised programmes characteristic of current PHC services to a more integrated, team-based approach within PHC. This research focused on the ethical challenges with regards to the implementation of Municipal Ward-based PHC Outreach Teams; one of the three streams in the model for PHC re-engineering (aside from district-based clinical specialist teams and school health services). The study conducted 28 focus group interviews with purposively selected stakeholders in 5 of the 7 sub-districts of the City of Johannesburg, including stakeholders from government, private and academic institutions, NGOs, and people in the community identified as influential to the implementation of PHC re-engineering. The data was analysed qualitatively following the framework method. The results revealed ethical concerns with the current health service including poor services; poor standards of care; concerns with medication; problematic attitudes; and fear of attending clinics. The ethical challenges particularly associated with PHC re-engineering included issues with confidentiality; the reception of Community Health Workers (CHWs) in the community; challenges encountered by CHWs; political dynamics; and transparency, corruption and nepotism. Beyond an ethical crisis in health care in South Africa, the research concludes that challenges with professionalism with regards to CHWs remains problematic. CHWs have an incredible potential to increase access to services and effect meaningful health prevention and promotion at community level, however, the researchers caution that it is unethical to send poorly trained, incapacitated non-professionals into dangerous, structurally violent areas to deal with serious social and health conditions without adequate support.

“The views of key leaders in South Africa on implementation of family medicine: critical role in the district health system”

Background: Integrated team-based primary care is an international imperative. This is required more so in Africa, where fragmented verticalised care dominates. South Africa is trying to address this with health reforms, including Primary Health Care Re-engineering. Family physicians are already contributing to primary care despite family medicine being a new discipline in South Africa. However the views of leaders on family medicine and the role of family physicians is not clear, especially with recent health reforms. The aim of this study was to understand the views of key government and academic leaders in South Africa on family medicine, roles of family physicians and human resource issues.

Methods: This was a qualitative study with academic and government leaders across South Africa. In-depth interviews were conducted with sixteen purposefully selected leaders using an interview guide. Thematic content analysis was based on the framework method.

Results: Whilst family physicians were seen as critical to the district health system there was ambivalence on their leadership role and ‘specialist’ status. National health reforms were creating both threats and opportunities for family medicine. Three key roles for family physicians emerged: supporting referrals; clinical governance / quality improvement; and providing support to community-oriented care. Respondents’ spoke of consolidating the development and training of family physicians, and shaping human resource policy to include family medicine.

Conclusions: Family physicians were seen as critical to the district health system in South Africa despite difficulties around their precise role. Whilst their role was dominated by filling gaps at district hospitals to reduce referrals it extended to clinical governance and developing community-oriented primary care – a tall order, requiring strong teamwork. It requires family physicians to proactively develop team-based models of care, reform education and advocate for clearer policy.