• Klaus B von Pressentin, Robert J Mash, Laurel Baldwin-Ragaven, Roelf Petrus Gerhardus Botha, Indiran Govender, Wilhelm Johannes Steinberg, and Tonya M Esterhuizen.
• Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa kvonpressentin@sun.ac.za.
• Ann Fam Med. 2018 Jan 1; 16 (1): 283628-36.

PurposeEvidence 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.MethodsWe 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.ResultsAmong 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).ConclusionsIn 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.© 2018 Annals of Family Medicine, Inc.

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