Family physician deployment in South Africa’s district health system: A cross-sectional study

Abstract

Background: Family physicians (FP) strengthen the quality of district health services. The South African Academy of Family Physicians (SAAFP) recommended that, by 2030, there be one FP per district hospital, community health centre or subdistrict without a community health centre. This study aimed to evaluate progress towards achieving the SAAFP’s goals. Methods: A cross-sectional, descriptive survey collected data from senior academics in family medicine at all ten universities for 2024. Data focused on the presence, number and characteristics of employment of FPs across all 52 districts, 242 subdistricts and 607 district health facilities. Descriptive and mixed-effects regression analyses were used. Results: South Africa achieved 18.9% of the SAAFP goals, with enormous variability between provinces. Gauteng achieved 55% coverage, while the Northern Cape had no coverage. The Western Cape (34.5%) and Limpopo (23.4%) exceeded that national average. Family physicians were more likely to be employed in district hospitals (odds ratio [OR] 8.5; 95% confidence interval [CI]: 4.1–17.4, p < 0.001) and metropolitan districts (OR 20.9; 95% CI: 4.0–109.4, p < 0.001). Approximately 1 in 10 held medical officer posts (11.7%), and almost all were employed full time (96.3%). A substantial number (40.7%) were joint staff with universities. Conclusion: The deployment of FPs within the district health system has expanded but remains limited relative to SAAFP goals, with ongoing inequities in distribution. Achieving the goals is possible with the commitment of national and provincial policymakers and of human resources for health planners. Contribution: This study provides the first national mapping of FP distribution in the district health system, offering critical insights for workforce planning and policy implementation in support of universal health coverage.