An exploration of how general practitioners, working in seven black townships in Cape Town, South Africa, perceive their role in strengthening the district health system
No Thumbnail Available
Date
2025
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Western Cape
Abstract
Despite the recognition of general practitioners’ (GPs) role within the health system, and more recently their role in implementing the National Health Insurance (NHI) in South Africa, very little is known about township GPs’ role, motivation and experiences and their contribution to strengthening the district health system (DHS). The aim of this study was to better understand private GP’s perceived roles in primary healthcare provision within the DHS, investigate their reasons for choosing the medical profession and explore their experiences of being a private GP in Cape Town’s black townships. A qualitative exploratory study was conducted amongst 12 township GPs who provided consent. The exploratory study examined their experiences, to better understand their histories, motivations and socio-cultural work contexts. In-depth interviews were conducted using a semi-structured interview guide consisting of open-ended questions, with interviews conducted face-to-face for approximately an hour per participant. Interviews were recorded with consent and collected data was analysed using thematic coding analysis (TCA). The participants, who had rural and township upbringing obtained positive role modelling from their local GPs, hospital doctors and peers who were medical students. Parental guidance also influenced their choice of profession. These influencers changed their trajectory towards medicine during their secondary schooling. The GPs perceived their role in the DHS as providers of quality primary healthcare in low socioeconomic areas burdened by high morbidity and mortality. They emphasized offering quality medication which the public sector cannot offer, thereby preventing mortality in vulnerable communities. Additionally, they viewed themselves as facilitators and advocates, who support patients and connect them to appropriate public or private clinics and hospitals, or to other sectors like police or social services. Ensuring continuity of care for optimal results was also highlighted as a significant feature in their practices as they established good relationships with their clients, referring them accordingly while working in co-ordination with other actors for their wellbeing. The GPs noted that the absence of language barriers (enabled by their fluency in vernacular) enhanced quality service delivery and clinical outcomes in the townships. They also emphasized cultural understanding as key to strengthening doctor-patient relationships and were supportive of traditional healing as it was embedded in the community. Health promotion in the form of health education on disease management and prevention, was cited as central to their work to enable patients to take control of their health, improve it and that of their families plus the broader community.
Description
Keywords
District health system, General practitioners, National health insurance, Primary health care, Health service providers