District health service delivery and the contribution of family physicians

Most health care in South Africa takes place in the district health system.In the public sector, this includes primary health care and district hospitals.Although there have been improvements in health and health care, there are still inequities, many instances of poor quality, and weakness regarding community engagement and multisectoral action.Service delivery is currently challenged by budget cuts and loss of resources.Ongoing reforms are needed to improve performance and accommodate the introduction of national health insurance.The deployment of family physicians is an overlooked reform that can improve the model of care, quality, and resilience.In this Commentary, we look at the current state of district health service delivery in South Africa and comment on the potential contribution of family physicians to improving delivery as part of future health reforms. Understanding district health service deliveryPrimary health care (PHC) is at the heart of district health services, with support from district hospitals.Governments around the world re-committed themselves in the 2018 Astana Declaration to strengthening PHC. 1 They stated that strengthening PHC is the most inclusive, effective and efficient approach to enhance people's physical and mental health, as well as social well-being, and that PHC is a cornerstone of a sustainable health system for universal health coverage (UHC) and health-related Sustainable Development Goals.Following this statement, the World Health Organization (WHO) published an operational plan that defined the key components of PHC as integrated primary care services with essential public health functions, empowerment of people and communities, and multisectoral policy and action. 2The operational plan was supported by a new conceptual and measurement framework for the health system through a PHC lens. 3 This framework defined the essential processes of service delivery as being the model of care, systems for improving the quality of care, and resilient health facilities and services.These processes determine the access, availability, and quality of service delivery.Ultimately, service delivery should enable universal health coverage (UHC), improved health status and health equity.The term 'model of care' refers to the design, selection and planning of services. 3What services should be offered in the community, in primary care facilities and at district hospitals?It also includes the organisation of services and how they are managed.In addition, it includes attention to community-based services, community linkages and engagement, and not just facility-based services.