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Background: Completion of a research assignment is a requirement for specialist training in South Africa. Difficulty with completion delays graduation and the supply of family physicians. The aim of this study was to explore the experience of registrars with their research in postgraduate family medicine training programmes. Methods: An explorative descriptive qualitative study. Extreme case purposive sampling selected registrars who had and had not completed their research on time, from all nine training programmes. Saturation was achieved after 12 semi-structured interviews. The framework method was used for data analysis, assisted by ATLAS.ti software. Results: The assumption of prior learning by teachers and supervisors contributed to a sense of being overwhelmed and stressed. Teaching modules should be more standardised and focussed on the practical tasks and skills, rather than didactic theory. Lengthy provincial and ethics processes, and lack of institutional support, such as scholarly services and financial support, caused delays. The expertise of the supervisor was important, and the registrar-supervisor relationship should be constructive, collaborative and responsive. The individual research experience was dependent on choosing a feasible project and having dedicated time. The balancing of personal, professional and academic responsibilities was challenging. Conclusion: Training programmes should revise the teaching of research and improve institutional processes. Supervisors need to become more responsive, with adequate expertise. Provincial support is needed for streamlined approval and dedicated research time. Contribution: The study highlights ways in which teaching, and completion of research can be improved, to increase the supply of family physicians to the country. [ABSTRACT FROM AUTHOR]

Globally, universal health coverage (UHC) has gained traction as a major health priority. In 2011, South Africa embarked on a UHC journey to ensure that everyone has access to quality healthcare services without suffering financial impoverishment. National Health Insurance (NHI) and primary healthcare (PHC) re-engineering were two vehicles chosen to reach UHC over a 14-year period (2012–2026). The first phase of health system strengthening (HSS) initiatives to improve the quality of health services in the public sector began in 2012. These HSS initiatives are still being carried out by the Department of Health in conjunction with other partners. A qualitative case study design utilising a theory of change (TOC) approach was employed. Data were collected from key informants (n = 71) during three phases: 2011–2012 (contextual mapping), 2013–2014 (Phase 1) and 2015 (Phase 2). In-depth face-to-face interviews were conducted with participants using a TOC interview guide, adapted for each phase. All interviews were audio-recorded and transcribed verbatim. An iterative, inductive and deductive data analysis approach was utilised. Transcripts were coded with the aid of MAXQDA 2018. Six broad themes emerged: make PHC work, transform policy development, transform policy implementation, establish public–private partnerships, transform systems and processes and adopt a systems lens. A third great transition seems to be sweeping the globe, changing how health systems are organised. Actors in our study have identified this need also. Health system transformation rather than strengthening, they say, is needed to make UHC a reality. Who is listening? [ABSTRACT FROM AUTHOR]

Background: National Health Insurance (NHI) intends to provide universal health coverage to all South Africans, with equity and quality as its tenets. The participation of private general practitioners (GPs) in NHI is essential. The aim was to explore perceptions of GPs on NHI in Chris Hani district, Eastern Cape, South Africa. Methods: A descriptive phenomenological qualitative study using semi-structured individual interviews of 12 GPs from six municipalities was undertaken. Data analysis used the framework method assisted by Atlas.ti software. Results: GPs in Chris Hani district felt that NHI would improve health and benefit society and be of particular benefit to poor and rural people as it will improve access to healthcare. Lack of governmental administrative capacity and a human resource plan were seen as barriers to implementation. They believed that NHI would benefit them through a single purchaser system and support more comprehensive care. GPs were concerned about a lack of information on primary care packages, accreditation, remuneration and patient allocation. They thought that NHI might disadvantage solo GPs. NHI implementation could be improved by actively engaging with GP organisations. Improvement of existing government health facilities and continued medical education were seen as possible ways to better implement NHI. Conclusion GPs in this study were generally positive about NHI and thought it would benefit both patients and providers. However, they had concerns regarding the capacity of government to implement NHI and the implications for solo GPs, and needed more information. Government needs to actively engage GPs. [ABSTRACT FROM AUTHOR]

Objectives: This study was a qualitative assessment of a diabetes group education programme presented in community health centres of the Cape Town Metro District. The programme offered four sessions of group education and was delivered by trained health promoters using a guiding style derived from motivational interviewing. The aim of the study was to evaluate the programme by exploring the experiences of the patients who attended. Design: This was qualitative research that utilised in-depth interviews. Thirteen patients who had attended the educational programme, and who each came from a different health centre in the intervention arm of a larger randomised controlled trial, were purposively selected. The interviews were audiotaped, transcribed and then analysed using the framework approach. Setting and subjects: Patients with type 2 diabetes from community health centres in the Cape Town Metro District. Results: Patients gained useful new knowledge about diabetes and reported a change in their behaviour, especially with regard to diet, physical activity, medication and foot care. The educational material was experienced positively and enhanced recall and understanding. Health promoters were competent, utilised useful communication skills and structured the material well. There were organisational and infrastructural problems, especially with regard to space within which the groups could meet, and communication of the timing and location of the sessions. Conclusion: This study supports wider implementation of this programme, following consideration of recommendations resulting from patient feedback. [ABSTRACT FROM AUTHOR]