Reflections on the development of family medicine in the Western Cape: a 15-year review

Abstract

This article reviews how the model of family medicine has developed over the last 15 years in the Western Cape. It is based on a series of in-depth interviews with key role players. This period coincides with the immediate post-apartheid era, in which both the health system and health science education experienced rapid transformation. The new focus on primary health care, the district health system and community-based education provided an opportunity for the disciplines of family medicine and in primary care to develop. The model that emerged required the family physician to work at both the district hospital and in primary care, and to have a number of different roles: care provider, consultant, capacity builder, supervisor, manager and community leader. Family medicine was accepted as a new speciality in 2007. The first specialist family physicians will qualify in 2011, and start to consolidate the model that has been developed. Although the model shows promise, a number of challenges still remain, in relation to the health system, the relationship between universities and the province, the discipline of family medicine, research, and training programmes. It is hoped that these reflections will be of value to other provinces in South Africa, and other countries in the region, that are also thinking of including family physicians in their health systems.