Private General Practitioners’ Agreement on Skills and Competencies for Universal Health Coverage in Urban South Africa - A Descriptive Cross-Sectional Survey

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DOI: 10.21522/TIJAR.2014.SE.22.02.Art014

Authors : John Mukuka Musonda, Shabir Moosa


Globally, Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) are designed to ensure equity and quality health care. In South Africa, National Health Insurance (NHI) is the vehicle for it. Strategic purchasing and contracting private general practitioners (GPs) are key strategies. Skills training will prepare GPs for NHI. However, it is not clear as to which GP skills and competencies are currently implemented in practice. The study assessed GPs’ agreement on skills and competencies in urban South Africa. A descriptive cross-sectional design and the online semi-structured survey was undertaken between 30 September to 14 October 2020. We targeted 5,212 private GPs registered on Medpages in Gauteng Province. Respondents who answered all questions were conveniently sampled. Data analysis was performed using SAS institute software, version 9.4. A four-point Likert scale was categorized as agree or disagree. A Wald Chi-square test evaluated associations between variables. Findings revealed that most had no government contract (84.3%, n=97) and were solo (53%, n=61). The majority were agreeable to the eye, ear, nose, and throat skills (93.3%, n=207). The least agreeable was the abdominal skill (32.7%, n=72). Logistic regression showed qualifications, work experience and type of practice were significant predictors. The GP contracts affected the skills range. Surveyed GPs did not agree on many listed skills. Significant predictors of an agreement to skills in the current practice were identified. The findings highlight the need to fast-track GP skills training in South Africa.


[1] United Nations. Sustainable Development Goals. 2018. New York

[2] Tangcharoensathien V, Mills A, Palu T. Accelerating health equity: the key role of universal health coverage in the Sustainable Development Goals. BMC Medicine. 2015;13(1):101.

[3] Government of South Africa. Chapter 10: ‘Promoting Health in the National Development Plan 2030.’ 2018. Pretoria. Government of South Africa: 330–351.

[4] Department of Health South Africa. Health minister’s presentation on the NHI Bill. 2018.

[5] Government of South Africa. National Health Insurance. 2015.

[6] Department of Health South Africa. White paper: National health insurance for South Africa: Towards universal health coverage. Government gazette. Friday, 11 December 2015. Version 40.

[7] Uchenna C, Govender, I. Knowledge, attitudes, and practices of doctors at Jubilee Hospital, Tshwane District, regarding the syndromic management guidelines for sexually transmitted infections. SA Family Pract. 2018; 60(5):155–161.

[8] Couper I, Mash R. Obtaining consensus on core clinical skills for training in family medicine. SA Family Pract.2008; 50(6):69–73.

[9] Mash B, Couper I, Hugo J. Building consensus on clinical procedural skills for South Africa family medicine training using Delphi technique, SA Family Pract. 2006; 48(10):14a-e.

[10] Malan Z, Cooke R, Mash R. The self-reported learning needs of primary care doctors in South Africa: a descriptive survey. SA Family Pract. 2015; 57(1):35–43.

[11] Mash R, Malan Z, von Pressentin K, Blitz J. Strengthening primary health care through primary care doctors: the design of a national postgraduate diploma in family medicine. SA Family Pract. 2016; 58(1). doi:10.1080/20786190.2015.1083719.

[12] Moosa S, Gibbs A. A focus group study on primary health care in Johannesburg Health District: “We are just pushing numbers.” SA Family Pract. 2014; 56(2):147-152.

[13] South African Government. South Africa’s provinces. 2019.

[14] South African Demographic and Health Surveys Program. The DHS Program - Research Topics - Wealth Index. The 2019 South African Demographic and Health Surveys. 2019.

[15] Medpages. Statistics - Medical professionals in South Africa. 2020.

[16] Bitton A, Fifield J, Ratcliffe H. Primary healthcare system performance in low-income and middle-income countries: a scoping review of the evidence from 2010 to 2017. BMJ Global Health. 2019;4: e001551.

[17] Von Pressentin K, Mash R, Esterhuizen T. Examining the influence of family physician supply on district health system performance in South Africa: An ecological analysis of key health indicators. Afr J Prim Health Care Fam Med. 2017; 9(1). doi:10.4102/phcfm. v19i1.1298.

[18] Von Pressentin K, Mash R, Baldwin-Ragaven L, Botha R, Govender I, Steinburg W, et al. The
Influence of Family Physicians Within the South African District Health System: A cross-sectional study. Ann of Fam Med. 2017;16(1):28–36.

[19] Moosa, Downing R, Mash R, Essuman A, Reid S, Pentz S. Understanding of family medicine in Africa - a qualitative study of leaders’ views. Bri J Gen Pract. 2018; e209-216.

[20] Mash R, Ogunbanjo G, Naidoo SS, Hellenberg D. The contribution of family physician to district health services: a national position paper for South Africa. SA Family Pract. 2015; 57(3):54–61.

[21] Mofolo N, Heunis C, Kigozi GN. Towards national health insurance: Alignment of strategic human resources in South Africa. African Journal of Primary Health Care and Family Medicine. 2019; 11(1):7.

[22] Chan C, Wun Y, Cheung A, Chan K, Lee H, Yung Y. Communication skill of general practitioners: any room for improvement? How much can it be improved? Medical Education. 2003; 37:514–526.

[23] Mathew S, Mash R. Exploring the beliefs and attitudes of private general practitioners towards national health insurance in Cape Town, South Africa. Afr J Prim Health Care Fam Med. 2019; 11(1): e1–e10.

[24]   Akoojee Y, Mash R. Reaching national consensus on the core clinical skill outcomes for family medicine postgraduate training programs in South Africa. Afr J Prm Health Care Fam Med. 2017; 9(1): a1353.