Evaluating the performance of South African primary care: a cross-sectional descriptive survey

Abstract

In 2018 governments reaffirmed their commitment to implementing primary health care (PHC) in the Astana Declaration. South Africa has introduced a number of health reforms to strengthen PHC and enable universal health coverage (UHC). UHC requires access to quality primary care and progress needs to be measured. This study aimed to evaluate the quality of South African primary care using the Primary Care Assessment Tool (PCAT). Methods: A descriptive cross-sectional survey used data derived from a previous analytical observational study. Data from 413 patients, 136 health workers and 55 managers were analysed from 30 community health centres across four provinces of South Africa. Scores were obtained for 10 key domains and an overall primary care score. Scores were compared in terms of respondents, provinces and monthly headcount. Results: Patients rated first contact accessibility, ongoing care and community orientation as the poorest performing elements (< 50% scoring as 'acceptable to good'); first contact utilisation, informational coordination and family-centredness as weaker elements (< 66% scoring as 'acceptable to good'); and comprehensiveness, coordination, cultural competency and availability of the PHC team as stronger aspects of primary care (≥ 66% or more scoring as 'acceptable or good'). Managers and providers were generally much more positive about the performance of PHC. Conclusion: Gaps exist between PHC users' experience of care and what PHC staff believe they provide. Priorities to strengthen South African primary care include improving access, informational and relational continuity of care, and ensuring the implementation of community-orientated primary care. The PCAT is a useful tool to measure quality of primary care and progress with UHC.

Primary health care performance: a scoping review of the current state of measurement in Africa

“…The databases search yielded 5215 peer-reviewed studies (figure 1). At this stage a newly published study24 not yet indexed in Medline was added; it met the HR-1 rating. All titles were screened; abstracts of titles that screened positive or uncertain were examined.…”

“…Thirteen studies24–36 addressed eight nationally validated PC performance instruments—namely the South African and Malawian versions of the Primary Care Assessment Tool (ZA PCAT and PCAT-Mw respectively)26 34; the electronic Tool to Improve Quality of Healthcare (e-TIQH) in Tanzania25; the Nigerian Patient Evaluation Scale (PES)31; the South African Ideal Clinic Realisation and Maintenance (ICRM) instrument29; SafeCare Essentials tool33; the European Task Force for Patient Evaluation of General Practice (EUROPEP)37; and the Client Satisfaction Survey Questionnaire 35. (Information on instruments is summarised in Appendix D uploaded as a supplementary file.)…”

The quality of feedback from outpatient departments at referral hospitals to the primary care providers in the Western Cape: a descriptive survey

“…14 Although not noted in this study, first contact access to PCPs and their expertise have been identified as issues elsewhere. 7,15 Transport came through as a major barrier to care in this study, but was not mentioned in the systematic review.…”

Patient experiences in a public primary health care clinic: A South African case study

“…The quality of care in PHC facilities is a reoccurring topic that attracts public attention and scrutiny, following strong evidence throughout the years that the health system should be more responsive (e.g. Bresick et al 2019aBresick et al , 2019bKelly et al 2019;Peltzer 2009;Peltzer -Phaswana-Mafuya 2012).…”