Performance of primary care in different healthcare facilities: a cross-sectional study of patients’ experiences in Southern Malawi

Abstract

ObjectiveIn most African countries, primary care is delivered through a district health system. Many factors, including staffing levels, staff experience, availability of equipment and facility management, affect the quality of primary care between and within countries. The purpose of this study was to assess the quality of primary care in different types of public health facilities in Southern Malawi.Study designThis was a cross-sectional quantitative study.SettingThe study was conducted in 12 public primary care facilities in Neno, Blantyre and Thyolo districts in July 2018.ParticipantsPatients aged ≥18 years, excluding the severely ill, were selected to participate in the study.Primary outcomesWe used the Malawian primary care assessment tool to conduct face-to-face interviews. Analysis of variance at 0.05 significance level was performed to compare primary care dimension means and total primary care scores. Linear regression models at 95% CI were used to assess associations between primary care dimension scores, patients’ characteristics and healthcare setting.ResultsThe final number of respondents was 962 representing 96.1% response rate. Patients in Neno hospitals scored 3.77 points higher than those in Thyolo health centres, and 2.87 higher than those in Blantyre health centres in total primary care performance. Primary care performance in health centres and in hospital clinics was similar in Neno (20.9 vs 19.0, p=0.608) while in Thyolo, it was higher at the hospital than at the health centres (19.9 vs 15.2, p<0.001). Urban and rural facilities showed a similar pattern of performance.ConclusionThese results showed considerable variation in experiences among primary care users in the public health facilities in Malawi. Factors such as funding, policy and clinic-level interventions influence patients’ reports of primary care performance. These factors should be further examined in longitudinal and experimental settings.

Evaluation of the first level of care for tuberculosis control in Buenos Aires, Argentina

“…This study included PHC centers and centers specializing in TB treatment (in general, hospitals with highly qualified human and technical resources), without differentially disaggregating the results; thus, it is hard to compare these results with those of this study. Other studies in South Africa, Malawi, Hong Kong, and Shanghai that used the PCAT tool to evaluate health systems from the users' perspective found, as in this study, unsatisfactory average values for several domains (21)(22)(23). Nevertheless, none of these studies focused on vulnerable populations with TB.…”

Evaluación del primer nivel de atención para el control de la tuberculosis en Buenos Aires, Argentina

“…Otros estudios realizados en Sudáfrica, Malawi, Hong Kong y Shanghái, que utilizaron el instrumento PCAT para evaluar los sistemas de salud desde la perspectiva de los usuarios, encontraron, al igual que en el presente estudio, valores promedios no satisfactorios para varios dominios (21)(22)(23). No obstante, Grupos…”

Factors associated with poor self-rated health in primary care in Malawi

“…Data was collected through face-to-face interviews using the Malawi Primary Care Assessment Tool (PCAT-MW), which was validated for use in Malawi (20,23). The questionnaire has 29 items, which measure patients' experiences of the ve core dimensions of primary care: rst-contact-access; continuity-communication; continuity-relation; comprehensiveness of services; coordination of care; and community orientation (23).…”