The quality of primary care services in public sector facilities in a Ugandan district: a cross-sectional descriptive study

Abstract

Background In order to strengthen primary health care (PHC), there is a need to measure its performance. The World Health Organisation has published a measurement framework for PHC. This framework emphasised the core functions of primary care: access, continuity, coordination, comprehensiveness and person-centredness. This study aimed to measure the performance of primary care using the Primary Care Assessment Tool (PCAT) in one rural Ugandan district. Methods A cross-sectional survey of Tororo District administered the PCAT across a sample of 51/58 PHC facilities. There were four levels of health facilities (health centres II to general hospital). A random sample of at least 100 users was obtained from each level, and from all primary care providers and managers. Data was collected in REDCap software, and analysed in the Statistical Package for Social Sciences vs23. Results Only 35.1% of users had a strong affiliation with their PHC facility. The overall primary care score suggested that performance was acceptable to the majority of users (58.9% rating the performance at least acceptable). Ongoing care was rated by users as very poor (< 25% of people rating it at least acceptable). Comprehensiveness (services available) was rated as poor by users (≤ 50% finding it at least acceptable). Users rated first contact access and coordination (information systems) as acceptable (51–75% finding them at least acceptable). Person-centredness and comprehensiveness (services provided) were rated as good by users (> 75% rating them as acceptable or more). Providers and users differed significantly in their scoring across all domains, with providers usually more positive. Performance significantly improved as the PHC level increased, with the general hospital having the highest score. Conclusion The PCAT was able to identify the primary care functions that needed improving. The results will be used to co-design interventions to improve performance. The PCAT may be a useful tool to measure PHC performance across the region.