The Quality of Primary Care Performance in Private Sector Facilities in Nairobi, Kenya: A Cross-Sectional Descriptive Survey

Abstract

BackgroundIntegrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is little information on these key elements and such information is needed to improve service delivery. This study aimed to evaluate the quality of primary care performance in a group of private sector clinics in Nairobi, Kenya.Methods A cross-sectional descriptive study adapted the Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data was analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences.Results Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying poor overall performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact (access), coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good.Conclusion These primary care clinics in Nairobi had a poor overall performance. There was a report of acceptable-to-good performance in first-contact utilisation, the information systems, family centredness and cultural competence. However, patients rated first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team, as poor. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, improving access after-hours and marketing the use of the clinics to the practice population.

The quality of primary care performance in private sector facilities in Nairobi, Kenya: a cross-sectional descriptive survey

“…Even in high income countries such as Canada, comprehensive care is still an issue, despite having high relational continuity with providers [ 32 ]. In addition, the training of doctors in Kenya does not prepare them for comprehensive primary care, although additional training in family medicine may narrow this gap [ 46 , 47 , 48 ]. Comprehensive care plays a fundamental role in care continuity and when both are not delivered at an acceptable level it has implications for health outcomes [ 28 , 49 , 41 ].…”

“…Services may not be provided by the GPs due to the availability of hospital specialists [ 50 ], which in turn results in the GPs becoming deskilled [ 51 ]. General practitioners may also lack certain skills to provide essential PC in specific areas of surgery, women’s health, ear, nose and throat, ophthalmology and orthopaedics, which may result in increased overall costs and hospital visits [ 48 , 52 ].…”

“…Several studies have related geographical proximity [ 37 ], family medical insurance cover [ 26 , 27 ], duration of affiliation, and high utilisation of PC, with higher family-centredness [ 36 , 54 ]. On the other hand, evaluation of consultations in the same settings showed that the GPs did not explore the family and social context in more than half of the consultations [ 48 ]. Patients clearly felt that GPs were open to considering family in the consultations, although this was not borne out by actual observation of the consultations [ 48 ].…”

“…On the other hand, evaluation of consultations in the same settings showed that the GPs did not explore the family and social context in more than half of the consultations [ 48 ]. Patients clearly felt that GPs were open to considering family in the consultations, although this was not borne out by actual observation of the consultations [ 48 ].…”

“…The users rated the composition of members of the primary health care team as low, which could be due to lack of awareness of the available services [ 26 ], or gaps in access to a multidisciplinary team and comprehensive care [ 26 , 27 ]. Despite the gap in the PC team, there was a high level of care coordination within the teams at the facilities [ 48 ]. Many of the disciplines usually found in PC were actually located in the tertiary hospital, such as family medicine, social work, physiotherapy, dentistry and dietetics [ 26 ].…”