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

Graham Bresick,Klaus B Von Pressentin,Robert Mash

doi:10.4102/safp.v61i3.4981

Graham Bresick, Klaus B Von Pressentin + Show 1 more

Open Access

https://doi.org/10.4102/safp.v61i3.4981

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Abstract

Introduction: 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.

Highlights

In 2018 governments reaffirmed their commitment to implementing primary health care (PHC) in the Astana Declaration
The distribution of sites across the provinces differed from the intended sampling method as some provinces did not employ FPs at CHCs or instead exposed all CHCs to FPs employed at the sub-district level
In total 136 primary care providers completed the questionnaire of whom 45.6% were nurse practitioners, 30.9% doctors and 23.5% other healthcare workers

Summary

Introduction

In 2018 governments reaffirmed their commitment to implementing primary health care (PHC) in the Astana Declaration. Ten years ago the World Health Organization reiterated that health systems needed primary health care ‘ more than ever’ and proposed four key reforms related to person-centredness, realising universal coverage, a ‘health in all policies’ approach, and leadership which is more responsive and accountable to society’s needs.[2] In 2018 countries met again to renew their commitment to primary health care (PHC) at Astana and to make a new declaration.[3] Despite this global commitment to the principles of and need for PHC, actual implementation has not lived up to expectations. Such an approach reduces PHC to vertical, selective programmes in tackling aspects of the burden of disease rather than promoting delivery of comprehensive PHC that includes health promotion and disease prevention.[4]

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