Original Research

Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013)

Graham F. Bresick, Abdul-Rauf Sayed, Cynthia le Grange, Susheela Bhagwan, Nayna Manga, Derek Hellenberg
African Journal of Primary Health Care & Family Medicine | Vol 8, No 1 | a1057 | DOI: https://doi.org/10.4102/phcfm.v8i1.1057 | © 2016 Graham F. Bresick, Abdul-Rauf Sayed, Cynthia le Grange, Susheela Bhagwan, Nayna Manga, Derek Hellenberg | This work is licensed under CC Attribution 4.0
Submitted: 14 October 2015 | Published: 19 May 2016

About the author(s)

Graham F. Bresick, Division of Family Medicine School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, South Africa, South Africa
Abdul-Rauf Sayed, Division of Family Medicine School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, South Africa
Cynthia le Grange, Division of Family Medicine School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, South Africa
Susheela Bhagwan, Division of Family Medicine School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, South Africa
Nayna Manga, Division of Family Medicine School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, South Africa
Derek Hellenberg, Division of Family Medicine School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, South Africa


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Abstract

Background: Major health sector reform and the need for baseline measures of performance to determine impact.

Aim: Baseline audit of primary healthcare (PHC) performance.

Setting: Cape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa.

Method: The South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study.

Results: Data from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance ‘acceptable to good’). 11.5% users scored access ‘acceptable to good’; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers.

Conclusion: Gaps between users’ experience and providers’ assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research.


Keywords

primary care metrics; essential elements; measuring performance

Metrics

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