An early morning queue outside Nyanga clinic in 2015. Photo: Masixole Feni
29 September 2016
Patients’ experiences of primary healthcare are vastly different from what doctors and nurses believe is being provided.
This is according to a published study published in May by researchers at the University of Cape Town that measured the performance of primary care facilities in Cape Town and the Winelands.
Overall, only about 50% of patients scored the facilities as “acceptable to good”, compared to managers and clinicians, of which about 80% and nearly 90% respectively rated them as “acceptable to good”.
Both nationally and provincially, great emphasis is placed on providing good primary health care. The Western Cape Government calls it the most “critical component” of healthcare as it is the entry-point to receiving care. At the national level there is also a plan to “reengineer” the primary healthcare system, to one with a “more proactive, integrated and population-based approach”.
The study’s findings are therefore a “cause for concern”, say its authors as they show a large gap in this system, where the doctors and nurses who care for patients believe that the services rendered by their facilities are much better than that actually experienced by the patients.
The study interviewed thousands of patients, 100 doctors and nurses, as well as over 60 managers in 10 urban and rural sub districts in the Western Cape.
The three areas where these discrepancies were largest were in comprehensiveness of services, family centeredness and community orientation.
Comprehensive care refers to the provision of a range of essential health services. Only about 40% of patients rated the comprehensive care provided as good, compared to more than 70% of doctors and nurses who thought that a thorough service was provided.
Large differences were also seen between practitioners and patients in the arena of community orientation. This looks at how well the service is targeted at its population and how it responds to the community’s needs. Just over 20% of patients rated the facilities as adequately community orientated. In contrast, about 80% of practitioners believed the facilities to be community orientated, as did nearly 70% of managers.
During feedback sessions, managers of these facilities were surprised at the low score that the patients had given and believed that perhaps the community was not aware of some of the services on offer.
Family centeredness scored relatively low amongst managers and patients – only 45% of managers rated the family centeredness of the facility as “good” and only just over 50% of patients rated them as such.
This is compared to nearly 80% of doctors and nurses who scored the facility’s family centeredness as “good”. Family centred healthcare sees the family as an important part of diagnosis and patient care. It has also been shown to improve health outcomes.
Access to primary healthcare was the lowest rated item across the board, with only about 10% of patients rating it as “acceptable to good”. Factored into this score are opening and waiting times, as well as staff attitudes.
GroundUp has previously reported the long waiting times that patients experience at clinics in Cape Town, with some patients arriving at facilities long before the sun rises and hours before the clinic opens.
The study recommends two interventions to strengthen public healthcare: partnerships with the community the facilities serve, and the registration of patients at a particular facility. “An audit is of little use if the information generated is not used to identify and guide interventions – in this case directed at strengthening public health care,” state the authors.