Lessons Learnt From the Experiences of Primary Care Physicians Facing COVID-19 in Benin: A Mixed-Methods Study

Abstract

IntroductionIn sub-Saharan Africa, there is a need to better understand and guide the practice of primary care physicians (PCPs), especially in a crisis context like the COVID-19 pandemic. This study analyses the experiences of PCPs facing COVID-19 in Benin and draws policy lessons.MethodsThe study followed a fully mixed sequential dominant status design. Data were collected between April and August 2020 from a sample of PCPs in Benin. We performed descriptive analyses on the quantitative data. We also performed bivariate analyses for testing associations between various outcomes and the public/private status of the PCPs, their localization within or outside the cordon sanitaire put in place at the beginning of COVID-19, and their practice' category. A thematic content analysis was done on qualitative data. Results from both analyses were triangulated.ResultsNinety PCPs participated in the quantitative strand, and 14 in the qualitative. The median percentage of the COVID-19 control measures implemented in the health facilities, as reported by the PCPs, was 77.8% (interquartile range = 16.7%), with no difference between the various groups. While 29.4% of the PCPs reported being poorly/not capable of helping the communities to deal with COVID-19, 45.3% felt poorly/not confident in dealing with an actual case. These percentages were bigger in the private sector. The PCP's experiences were marked by anxiety and fear, with 80.2% reporting stress. Many PCPs (74.1%) reported not receiving support from local health authorities, and 75.3% felt their concerns were not adequately addressed. Both percentages were higher in the private sector. The PCPs especially complained of insufficient training, insufficient coordination, and less support to private providers than the public ones. For 72.4 and 79.3% of the PCPs, respectively, the pandemic impacted services utilization and daily work. There were negative impacts (like a decrease in the services utilization or the quality of care), but also positive ones (like improved compliance to hygiene measures and new opportunities).ConclusionOur study highlighted the need for more structured support to PCPs for optimizing their contribution to epidemics control and good primary healthcare in Benin. Efforts in this direction can build on several good practices and opportunities.

Primary health care improvement in Benin: Cocreating an evidence-informed policy framework to guide the practices of primary care physicians

“…This is consistent with the views reported elsewhere on family physicians' role in Africa [11,47], and it entails allowing competent non-physicians to contribute to patient management. This recommendation is also supported by empirical work in Benin, which showed that patients spontaneously chose nurses for simple cases [32]. Furthermore, international literature indicates that task sharing between physicians and nurses increases accessibility [5,39,48] and that experienced nurse practitioners can adequately care for many primary care encounters [49].…”

“…The first study described and categorised the PCPs' practices in Benin [18]. The second study learnt from the PCPs' experiences with the COVID-19 pandemic to further understand the strengths and weaknesses of their practices, especially during crises [10]. In the third study, we analysed the performance of 8 interesting cases of PCPs' practices, selected based on their performance levels and other characteristics, to understand the factors that influence these practices [32].…”

“…Regarding the objective to ensure patient and community satisfaction, it strongly reflects a subject currently high on the agenda in Benin [32,40] and the international community [11,41]: improving patient welcome and respectful care. However, this objective could be further discussed in Benin to reflect a more active role for patients and communities.…”

“…It involves a genuine collaboration where each team member brings an added value. Unfortunately, in many cases, such teamwork is inexistent in Benin [32]. The Benin PCPs policy framework's recommendation of teamwork will thus improve PCPs' performance and ensure patients benefit from a diverse range of complementary skills among PCPs and their team members.…”

“…Whatever referral system is chosen, PCPs and their teams will need direct communication lines, regular contacts for learning and sharing and good coordination with various providers within the referral network. This communication is often lacking in Benin [10], and some good practices can inspire the country. For instance, online platforms can collect and share patient data among relevant providers and provide guidelines and other useful resources to health providers for one-on-one discussions between providers and continuous group discussions [48,60].…”