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

Abstract

Background Integrated 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 paucity of information on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya. Methods A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data were 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 an overall low 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 showed gaps in performance. Performance was rated as acceptable-to-good for first-contact utilisation, the information systems, family-centredness and cultural competence. However, patients rated low performance related to first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, incentivising use of these PC clinics rather than the tertiary hospital, improving access after-hours and marketing the use of the clinics to the practice population.

Adaptation and validation of the Ugandan Primary Care Assessment Tool

“…The Kenyan version (KE-PCAT), also adapted from the ZA PCAT, is similar to the UG-PCAT with only three items removed and two rephrased. 32 The same three items removed from the Kenyan version were also removed from the UG-PCAT and were from the same domain of comprehensiveness (services available). Therefore, other than the added person centredness domain to the UG-PCAT, the two versions are very similar.…”

The quality of primary care services in public sector facilities in a Ugandan district: a cross-sectional descriptive study

“…All the domains with poor primary care performance in the Ugandan study also had poor performance in the Kenyan study, an indication of similarity in the health system organisation and function probably due to contextual proximity. (25) The users' perspective was different from providers in all 11 domains and from the managers in seven domains. Their perspective was mostly more negative than the providers.…”

“…First contact (access) was just acceptable, and this was similar to ndings from other African studies. (21,25,30) Access is one of the preconditions for ongoing care as users can only continue to use services which are accessible. (31) This may be the explanation for the rating of on-going care as poor (providers) and very poor (users).…”

“…The PCAT was originally developed in the United States of America at The John Hopkins Policy Centre, (22) and has been adapted and validated for use in multiple countries. (23)(24)(25)(26)(27) As a prelude to this survey the PCAT was adapted and validated in the Ugandan context. (19) The Ugandan PCAT (UG PCAT) has an additional domain on person-centredness with 13 items.…”

How does people-centered integrated care in medical alliance in China promote the continuity of healthcare for internal migrants: The moderating role of respect

“…Li also proposed that interprofessional collaboration and two-way referral enable patients gain access to the green channel provided by hospital, so that reduce the segments of waiting time, and promote coherent information and health services ( 50 ). Gulnaz et al proposed that poor continuity is usually associated with missing the opportunities for health promotion and disease prevention ( 51 ).…”