Core functions of primary care in Amathole district, South Africa: a descriptive study

Background: Strengthening primary care is a priority globally and for the South African health system. The current measurement tools in South Africa do not measure the core functions of primary care: access, comprehensiveness, coordination, continuity and person-centredness. A new regional version of the Primary Care Assessment Tool (PCAT) has just been validated and can measure these core functions.

Aim: To field test the regional PCAT and measure the core functions of primary care performance.

Design & setting: A descriptive cross-sectional survey in Amathole District, South Africa.

Method: Data were collected from 386 randomly selected patients from 40 clinics and six subdistricts. Data was collected using the REDCap mobile App and analysed in the Statistical Package for Social Sciences version 27.

Results: The median primary care score was 3.3 (IQR 3.2-3.5) where a score>3 was seen as acceptable performance and>3.5 as good. Person-centredness, coordination and utilisation were all scored as good (4.0 (IQR 4.0-4.0). Comprehensiveness (3.3 (IQR 2.9-3.6) and continuity (3.2 (IQR 3.1-3.6) were scored as acceptable. Access to care was scored as poor (1.7 (IQR 1.0-2.9). There were significant differences in primary care scores between subdistricts. Those with a worse health status or chronic condition gave lower scores. The most affluent and the poorest groups also gave lower scores.

Conclusion: The district needs to focus on improving access to care as well as some aspects of comprehensiveness, continuity, and coordination. The newly validated regional PCAT provided the district with novel information for performance management and improvement.