Evaluating the performance of South African primary care: a cross-sectional descriptive survey

Introduction: In 2018 governments reaffirmed their commitment to implementing primary health care (PHC) in the Astana Declaration. South Africa has introduced a number of health reforms to strengthen PHC and enable universal health coverage (UHC). UHC requires access to quality primary care and progress needs to be measured. This study aimed to evaluate the quality of South African primary care using the Primary Care Assessment Tool (PCAT). Methods: A descriptive cross-sectional survey used data derived from a previous analytical observational study. Data from 413 patients, 136 health workers and 55 managers were analysed from 30 community health centres across four provinces of South Africa. Scores were obtained for 10 key domains and an overall primary care score. Scores were compared in terms of respondents, provinces and monthly headcount. Results: Patients rated first contact accessibility, ongoing care and community orientation as the poorest performing elements (< 50% scoring as 'acceptable to good'); first contact utilisation, informational coordination and family-centredness as weaker elements (< 66% scoring as 'acceptable to good'); and comprehensiveness, coordination, cultural competency and availability of the PHC team as stronger aspects of primary care (>= 66% or more scoring as 'acceptable or good'). Managers and providers were generally much more positive about the performance of PHC. Conclusion: Gaps exist between PHC users' experience of care and what PHC staff believe they provide. Priorities to strengthen South African primary care include improving access, informational and relational continuity of care, and ensuring the implementation of community-orientated primary care. The PCAT is a useful tool to measure quality of primary care and progress with UHC.