WESTERN CAPE PRIMARY CARE ASSESSMENT TOOL (PCAT) STUDY: A BASELINE MEASURE OF PRIMARY CARE PERFORMANCE IN SOUTH AFRICA (2013)

Introduction and Objectives: The South African health system is undergoing major reform. Good PHC performance is associated with improved health and reduced costs. Urban and rural public PHC facilities (PCFs) in Western Cape Province, South Africa, were audited for baseline performance prior to reform. Method: The South African cross-culturally validated ZA PCAT was administered to users, practitioners and managers to audit performance on 11 primary care sub-domains. Adult users were systematically sampled. All full-time practitioners (doctors and nurse practitioners) in PCFs sampled and all PCF managers in districts sampled were invited into the study. Results and Conclusions: 1432 users, 100 practitioners and 64 managers in 13 PCFs in 10 urban and rural sub-districts were surveyed. (Percentages indicate proportions scoring sub-domains "acceptable to good“).11.5% of users scored access as "acceptable to good“; for community orientation and comprehensive services provided users’ scores were 20.8% and 39.9% respectively. Total primary care score for users, managers and practitioners was 50.2%; 82.8% and 88.0% respectively. Practitioners scored access lowest (33.3%); comprehensive services available (100%) and PHC team (98%) highest. Managers scored access (13.5%) and family centeredness (45.6%) lowest; comprehensive services available (90.6%) and PHC team (85.9%) highest. Managers scored access, family centeredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers. Conclusion: Significant gaps exist between user experience and practitioner and manager assessments. PHC needs aligning with best practice and national and provincial health policies. Results should inform training, health policy and research.