Primary care performance in a Ugandan rural district: a cross-sectional descriptive study.

Abstract

Background: To strengthen primary health care (PHC), there is a need to measure its performance. Global recommendations emphasise patient involvement in the improvement of services.

Aim: To measure primary care performance in one rural Ugandan district.

Design & setting: A cross-sectional survey of Tororo District where the Ugandan Primary Care Assessment Tool (UG-PCAT) was administered across a sample of 51 facilities. There were four levels of health facilities (health centre [HC] II, HC III, HC IV, and general hospital).

Method: A sample of 488 users was obtained from each of the four levels while including all primary care providers and managers at the health facilities. Data were collected in REDCap software, and analysed using Statistical Package for Social Sciences (version 23).

Results: Only 35.1% of users had a strong affiliation with their PHC facility. Overall, the primary care score suggested that performance was acceptable to the majority of users (58.9% rating performance at least acceptable). Ongoing care was rated by users as very poor (<25% of people rating it at least acceptable). Comprehensiveness (services available) was rated poor by users (<50% finding it at least acceptable). Users rated first-contact access and coordination (information systems) acceptable (51-75% finding them at least acceptable). Person-centredness and comprehensiveness (services provided) were rated good by users (>75% rating them as acceptable or more). Providers and users differed significantly (P value <0.05) in their scoring across all domains, with providers usually more positive. Performance significantly improved as the PHC level increased (P value <0.05).

Conclusion: Primary care performance in the study district was suboptimal. The UG-PCAT identified primary care functions that needed improving and may be a useful tool to measure PHC performance across the region.