Identifying primary health-care challenges using the importance–Performance analysis: Implications for a low- and middle-income country

Background: Including patient's evaluation in the comprehensive measurement of primary health-care (PHC) performance is a valid and reliable approach for the assessment and improvement of local PHC system. Aim: This study demonstrates the use of the importance–performance analysis (IPA) for identifying challenges in PHC centers in Obio-Akpor. Materials and Methods: This was a quantitative survey of first-time visitors to four PHC centers in Obio-Akpor. A total of 337 participants were selected from a two-stage sampling approach and administered the Patient Evaluation Scale which was structured to elicit their ratings on the importance of PHC centers' attributes before and the performance on these attributes after their encounter with the facility. Descriptive and inferential statistics were performed using the SPSS version 21, and PHC centers' attributes were aggregated across each of the four IPA quadrants. Results: The response rate was 89% and the Cronbach's alpha coefficient was 0.91 and 0.94 for the importance and performance measurement scales, respectively. More of the respondents were below 40 years (87.7%), female (73.7%), and currently married (69.3%). Observed areas of concentration for PHC improvement were staff availability during operating times, ease of payment, waiting time, convenience of operating hours, and availability of electricity in the facility. Conclusion: Findings provide evidence of patients' concerns in the local PHC system. Subsequent validation and focused interventions aimed at resolving identified challenges can positively influence the demand and social relevance of PHC in this setting.