Improving the core functions of primary care in sub-Saharan Africa

• Research question

The Primary Care Assessment Tool (PCAT) has the potential to measure all the core functions of primary care in the manner suggested by World Health Organization (WHO) and to enable improvement in the quality of care. The question is how best to create a PCAT for general use in sub-Saharan Africa so that countries can measure and monitor the core primary care functions and drive improvement in quality of care.

• Background

The vital role of a comprehensive primary care system within any healthcare infrastructure cannot be overstated. It functions as the initial point of contact for individuals within the healthcare system, providing an enduring continuum of care and a broad range of services. This need is acutely felt in sub-Saharan Africa, a region grappling with a multitude of health-related challenges.

The World Health Organization (WHO) has delineated several fundamental functions of primary care, which encompass first-contact accessibility, continuity, comprehensiveness, coordination, and a people-centric approach. However, the evaluation of these core functions presents a formidable challenge, particularly in low to middle income nations with restricted access to data and health information systems.

To rectify this, the Primary Care Assessment Tool (PCAT) has been developed and implemented in various countries, demonstrating its potential to measure all core functions of primary care. • Aims and objectives

This study aims to adapt a PCAT for widespread use in sub-Saharan Africa, allowing countries to track and monitor their primary care functions and improve the quality of care provided. The proposed PCAT will be multilingual and available in digital and paper formats, ensuring its accessibility and usability throughout the region. Local and regional stakeholders will engage with the PCAT findings and plan interventions to improve the quality of primary care.

• Methods

The methodology of this study will involve employing the PCAT to evaluate the core dimensions of primary care from the perspectives of users at a primary care facility. The research will be conducted in eleven countries in sub-Saharan Africa, each represented by a local researcher and stakeholders from the department of health. This will yield invaluable insights into the performance of primary care in each country, facilitating comparisons between rural and urban areas and inter-country disparities.

• Timelines for delivery

The proposed timeline for this study spans three years, with the initial year dedicated to the development of the PCAT for sub-Saharan Africa. The second year will focus on the assessment of core primary care functions in the selected countries, while the final year will involve stakeholder engagement, planning for intervention, and dissemination of findings.

• Anticipated impact and dissemination

The anticipated impact of this study is significant. The findings are expected to inform improvements in the core functions of primary care in African healthcare systems, thereby enhancing access, comprehensiveness, continuity, coordination, and people-centeredness of care. The PCAT is anticipated to become a widely used tool for primary care researchers and health information systems for gauging the performance of primary care.

The evidence generated could potentially inform WHO recommendations on the measurement of core primary care functions.