Critical evaluation of the influence of ideal clinic status on the quality of primary care services provision in eThekwini District, South Africa

Abstract

Introduction and background As the global world commits to achieving universal health coverage by 2030, there is a growing acknowledgement that optimal cannot be delivered by simply ensuring the coexistence of infrastructure, medical supplies and providers. Improvement in delivery requires deliberate focus on quality of health services that include providing effective, safe, people-centered care that is timely, equitable, integrated and efficient. Global quality reports note that billions of people will not gain from potential universal coverage benefits unless improvements in health system quality are realised. In South Africa, several quality improvement initiatives have been implemented, the Ideal Clinic Realisation and Maintenance initiative being the latest initiative aimed at improving quality services provision, especially at primary care level as the entrance point into the system. Research on improved quality provision in facilities with ideal status is thus crucial to providing quality health services for all South Africans based on their needs, irrespective of socio-economic status. Aim of the study The study aimed to critically evaluate the influence of Ideal Clinic status on the quality of primary health care service provision in eThekwini District, South Africa, thereby proposing an Ideal Clinic practice framework that will enhance an improved quality of healthcare service provision in primary health care facilities. Objectives of the study The objectives of the study were to determine the current practices of providers and the status of user records in ideal primary facilities; to explore the perspectives of healthcare providers regarding the influence of Ideal Clinic status on quality of patient care; to ascertain the perspectives of the health care users on the quality of care received in facilities with ideal status; and, to propose an Ideal Clinic prctice framework that can be used to enhance improved quality healthcare service provision in primary health care facilities irrespective of Ideal Clinic status. iii Methodology A convergent parallel design, where both qualitative and quantitative methods were used to collect data within a short period to avoid potential threats to validity. The quantitative data collection consisted of (n = 360; 88.8%) retrospective record reviews of adult clinical records and (n = 45; 11.1%) children’s records and a self administered questionnaire from (n = 54; 85.7%) professional nurses and (n = 9; 14.2%) facility operational managers. The qualitative data collection consisted of semi-structured interviews with (n = 8) healthcare providers to explore their perspectives regarding the influence of Ideal Clinic status on the quality of care provision to healthcare users and (n = 14) healthcare users. The perspectives of the healthcare users regarding the quality of care received in facilities with ideal status were ascertained. Data analysis of the quantitative data was via descriptive and inferential statistics, and the qualitative analysis was via thematic analysis. The two data strands were analysed independently and inferences made from each strand were synthesized to form conclusions about the findings. The results of the two separate analyses were mixed for an overall interpretation of the findings. Findings Although the PHC facilities included in the study had been awarded Ideal Clinic status, it was evident that Ideal status did not automatically translate to quality of care in most facilities. There were important care assessments that had been inadequately performed or not done at all. These included physical examinations that were not performed, poor or no documentation on clinical records, shortage of medical supplies, and lack of training and support for staff. Recommendations Recommendations are of a short-term nature and can be achieved with buy-in from the policy makers. Long-term recommendations include renovation of primary health care facilities to cater for the full package of primary health care services, human resources and medical equipment. Conclusion Based on the findings, a practice framework was developed to provide structure using evidence-based practices on interventions that would assist policy makers and implementers to engage in relevant actions for improving quality service provision irrespective of the Ideal Clinic status.