Article Text
Abstract
Introduction Countries with strong primary healthcare (PHC) report better health outcomes, fewer hospital admissions and lower expenditure. People-centred care that delivers essential elements of primary care (PC) leads to improved health outcomes and reduced costs and disparities. Such outcomes underscore the need for validated instruments that measure the extent to which essential, evidence-based features of PC are available and applied to users; and to ensure quality care and provider accountability.
Methods A systematic scoping review method was used to identify peer-reviewed African studies and grey literature on PC performance measurement. The service delivery dimension in the Primary Healthcare Performance Initiative conceptual framework was used to identify key measurable components of PC.
Results The review identified 19 African studies and reports that address measuring elements of PC performance. 13 studies included eight nationally validated performance measuring instruments. Of the eight, the South African and Malawian versions of Primary Care Assessment Tool measured service delivery comprehensively and involved PC user, provider and manager stakeholders.
Conclusion 40 years after Alma Ata and despite strong evidence for people-centred care, significant gaps remain regarding use of validated instruments to measure PC performance in Africa; few validated instruments have been used. Agreement on indicators, fit-for-purpose validated instruments and harmonising existing instruments is needed. Rigorous performance-based research is necessary to inform policy, resource allocation, practice and health worker training; and to ensure access to high quality care in a universal health coverage (UHC) system—research with potential to promote socially responsive, accountable PHC in the true spirit of the Alma Ata and Astana Declarations.
- Public Health
- Health policy
- Health systems evaluation
- Review
- Health services research
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Footnotes
Handling editor Stephanie M Topp
Contributors The study outline was formulated by GB with contributions from FC, IB, MM, LD and SM. All authors participated in the initial search, selection and data extraction. GB collated the data extracted by each author, coordinated the selection process, and wrote the initial draft to which the other authors contributed. GB conducted the second search, data extraction and final study selection with feedback from the co-authors. GB and FC drafted the final manuscript. All authors approved the final manuscript.
Funding The workshop during which the NGT was conducted (methods section) was funded by the Division of Family Medicine and Primary Care, Stellenbosch University.
Competing interests As noted in the results section GB and LD were co-investigators in the validation of South African and Malawian versions of the PCAT respectively.
Patient consent for publication Not required.
Ethics approval This scoping review involved data taken from published studies; no ethical approval was required from any of the institutions represented.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.