Macarayan EK, et al. - In this descriptive analysis, researchers investigated whether existing facility surveys capture relevant aspects of primary care performance, and assessed the quality of primary care in 10 low- and middle-income countries. Findings revealed that facility surveys did not capture key elements of primary care quality, suggesting significant gaps in primary care quality. The outcomes indicated that these gaps will limit the contribution of primary care to reaching the ambitious Sustainable Development Goals if left unaddressed.

Methods

• Using Service Provision Assessment surveys, the most comprehensive nationally representative surveys of health systems, researchers selected indicators corresponding to three of the process quality domains (competent systems, evidence-based care, and user experience) identified by the Lancet Global Health Commission on High Quality Health Systems in the Sustainable Development Goals Era.
• Composite and domain quality scores were calculated for first-level primary care facilities across and within 10 countries with available facility assessment data (Ethiopia, Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda).

Results

• Data were available for 7,049 facilities and 63,869 care visits.
• They found gaps in measurement of important outcomes (eg, user experience, health outcomes, and confidence) and processes (eg, timely action, choice of provider, affordability, ease of use, dignity, privacy, non-discrimination, autonomy, and confidentiality).
• Outside out maternal and child health, no information about care competence was available.
• They noted that scores for primary care quality were low (mean 0.41, on a scale of 0-1).
• Scores were lowest for user experience at a domain level, followed by evidence-based care, and then competent systems.
• Scores for patient focus, prevention and detection, technical quality of sick-child care, and population-health management were lower at the subdomain level vs for other subdomains.