The quality of primary care performance in private sector facilities in Nairobi, Kenya: a cross-sectional descriptive survey

Abstract

Background: Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is paucity of information on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya. Methods: A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data were analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences. Results: Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying an overall low performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact-access, coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good. Conclusion: These primary care clinics in Nairobi showed gaps in performance. Performance was rated as acceptable-to-good for first-contact utilisation, the information systems, family-centredness and cultural competence. However, patients rated low performance related to first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, incentivising use of these PC clinics rather than the tertiary hospital, improving access after-hours and marketing the use of the clinics to the practice population.