摘要：Introduction: In 2018 governments reaffirmed their commitment to implementing primary health care (PHC) in the Astana
Declaration. South Africa has introduced a number of health reforms to strengthen PHC and enable universal health
coverage (UHC). UHC requires access to quality primary care and progress needs to be measured. This study aimed to
evaluate the quality of South African primary care using the Primary Care Assessment Tool (PCAT).
Methods: A descriptive cross-sectional survey used data derived from a previous analytical observational study. Data from 413
patients, 136 health workers and 55 managers were analysed from 30 community health centres across four provinces of South
Africa. Scores were obtained for 10 key domains and an overall primary care score. Scores were compared in terms of
respondents, provinces and monthly headcount.
Results: Patients rated first contact accessibility, ongoing care and community orientation as the poorest performing elements
(< 50% scoring as ‘acceptable to good’); first contact utilisation, informational coordination and family-centredness as weaker
elements (< 66% scoring as ‘acceptable to good’); and comprehensiveness, coordination, cultural competency and
availability of the PHC team as stronger aspects of primary care (≥ 66% or more scoring as ‘acceptable or good’). Managers
and providers were generally much more positive about the performance of PHC.
Conclusion: Gaps exist between PHC users’ experience of care and what PHC staff believe they provide. Priorities to strengthen South
African primary care include improving access, informational and relational continuity of care, and ensuring the implementation of
community-orientated primary care. The PCAT is a useful tool to measure quality of primary care and progress with UHC.
关键词：primary health care ; primary care ; health services evaluation ; continuity ; accessibility ; comprehensiveness; coordination ; South Africa
