Quality of care offered to children attending primary health care clinics in Johannesburg, South Africa
To assess the quality of child health services provided at primary health care (PHC) facilities in Johannesburg, South Africa.
Observational study conducted at 16 PHC clinics. A researcher-developed structured checklist, based on national guidelines and protocols, was utilised.
A total of 141 sick child and 149 well child visits were observed. Caregivers experienced long waiting times (mean [SD] of 13572 minutes). Health professionals were experienced and well-trained. Despite this, many routine examination procedures were poorly performed, with an adequate diagnosis established in 108 of 141 consultations (77%). Triage and attention to danger signs was poor. An antibiotic was prescribed in almost half (65/141) of the consultations; their use was unwarranted in one-third of instances. Health promotion activities (such as growth monitoring) were consistently ignored during sick child visits. The mother or child’s HIV status was seldom requested or investigated. Growth monitoring and nutritional counselling at well child visits was generally inadequate with not one of 11 children qualifying for food supplementation receiving it. The majority of facilities were adequately equipped and well-stocked with drugs.
The poor quality of PHC offered to children in the richest city in Africa is a sad indictment of the inability of health service providers in the city to meaningfully address children’s health needs. Nothing short of a deliberate and radical restructuring in the way that PHC is organised for children, with clearly defined and monitored standard clinical practice routines and norms, is likely to significantly change the status quo.
Kebashni Thandrayen, University of Witwatersrand, Department of Paediatrics and Child Health
Haroon Saloojee, University of Witwatersrand, Department of Paediatrics and Child Health
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Date published: 2010-10-04
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