Evaluating primary care performance in the Western Cape: a follow-up study using the Primary Care Assessment Tool

Weenink, Johanna Sophia

Evaluating primary care performance in the Western Cape: a follow-up study using the Primary Care Assessment Tool

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Division of Public Health

Faculty

Faculty of Health Sciences

Abstract

Background: Primary health care is a fundamental pillar of universal health coverage, ensuring accessible, equitable, and cost-effective health services. The Western Cape Department of Health and Wellness prioritises strengthening primary care to advance universal health coverage. However, resource constraints, service delivery inefficiencies, and accessibility gaps persist. This study aimed to evaluate the performance and progress of primary healthcare in the Western Cape province over time using the Primary Care Assessment Tool. Methods: A repeated cross-sectional study was conducted at four public-sector primary care facilities. The Primary Care Assessment Tool was administered between June 2015 and March 2016 (timeframe 1) and repeated between August 2023 and January 2024 (timeframe 2). Results: For the follow-up study, data from 48 patients, 15 healthcare providers, and eight managers were analysed. Compared to timeframe 1, patient-reported scores declined in timeframe 2, while provider and manager ratings remained stable. Although the median primary care score and the extended score remained within ‘acceptable to good', the percentage of patients who agreed declined, whereas the percentage of managers increased. The change in primary care score was not statistically significant (p-value 0.582), but the primary care extended score showed a significant difference (p-value <0.001). Ongoing care was the only domain that scored <3 across all respondent categories (p-value 0.005). Among patients, access to care received the lowest score (mean 1.7; CI 1.2-3.4). Conclusion: Disparities between patient experiences and staff evaluations highlight the need for targeted improvements in healthcare delivery. Addressing these gaps can help policymakers make informed decisions, optimise resource distribution, and implement strategic interventions to enhance patient experiences and outcomes. Contribution: The Primary Care Assessment Tool remains a valuable instrument for bridging the gap between patient perspectives and clinical evaluations, thereby supporting the shift toward evidence-based, patient-centred healthcare. Repeated assessments provide critical insights into performance trends over time.

Keywords

Performance

Primary Care

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