Evaluation of the Quality of Care for Sexually Transmitted Infections in Primary Health Care Centres in South Africa

Abstract

Sexually transmitted infections (STIs) are one of the most common illnesses among adolescents and adults in developing countries. While research from other countries indicates that a lack of financial, infra-structural and human resources are central determinants of the quality of care for STIs, South African studies suggest that there are also problems in health workers' interactions with STI patients. This study investigates the quality of care for STIs at 24 primary health care (PHC) centres in four provinces of South Africa (SA). Semi-structured interviews were conducted with STI patients and health providers. In addition, in-depth interviews were conducted with a sample of STI patients, and focus group discussions were held with diverse community groupings. Simulated patients also completed questionnaires on the care they received at the centres. Frequencies were computed on close-ended questions in order to describe patterns and trends in the data. Cross-tabulations were calculated to check for gender, provincial and urban-rural differences. Composite scores were also generated for the purpose of comparing quality of care across the different participating groups. Finally, the depth interviews and focus groups were analysed thematically. The results show that PHC centres in SA are relatively well-resourced. However, problems were found in the actual encounter between health workers and STI patients, which severely undermines the quality and effectiveness of treatment. It is strongly recommended that attention be given to health providers, in particular through the provision of further training and support in relation to effective STI management.