Block appointments in an overloaded South African health centre: quantitative and qualitative evaluation

Long waiting times are a serious problem for patients using urban health centres in developing countries. A block appointment system was introduced and evaluated in a large South African health centre. Waiting times of all patients were measured over a one-week period before and after the implementation of appointments. Focus group and individual interviews were conducted with staff and patients. After introducing appointments, patients with acute and chronic illnesses and having appointments had significantly shorter waits than similar patients without appointments (difference in median waits: 63 and 39 minutes respectively). Appointments had no benefits for patients not seeing doctors or collecting repeat medication. There was, however, an overall increase in patients' waiting times after introducing the system, mainly due to one atypical day in the follow-up study. Focus groups and interviews revealed that staff were sceptical at baseline but at follow-up were positive about the system. Patients were enthusiastic about the appointment system at all stages. The study shows that block appointments can reduce patient waiting times for acute patients, but may not be suitable for all patients. Staff and patients had different views, which converged with experience of the new system.