Patient's perceived quality of care in South Africa's public health sector

South Africa's Ideal Clinic Realisation and Maintenance (ICRM) programme aims to enhance the quality of care at the primary healthcare (PHC) level. Patients' perceptions of care quality are becoming increasingly important in assessing and reforming healthcare services. We investigated the impact of the ICRM programme on patients' perceived quality of care.

From February to August 2021, we conducted a mixed-methods, cross-sectional survey with adult participants (aged ≥ 18 years) recruited from a representative 10% sample of 45 public clinics across Gauteng (targeting 40/clinic, N = 1,800). At enrollment, trained study staff administered a semi-structured questionnaire. High-quality care was defined as a score > 3.5 on a ten-item scale (Cronbach's alpha = 0.67), assessing agreement with statements about care experiences, including staff communication, attitudes, and clinic facilities. Responses to open-ended questions were thematically analysed and coded to identify complaints expressed in patients' statements.

Of the 1,788 participants enrolled in the study, 70.2% reported high-quality service (95% CI: 63.6, 76.0). 32.8% were seeking HIV/TB care (95% CI: 30.0, 37.2), and 66.3% were seeking non-HIV/TB care services during study enrolment. At the facility level, perceived quality of care did not differ by ICRM certification status but was significantly lower among patients attending facilities whose certification status had regressed between 2018 and 2021 (RR, 0.73; 95% CI, 0.54-0.98). Notably, 31.7% of participants who rated the service as high quality still had complaints. Among participants who rated the services as low to moderate quality, 69.6% reported complaints (95% CI, 62.3% to 76.0%), including long waiting times, inefficiencies in the clinic appointment system, staff shortages, and poor time management by staff. Moreover, participants described feeling disrespected by clinic staff and experiencing poor communication.

Among patients attending public-sector PHC facilities in Gauteng, perceived quality of care was not associated with ICRM certification status. Nearly one-third of patients rating care quality as high still reported complaints, suggesting that composite scores may mask specific dissatisfaction with non-clinical dimensions of care, including waiting times and communication, that are essential determinants of care-seeking behaviour among individuals with chronic conditions. Standardised patient-reported experience measurement should be integrated into routine ICRM monitoring.