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Background: Universal health coverage is one of the Sustainable Development Goal targets known to improve population health and reduce financial burden. There is little qualitative data on access to and quality of primary healthcare in West and East Africa. We elicited in-depth viewpoints of healthcare users and providers, and other stakeholders regarding access to and quality of healthcare.
Methods: A qualitative case study was conducted in four communities in Nigeria, and one community each in Kenya, Uganda and Tanzania in 2018. Purposive sampling was used to recruit 155 participants for 24 focus group discussions, 24 in-depth interviews, and 12 key informant interviews. The conceptual framework in this study combined elements of the Health Belief Model, Health Care Utilisation Model, four ‘As’ of access to care, and pathway model to better understand health-seeking behaviours of the study participants. The data were analysed with MAXQDA 2018 qualitative software to identify three themes identified a priori and one emerging theme.
Results: Access to primary healthcare in the seven communities was limited. Quality of care was perceived to be unacceptable in public facilities whereas cost of care was unaffordable in private facilities. Patients and health providers and stakeholders highlighted shortage of equipment, frequent drug stock-outs and long waiting times as major issues, but had varying opinions on satisfaction with care. Use of herbal medicines and other traditional treatments delayed or deterred seeking modern healthcare in Nigerian sites.
Conclusions: There was a substantial gap in primary healthcare coverage and quality in the selected communities in rural and urban East and West Africa. Alternative models of healthcare delivery should be used to fill this gap and facilitate achieving universal health coverage.
Keywords
access, quality, primary healthcare, universal health coverage, health-seeking behaviour, social entrepreneurship, Nigeria, Kenya, Uganda, Tanzania.
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CURRENT STATUS: Published
View the published article at BMC Primary Care.
No community comments so far
Editorial decision: Accept
On 08 Feb, 2021
Editor assigned
On 31 Dec, 2020
Submission checks complete
On 31 Dec, 2020
Editor invited
On 31 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 25 Dec, 2020
Review #2 received
Received 20 Dec, 2020
Review #1 received
Received 10 Dec, 2020
Reviewer #2 agreed
On 30 Nov, 2020
Reviewer #1 agreed
On 24 Nov, 2020
Reviewers invited
Invitations sent on 22 Nov, 2020
Editor assigned
On 21 Nov, 2020
Submission checks complete
On 21 Nov, 2020
Editor invited
On 21 Nov, 2020
Version 1
Posted 10 Aug, 2020
No comments provided
Editorial decision: Major revision
On 17 Oct, 2020
Review #2 received
Received 15 Oct, 2020
Reviewer #2 agreed
On 23 Sep, 2020
Review #1 received
Received 22 Sep, 2020
Reviewer #1 agreed
On 07 Sep, 2020
Reviewers invited
Invitations sent on 04 Sep, 2020
Editor assigned
On 10 Aug, 2020
Submission checks complete
On 06 Aug, 2020
Editor invited
On 06 Aug, 2020
First submitted
On 28 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Primary Care.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Primary Care.
No community comments so far
Editorial decision: Accept
On 08 Feb, 2021
Editor assigned
On 31 Dec, 2020
Submission checks complete
On 31 Dec, 2020
Editor invited
On 31 Dec, 2020
No comments provided
Editorial decision: Minor revision
On 25 Dec, 2020
Review #2 received
Received 20 Dec, 2020
Review #1 received
Received 10 Dec, 2020
Reviewer #2 agreed
On 30 Nov, 2020
Reviewer #1 agreed
On 24 Nov, 2020
Reviewers invited
Invitations sent on 22 Nov, 2020
Editor assigned
On 21 Nov, 2020
Submission checks complete
On 21 Nov, 2020
Editor invited
On 21 Nov, 2020
Version 1
Posted 10 Aug, 2020
No comments provided
Editorial decision: Major revision
On 17 Oct, 2020
Review #2 received
Received 15 Oct, 2020
Reviewer #2 agreed
On 23 Sep, 2020
Review #1 received
Received 22 Sep, 2020
Reviewer #1 agreed
On 07 Sep, 2020
Reviewers invited
Invitations sent on 04 Sep, 2020
Editor assigned
On 10 Aug, 2020
Submission checks complete
On 06 Aug, 2020
Editor invited
On 06 Aug, 2020
First submitted
On 28 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Primary Care.
Background: Universal health coverage is one of the Sustainable Development Goal targets known to improve population health and reduce financial burden. There is little qualitative data on access to and quality of primary healthcare in West and East Africa. We elicited in-depth viewpoints of healthcare users and providers, and other stakeholders regarding access to and quality of healthcare.
Methods: A qualitative case study was conducted in four communities in Nigeria, and one community each in Kenya, Uganda and Tanzania in 2018. Purposive sampling was used to recruit 155 participants for 24 focus group discussions, 24 in-depth interviews, and 12 key informant interviews. The conceptual framework in this study combined elements of the Health Belief Model, Health Care Utilisation Model, four ‘As’ of access to care, and pathway model to better understand health-seeking behaviours of the study participants. The data were analysed with MAXQDA 2018 qualitative software to identify three themes identified a priori and one emerging theme.
Results: Access to primary healthcare in the seven communities was limited. Quality of care was perceived to be unacceptable in public facilities whereas cost of care was unaffordable in private facilities. Patients and health providers and stakeholders highlighted shortage of equipment, frequent drug stock-outs and long waiting times as major issues, but had varying opinions on satisfaction with care. Use of herbal medicines and other traditional treatments delayed or deterred seeking modern healthcare in Nigerian sites.
Conclusions: There was a substantial gap in primary healthcare coverage and quality in the selected communities in rural and urban East and West Africa. Alternative models of healthcare delivery should be used to fill this gap and facilitate achieving universal health coverage.
Figure 1
This is a list of supplementary files associated with this preprint. Click to download.
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