Quality of Care at Primary Healthcare Facilities: Perceptions of Tuberculosis and HIV Co-Infected Patients

Monday, 31 July 2017: 10:55 AM

Deliwe Rene Phetlhu, PhD, MHS, BA
School of Nursing, University of Western Cape, Cape Town, South Africa
Siphokazi Mngcozelo, BCur
Nursing, University of the Western Cape, Cape Town, South Africa
Million Bimerew, PhD, MN, BN, RN
School of Nursing, University of the Western Cape, Bellville, South Africa
Joliana Selma Phillips, PhD
Department of Physiotheraphy, University of the Western Cape, Cape Town, South Africa

Purpose:  Tuberculosis (TB) has been declared a global emergency and in South Africa a national emergency over two decades ago. TB is the leading opportunistic infection worldwide and the primary cause of mortality among people living with Human Immunodeficiency Virus (HIV). Tuberculosis and HIV combined are responsible for the deaths of over 4 million people annually and more than 65% of individuals diagnosed with TB in South Africa are co-infected with HIV. Providing quality health care services is therefore of utmost importance in improving South Africa’s poor health outcomes in addition to restoring patient and staff confidence in the health system. The South African health consumers (patients) are increasingly becoming aware of their rights to quality care and their met or unmet expectations of quality services are directly linked to issues such as treatment adherence and patient retention. This could be a contributing factor in the increase in the TB/HIV co-infection rate in South Africa. Therefore, the purpose of this research was to explore and describe the perceptions of patients co-infected with TB and HIV regarding the quality of care at primary health care facilities in the Eastern Cape Province of South Africa.

Methods: Data collection commenced after ethical approval was received from the university’s ethics committee and the provincial health department’s research committee. The setting of the study was a sub-district that had primary health care facilities in rural, semi-rural and urban areas. Purposive sampling was used to select participants who then gave consent voluntarily after the study aim was explained to them and all other ethical concerns were addressed. Semi-structured interviews were conducted and data saturation was reached after the 18th participant was interviewed. The transcripts of the interviews were analysed thematically and a consensus meeting held to confirm and agree on common themes.

Results:  Two main themes were generated, that is; satisfaction with delivered services and impediments to quality of care. The sub-themes of the satisfaction theme were: positive nurse-patient relationship; non-discrimination; health promotion; and availability of resources. The sub-themes of the impediments theme were: lack of privacy and confidentiality and prolonged waiting time.

Conclusion: The findings indicated that the participants’ perception of quality of care were closely linked to their perception of nurses’ behaviour and the systemic dynamics. It is therefore important for nurses to be respectful and responsive to the patients’ individual needs to enable them to provide quality patient-centred care. The importance of nurses’ knowledge regarding TB and HIV and their role in providing health education to patients are also highlighted.