Nairobi's private clinics are culturally-sensitive, but treatments could improve

Researchers say Nairobi clinics could improve patient care by making more family doctors available, and by extending opening hours. This comes after a survey, which was intended to gather information to help Kenya move towards free healthcare, found that patients scored the clinics poorly on average.

For the survey, researchers specifically wanted to evaluate the quality of a group of private clinics in Nairobi. They identified the worst care aspects and how to improve them.

They adapted a survey created in the USA and altered in South Africa. They then conducted this new survey in 13 private clinics in Nairobi, Kenya. They interviewed 412 adult patients who had visited the same clinic at least 3 times.

The survey asked the patients to rate various aspects of the clinic on a scale from 1 (meaning poor) to 4 (meaning good). These aspects included the range of treatments the clinic offered, the communication between doctors, if care was available at all hours, and if the doctors were educated and compassionate to people from various cultural backgrounds. 

They then used the ratings to score each clinic, and to find an average score of the clinics.

The survey results suggested that clinics performed poorly on average, scoring about 2.6 out of 4. The highest-rated aspects were doctors’ communication skills, compassion for many cultures, and knowledge of how family characteristics impact health. 

The survey suggests that the clinics did not offer treatment at important times (such as nights and weekends), and could not treat many conditions.

Besides these findings, this study also showed that this kind of survey tool originally developed in countries like the USA could be adapted to fit African countries. 

The researchers hope the information gathered can help improve Kenya’s healthcare and help the country work towards a system that can treat anyone for free.

These researchers note that the COVID-19 pandemic may have influenced the results. For example, some clinics were closed in the evenings because of curfews. They also said that older patients or those who attended a clinic regularly rated clinics more highly. This could indicate a bias.

The South African and Pakistani researchers suggested that clinics in Kenya can improve in several ways. They should educate patients about all the available treatments and provide a wider range of treatments. For example, they could provide more family doctors. They should also offer consistent treatment after hours and during weekends.

Abstract

Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is little information on these key elements and such information is needed to improve service delivery. This study aimed to evaluate the quality of primary care performance in a group of private sector clinics in Nairobi, Kenya.

A cross-sectional descriptive study adapted the Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data was analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences.

Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying poor overall performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact (access), coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good.

These primary care clinics in Nairobi had a poor overall performance. There was a report of acceptable-to-good performance in first-contact utilisation, the information systems, family centredness and cultural competence. However, patients rated first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team, as poor. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, improving access after-hours and marketing the use of the clinics to the practice population.

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