Perceptions of the and HIV co-infected patients regarding quality of care provided at primary health care facilities in the Chris Hani district, Eastern Cape Province, South Africa
As early as 1993, the World Health Organisation declared Tuberculosis (TB) a global emergency and the South African Department of Health confirmed that TB was a national emergency. The primary cause of the rise in TB cases has been attributed to co-infection with HIV. TB is the leading opportunistic infection worldwide and the primary cause of mortality among people living with Human Immunodeficiency Virus (HIV). TB and HIV are two of the highest health threats globally and in South Africa. Tuberculosis and HIV combined are responsible for the deaths of over 4 million people annually. More than 65% of individuals diagnosed with TB in South Africa are co-infected with HIV. The importance of providing quality health services is a human right and non-negotiable. Better quality of health care is fundamental in improving South Africa's poor health outcomes and in restoring patient and staff confidence in the public and private health system. In 1996, the South African Department of Health introduced the topic of quality to raise its awareness and to make it an inherent part of the health care system. The South African health care consumers (patients) are increasingly becoming aware of their rights as patients and the gap between the actual and ideal health practices. They have broad knowledge and great expectations with regard to available care including effectiveness of service and treatment. Patients have desires for quality services when visiting a health care facility, and these desires are directly linked to the success of the healthcare system. If the desires are not met, they can negatively influence the outcome of healthcare processes such as treatment adherence and retention of patients on the system. This could possibly further escalate the TB/HIV co-infection rate in South Africa. The need to address TB and HIV together in the light of quality care is urgent so as to improve the provision of quality health services rendered to people co-infected with TB and HIV. The Institute of Medicine developed a framework that could guide on healthcare dimensions that need to be met for quality of care to be achieved and it is the underpinning theoretical framework for this study. The patients play a critical role in the healthcare system as they are the customers and therefore, the opinions of the patients need to be recognised to ensure that strategies and programmes that are developed are relevant. 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 the Primary Health Care facilities, in the Chris Hani District. A qualitative, explorative and descriptive design was used which enabled the researcher to understand the perceptions of TB and HIV co-infected patients regarding quality of care. The population studied in this research consisted of TB and HIV co-infected patients attending the Primary Health Care facilities at the Lukhanji Sub-district within the Chris Hani District. Purposive sampling was used to select participants with the assistance of nurses working at the selected facilities. The sample size was determined by data saturation, which was reached after 18 semi-structured interviews were conducted. Data analysis was carried out simultaneously with data collection. In consensus discussions, the researcher and the co-coder reached an agreement on the main theme, sub-theme and sub-categories. From the research findings, two main themes were identified namely; satisfaction with delivered services and impediments to quality of care. These were further divided in sub themes and categories. The conclusion that could be made on the quality of care provided to the TB and HIV co-infected patients in this study is that the nurses in the facilities aim to provide four of the six IOM aims of quality of care to the TB and HIV co-infected patients namely: equitable, effective, efficient and patient-centred domains. Therefore, the quality of care provided to these patients is partial as they are not provided with all the six aims that are needed to achieve quality of care. Recommendations are made for the field of community health nursing practice and nursing research on how to improve quality of care provided to TB and HIV co-infected patients at Primary Health Care facilities.