What does quality mean to lay people? Community perceptions of primary health care services in Guinea

The success of strategies to revitalize primary health care services such as those advocated by the Bamako Initiative requires a response adapted to the expectations of the population, especially in terms of quality. The goal of this study, conducted in two rural communities in Guinea, was to identify, characterize, and classify the criteria that the public uses to judge the quality of primary health care (PHC) services. This study included 180 participants in 21 focus group discussions. Forty-four main criteria were identified. These criteria vary depending on the respondents' sex and age, and their ability to access primary health care services. Some of the criteria correspond to those used by health care providers, while others do not. The general public places considerable emphasis on outcomes, but little emphasis on preventive services. The users appear very sensitive to aspects of the interpersonal relations they have with professionals and the technical quality of the care provided. A taxonomy of perceived quality is developed, which includes the following five categories: (1) technical competence of the health care personnel; (2) interpersonal relations between the patients and care providers; (3) availability and adequacy of resources and services; (4) accessibility and (5) effectiveness of care. It is a major challenge to refocus on quality in the development of health care services. This will require considerable changes for which training may be an effective, but certainly not a sufficient means. Promoting professionalism and changing the relations between public authorities and the general public are the only means of improving the quality of health care services as well as user perception. (C) 1998 Elsevier Science Ltd. All rights reserved.