Adapting the primary care assessment tool for sub-saharan Africa.

Background: The World Health Organization's (WHO) measurement framework for primary health care includes the core functions of primary care: first contact access, comprehensiveness, coordination, continuity, and person-centredness. The Primary Care Assessment Tool (PCAT), originally developed in the United States, was adapted for use by four African countries, and can measure the core functions of primary care.

Aim: To face and content validate a sub-Saharan PCAT that measures the core functions of primary care.

Design & setting: Twenty countries within the Primary Care and Family Medicine (PRIMAFAMED) network for sub-Saharan Africa participated in a validation study.

Method: Two stages included a PRIMAFAMED workshop to assess face validity and a Delphi study to reach consensus on content validity amongst an expert panel as well as key stakeholders.

Results: Thirteen countries participated in the workshop and suggested re-phrasing 39 items, deleting 6 and adding 4. Twenty countries participated in the Delphi and all panel members reached consensus (>70%) on including the items as written. Seven experts and stakeholders reviewed the PCAT and suggested re-phrasing 23 items, deleting 1 and adding 1. The final Sub-Saharan PCAT (PCAT-SSA) consists of 85 items that measure affiliation with the primary care facility, first contact access and utilisation, comprehensiveness, continuity, coordination, and person-centredness, as well as health, demographic and socio-economic status.

Conclusions: The PCAT-SSA will now be piloted in Benin, Uganda, and South Africa. Further psychometric evaluation will be possible followed by more widespread use by researchers, district managers and policymakers in the region.