ABSTRACT
Background e majority of South Africans depend on the public health sector for their health care needs [1]; the percentage of adults who reported that they have medical aid in the Demographic and Health Survey in 2003 was 14.2% [2]. Shisana et al. [3] found in a nationally representative survey that the majority (70%) indicated that they usually attended public health care services, while 23.3% attended private health care services, and a small proportion (0.1%) utilised traditional health practitioners. In many areas of South Africa, the Primary Health Care (PHC) facilities are the only available or easily accessible health service for local communities. As a result, PHC services, providers and facilities carry a large burden and responsibility for the provision of health care in South Africa. PHC is the basic mechanism for providing health care [4]. It was formally introduced in South Africa in April 1994 as the major principle for health care provision with the implementation of two policies, “Free health care for pregnant mothers and children under the age of six years” as well the “Universal Access to PHC for All South Africans” [4]. e Department of Health’s strategic framework for 2002-2004 identies improvements of quality of care as one of the four key challenges currently facing the health sector in South Africa [5]. Quality of care is concerned with the interface between provider and patients, between health services and community. A quality perspective changes the focus of health systems development from establishing structures to addressing what happens in the structures. Improving quality can,
therefore, be regarded as a second phase of health care transformation in South Africa. e rst phase was concerned with creating coherent health care structures and the second phase with ensuring quality of service delivery [5].
