Adaptation and validation of the Ugandan Primary Care Assessment Tool

BACKGROUND: Health systems based on primary health care (PHC) have better outcomes at lower cost. Such health systems need regular performance assessment for quality improvement and maintenance. In many low- and middle-income countries (LMICs), there are no electronic databases for routine monitoring. There is an urgent need for valid and reliable tools to measure PHC performance. AIM: This study aimed to adapt and validate the Primary Care Assessment Tool (PCAT) in the Ugandan context. SETTING: The experts that participated in the Delphi process were recruited from almost all over the country. METHODS: The study utilised a Delphi process with a panel of 20 experts (14 district health officers, 4 academics in primary care and 2 ministry of health MOH technical staff) who responded to iterative rounds of questionnaires in order to reach consensus (defined as 70% agreement). RESULTS: Consensus was reached after two rounds of the Delphi. In round one, four items in the comprehensiveness domain (services available) were removed and five items needed rephrasing. A new domain on person-centredness with 13 items was suggested. In round two, the new domain with each and every single one of its items and the items for rephrasing all achieved consensus. The final Ugandan version of the PCAT (UG-PCAT) has 12 domains and 91 items. CONCLUSION: The South African Primary Care Assessment Tool (ZA PCAT) was adapted and validated with an additional domain on person-centredness to measure primary care performance in the Ugandan context, and can now be used to measure the quality of core functions of primary care in Uganda.Contribution: The PCAT could fulfil the need for such a tool in a wider LMIC context. The UG-PCAT will be used to measure the quality of these core functions in Uganda and to assist with the improvement of PHC.