Primary care performance in Dominica

Objective. To document the structure and functions of primary care (PC) in the country of Dominica using the Primary Care Assessment Tools (PCAT), a set of questionnaires that evaluate PC functions. Methods. This cross-sectional study combined data from two surveys. The systems PCAT (S-PCAT) survey gathered national-level data from key informants about health system characteristics and PC performance. The provider version (P-PCAT) survey collected data on PC performance from health providers (nurses and physicians) at all PC facilities in the country. Provider-level data were aggregated to obtain national and district-level results for PC domains scored from 0.00 (worst) to 1.00 (best). Results. From the systems perspective, results showed several knowledge gaps in PC policy, financing, and structure. Key informants gave "Good" (adequate) ratings for "firstcontact" care (0.74), continuity of care (0.77), comprehensive care (0.70), and coordinated care (0.78); middling scores for family-centered care and community-oriented care (0.65); and low scores for access to care (0.57). PC providers assessed access to care (which included "first-contact" care, in the P-PCAT surveys) (0.84), continuity of care (0.86), information systems (0.84), family-centered care (0.92), and community-oriented care (0.85) as "Very Good"; comprehensive care as "Good" (0.79); and coordinated care as "Reasonable" (0.68). Overall, the scores for the country's health districts were good, although the ratings varied by specific PC domain. Conclusions. The assessments described here were carried out with relatively little expense and have provided important inputs into strategic planning, strategies for improving PC, and identification of priority areas for further investigation. This two-staged approach could be adapted and used in other countries.