Addressing the quality of paediatric primary care: health worker and caregiver perspectives from a process evaluation of PACK child, a health systems intervention in South Africa

Abstract Background The WHO’s Integrated Management of Childhood Illness (IMCI) has resulted in progress addressing infant and child mortality. However, unmet needs children continue to present a burden upon primary healthcare services. capacity services quality care offered require greater support address these by extending integrating curative preventive for the with long-term health condition older than 5, not prioritised IMCI. In response needs, PACK Child intervention was developed piloted October 2017–February 2019 Western Cape Province South Africa. We report worker caregiver perspectives existing paediatric context as well extent which functions perceived problems within current local system. Methods This process evaluation involved 52 individual interviews caregivers, 10 focus group discussions workers, 3 trainers, 31 training observations. Interviews groups explored participants’ experiences care, intervention, tensions implementation each context. Inductive thematic analysis used analyse verbatim interview discussion transcripts. Results Perspectives caregivers workers suggest an institutionalised treating children’s symptoms acute episodic conditions. Health workers’ reports imply that this is perpetuated interactions between contextual features such as, IMCI policy, documentation-driven consultations, overcrowded clinics verticalised care. Whilst conditions constrained ability translate skills into practice, initiated expanded 0–13 years those conditions, enhanced professional competence, improved teamwork referrals, streamlined triaging, facilitated probing psychosocial risk. Conclusion appears be catalysing broader children, including identification problems. maximise requires re-orientate from risk minimisation on day attendance towards view beyond presentation at clinics.