WHAT DOES QUALITY MEAN TO LAY PEOPLE - COMMUNITY PERCEPTIONS OF PRIMARY HEALTH-CARE SERVICES IN GUINEA

The success of strategies to revitalize primary health care services s uch as those advocated by the Bamako Initiative requires a response ad apted to the expectations of the population, especially in terms of qu ality. The goal of this study, conducted in two rural communities in G uinea, was to identify, characterize, and classify the criteria that t he public uses to judge the quality of primary health care (PHC) servi ces. This study included 180 participants in 21 focus group discussion s. Forty-four main criteria were identified. These criteria vary depen ding on the respondents' sex and age, and their ability to access prim ary health care services. Some of the criteria correspond to those use d by health care providers, while others do not. The general public pl aces considerable emphasis on outcomes, but little emphasis on prevent ive services. The users appear very sensitive to aspects of the interp ersonal relations they have with professionals and the technical quali ty of the care provided. A taxonomy of perceived quality is developed, which includes the following five categories: (1) technical competenc e of the health care personnel; (2) interpersonal relations between th e patients and care providers; (3) availability and adequacy of resour ces and services; (4) accessibility and (5) effectiveness of care. It is a major challenge to refocus on quality in the development of healt h care services. This will require considerable changes for which trai ning may be an effective, but certainly not a sufficient means. Promot ing professionalism and changing the relations between public authorit ies and the general public are the only means of improving the quality of health care services as well as user perception. (C) 1998 Elsevier Science Ltd. All rights reserved.