Intervening into primary health care services in Benghazi

Streamlining and gaining the public's lost trust of the primary health care (PHC) is under discussion among health care professionals in Libya (1). The ‘Quality of care and patient satisfaction from primary health care in Benghazi’ was studied by the Faculty of Public Health (2). A standardized tool – Charleston Psychiatric Outpatient Satisfaction Scale was used (3) in addition to qualitative techniques exploring concerns of facilities, staff and beneficiaries (4) at 16 PHC facilities covering 310 beneficiaries.

The study found that the qualified professionals – physicians and administrators in PHC of Benghazi – who manage clinical and administrative functions were supported by poorly qualified middle level and frontline staff. Concerns about the ‘future’ of health professionals in the PHC setting need attention through encouraging satisfactory performances and enabling a flourishing work environment in addition to perks, promotions and participation in decision making. Furthermore, staff profile – age, sex, skill level – facilitating specializations within the PHC setting need to be stressed by fixing ‘round pegs in round holes’. Task divisions and specializations are encouraged in order to create satisfying careers to people of all ages.

Public relations and customer care is a neglected aspect in PHC service in Benghazi. Empathy is of value in any service-oriented setting dealing with needy human beings and supporting people ‘to help the person in need to help him/her to overcome his/her needs’.

Administrators were found to be well qualified and talented, capable of innovation through translating managerial thoughts into action by implementing techniques viz., benchmarking and management by objectives (4); thereby yielding external comparisons, evaluation of current performance and identification of possible actions for the future to enable a deeper understanding of performance of the organization and the people – the results of the technique – highlight the ways of incorporating ideas into operations (5).

Resource constraints did not affect the PHC system in Benghazi. However, the PHC facilities in Benghazi suffered from problems such as the accumulation of unutilized equipment, underutilized manpower, lack of essential items, availability of luxurious items, manpower usage without task clarity, availability of equipment but non-availability of technicians, non-availability of equipment but availability of technician, availability of services not in demand – to name but a few deficiencies.

It was difficult to differentiate between health centres and polyclinics as both appeared similar in terms of manpower, infrastructure or services (2). Provision of specialist doctors and treatments were available at both health centres and polyclinics in contrast with the definition.

Only a few of the PHC facilities in Benghazi were actively implementing an electronic medical record system. Evidence showed that electronic medical record systems implemented at primary health centres had facilitated physician performance, the arrangement of patients’ being seen in turn, dispensing of medication from the pharmacy, written guidance of medication and accuracy and easiness of follow up (6). A concerted effort on similar lines, would create and be of value; making the facilities transparent and thus moving towards information-based management, offering medical resources and support for community efforts (7).

Among the three geographic zones, the City Centre had a better image and this was then followed by Al Birka. Facilities located at Al Slawy were least popular for quality. This geographic zone located on the outskirts of the city catered to those living in small hamlets (residential pockets) and working in traditional occupations like poultry, cattle rearing, fishing and cultivation. Facilities catering to this group of people were less suitable to their expectations. This limiting factor demands more detailed analysis and brainstorming as user expectations were of value in health planning and policy (8). Similarly, it was the polyclinics that had less scores on patient satisfaction, attributable to (1) efforts made to upgrade facilities or (2) shortage of man, money and materials to build facilities beyond the legal sanctions, where Total Quality Management (TQM) and continuous quality improvement (9) were of great value.

It is important, in this context, to look at utilities that were essential to the users. Provisions were needed to fulfill basic needs – namely; water, coffee, essential medicines and transport without burdening core expenditures. Taxonomy of perceived quality of PHC includes (1) technical competence of personnel (2) interpersonal relation between patient and care provider (3) availability and adequacy of resources and services and (4) accessibility and effectiveness of care (10).

In summary

An improvement in the Libyan National Health System (LNHS) will be possible when it adopts performance management and management by objectives rather than the prevailing crisis management (11).

Improving the ergonomics of PHC centers by reversing the current trend for less suitable tailor-made buildings and convert buildings to accommodate equipment and the volume of work into more comfortable and efficient spaces, will improve the overall PHC system's performance. An organizational diagnosis through job analysis and staff appraisal is advised. Not only is the team structure as well as co-ordination and managerial structures but also the characteristics of the catchment population are of importance (10, 12, 13).

Skill development starts with the staffing process (recruitment, selection and socialization) that puts adequately skilled people at positions which encourage rising beyond expectations and making value additions (14). Factors that are of importance in creating satisfaction among primary health care users are interpersonal – communication from receptionist, duration of consultation time, physician greetings, way of examination – and physician management, as well as waiting time and drug supply (8, 15).

Asharaf Abdul Salam
Center for Population Studies
King Saud University, Riyadh, Saudi Arabia
Email: asharaf_a@indiatimes.com