ABSTRACT
Objective. To assess the quality of child health services provided at primary health care (PHC) facilities in Johannesburg; South Africa. Design. Observational study conducted at 16 PHC clinics. A researcher-developed structured checklist; based on national guidelines and protocols; was utilised. Results. The majority of facilities were adequately equipped and well stocked with drugs. A total of 141 sick child and 149 well child visits were observed. Caregivers experienced long waiting times (mean 135 (standard deviation 72) minutes). Many routine examination procedures were poorly performed; with an adequate diagnosis established in 108 of 141 consultations (77); even though health professionals were experienced and well trained. Triage and attention to danger signs were poor. An antibiotic was prescribed in almost half (65/141) of the consultations; but antibiotic use was unwarranted in one-third of these cases. Health promotion activities (such as growth monitoring) were consistently ignored during sick child visits. HIV status was seldom asked about or investigated; for the mother or for the child. Growth monitoring and nutritional counselling at well child visits was generally inadequate; with not one of 11 children who qualified for food supplementation receiving it. Conclusion. The poor quality of PHC offered to children in the richest city in Africa is a sad indictment of the inability of health service providers to address children's health needs meaningfully. A deliberate and radical restructuring of PHC for children; with clearly defined and monitored standard clinical practice routines and norms; is required to change the status quo