This study considers the reliability of a standardised client approach to inform policy makers about the quality of the clinical encounter at primary healthcare centres in the Western Cape and Eastern Cape metro areas. It is notoriously difficult to monitor clinical quality at primary care level and consequently there has been significant interest in this approach. It has never been implemented in any country on the African continent. Early detection of problems with protocol implementation or early flagging of inadequate quality of care can save lives.
According to the standardised client approach a field worker visits the primary health care facility with typical symptoms, providing an opportunity to observe her in a natural environment. The aim is to understand whether the nurse asks the right questions and arrives at the correct diagnosis. To enhance recall and clarity, the debriefing session with the field worker occurs right after the health worker visit, using a scoring sheet with a tick list. This method can then be contrasted with routine indicators on facility-level quality.