Dec. 2, 2016
Patient–centered care (PCC) is increasingly recognized as a key dimension of quality healthcare, but unfortunately remains poorly implemented in practice. This paper explores the current state of PCC in sub-Saharan Africa and potential barriers to its implementation, with a focus on public first line health services. They develop an analytical framework based on expert knowledge, field experience, and a conceptual literature review. Factors contributing to the (lack of) implementation of PCC are structured in three distinct but interacting layers. The first layer encompasses factors that influence and shape the performance of providers. The training of health workers is key in that respect. Training models remain dominated by a biomedical perspective, with little attention for psychosocial dimensions of the illness experience. The second layer of determinants relates to the structural and organizational features of the health system. The emphasis in many African health care systems on specific programmatic outputs, and ...