Utilization of primary health services in Port Sudan Sudan.

Primary health care service utilization patterns at 2 health centers and 1 hospital outpatient clinic in Port Sudan Sudan were assessed during January and February 1980 by observing the activities at the clinics reviewing patient records and surveying a sample of 360 patients who visited the hospital clinic and 462 patients who visited the health centers. Outpatient services are provided for Port Sudans 250000 residents at the hospital clinic 5 health centers 5 dispenseries and 20 dressing stations. The residents may use the services of any of these facilities regardless of the nature of their illness. The health centers are staffed only by paramedical and auxiliary health personnel whereas the hospital clinic staff includes physicians. The facilities chosen for inclusion in the study included 2 health centers on opposite sides of the city and the centrally located hospital. Results of the study showed that almost all of the patients at the 3 facilities reported for treatment in the morning rather than the afernoon. 50% of the health center patients and 44% of the hospital clinic patients were between the ages of 5-14 years. Disease patterns were remarkably similar at all 3 facilities. The precent of patients at each of the clinics who presented for specific diseases ranged narrowly from 21%-15% for respiratory tract diseases from 20%-22% for gastrointestinal disorders from 16%-18% for minor traumas from 5%-10% for skin diseases from 4%-8% for anemia and malnutrition from 7%-10% for urinary tract diseases and from 22%-24% for other disorders. Many patients who could have received treatment at nearby health centers were apparently willing to travel greater distances to obtain services at the hospital. 90% of the health center patients traveled less than 2 kilometers while 40% of the hopital patients were willing to travel more than 5 kilometers to obtain services. The average amount of time patients had to wait for service at the hospital was 3 1/2 hours but only a 1/2 hour at the health centers. Care at both the hospital and the health centers was limited. At both types of facilities the average amount of time spent in history taking examination and consultation was only 2 minutes and less than 1% of the patients received more than 5 minutes of treatment. Dissatisfactions expressed by center patients included the lack of drugs and physicians and the limited nature of the examinations. Hospital patients were dissatisfied with the long waiting time the unavailability of drugs and the lack of concern exhibited by clinic personnel. The findings suggest that the patients at all 3 facilities received only palliative care for common diseases and that little or no effort was made to promote or provide preventive health care. Consideration should be given to reorganizing the provision of services. Costs could be minimized and patient waiting time reduced if all patients were seen initially at the health centers. Patients who had minor problems could be treated at the centers and patients requiring more extensive treatment could be referred to the hospital.