Barriers to good consultations in public primary healthcare clinics.

STUDY AIM: To explore the barriers to good consultations in government primary health care (PHC) clinics, in Botswana. BACKGROUND: Good consultations improve adherence to treatment, treatment outcomes, and health seeking behaviour while bad consultations do the opposite. We explored the barriers to good consultations (doctor patient interactions) in public PHC clinics in Botswana. Knowledge of these barriers may help in crafting strategies to eliminate the barriers and improve health care. METHODS: This was a descriptive qualitative study in which patients and doctors were interviewed. A semi structured interview guide was used to collect data, until data saturation. Public PHC clinics and participants were purposively selected to ensure variety in both. The data was analysed for themes, manually and using NVivo software. FINDINGS: Barriers included patients' and doctors' negative behaviours and attitudes, inadequate time to conduct consultations, not having time to do physical examination of patients, and high patient volumes. Other barriers were drug and equipment shortages, lack of privacy, and communication barriers. CONCLUSION: Barriers to good consultations included health system level, doctor level, and patient level barriers. Thus, corrective interventions will need to target patient, doctor, and health system factors. These interventions should target improving doctors' and patients' behaviours and attitudes during consultations. Health system interventions should be directed at medicine and equipment shortages, as well alleviating the problem of high patient loads per doctor. Addressing communication barriers between patients and doctors should be part of the interventions to improve consultations and healthcare in public PHC clinics.