Patient-reported quality of primary care and facility endorsement in Addis Ababa

BACKGROUND: High-quality primary healthcare is essential for improving health outcomes and patient satisfaction. Facility endorsement-patients' willingness to recommend a health facility-reflects trust and perceived service quality and can provide actionable feedback for quality improvement. This study assessed perceived quality of care and its association with facility endorsement among primary care patients in Addis Ababa. METHODS: A mobile-based interactive voice response (IVR) survey was administered to 1,584 patients receiving primary care services from public and private health facilities in Addis Ababa. Perceived quality of care was assessed across three dimensions: structural quality, provider competence, and patient-centered care. Linear and ordered logit regression models were used to examine associations between quality dimensions and endorsement, and a Chow test assessed structural differences across facility types. RESULTS: Overall perceptions of care quality were moderate, corresponding to average scores of around 50-60% across all quality dimensions, indicating room for improvement. Average scores across facility types were 55.9% for structural quality, 58.0% for provider competence, and 51.2% for patient-centered care. Private facilities-particularly clinics-consistently outperformed public hospitals and health centers, with 60-70% of patients in private facilities rating quality indicators as "good" or "very good," compared with 40-50% in public facilities. The Chow test confirmed significant differences in patient responses by facility type (χ² = 96.7, p < 0.001). Provider competence was a strong and consistent predictor of facility endorsement across all settings; for example, in private hospitals, a one-unit increase in perceived competence more than doubled the odds of endorsement (OR = 2.37, 95% CI: 1.42-3.95). Patient-centered care was also positively associated with endorsement across all facility types. Structural quality influenced endorsement only in public hospitals. CONCLUSION: Perceived quality of primary care in Addis Ababa remains moderate, with clear disparities between public and private facilities. Provider competence and patient-centered care are the strongest drivers of patient endorsement, highlighting the importance of clinical skills, communication, and respectful care as key factors associated with patient endorsement. In public hospitals, addressing structural gaps through targeted investments in infrastructure, medicines, and diagnostics remains important for improving patient experience and may contribute to broader system performance.