Community perspectives on health professionals' competence for quality primary health care in Amhara region, Ethiopia: a qualitative study.

Communities, as funders and users of the health system, have a vital role in ensuring the provision of integrated people-centered primary health care (PHC). However, there is a lack of information on community voices about the competence of health professionals in Ethiopia. Therefore, this study aimed to explore the community voices on the competence of health professionals for the provision of quality PHC services. A qualitative case study involving 10 key informant interviews and 6 FGDs was conducted from June 1 to July 30, 2023, in the Amhara Region among community representatives. The sample size was determined based on data saturation, and purposive heterogeneous sampling was employed. The high-quality health system framework and the Standards for Reporting Qualitative Research (SRQR) were used for analysis and report writing, respectively. The key informants and discussants shared views regarding the competence of health professionals working in PHC facilities. These were categorized into three main themes and six subthemes. The main themes were quality impacts, process of care, and foundations. The subthemes were confidence in health professionals' competence, health outcomes of the care provided by health professionals, economic benefits of the care, users' experiences, competent care and system, and governance. The community had lost trust/confidence in the health professionals working at the PHC settings due to their negative experiences with them and forgone health care services. The community recommended that primary health care should have highly competent health professionals who receive adequate support, payment, working conditions, training, regulation, and who prioritize the people's needs and expectations in their practices. This implies that the region has not yet achieved effective implementation of UHC principles through PHC. Thus, the regional and sub-regional governments and health professionals should work to rebuild the confidence (trust) of the community by paying attention to their concerns and pain points.