Healthcare workers’ perspectives on patient bypassing of Primary Health Care facilities in Mpumalanga province, South Africa

Background: South Africa’s Referral Policy and Implementation Guidelines aim to ensure continuity of care, manage patient flow, and improve health system efficiency. However, in Mpumalanga province, a growing number of patients bypass Primary Health Care (PHC) clinics and seek hospital services without formal referral. This trend undermines the structured referral pathway and strains healthcare resources. Aim: This study sought to identify the key factors that influence patients to bypass PHC facilities in Mpumalanga province. Setting: The study was conducted across the three districts in Mpumalanga province. Methods: A qualitative exploratory design was employed to better understand the factors influencing patients to bypass PHC clinics from the perspective of healthcare workers (HCWs). Using purposive sampling techniques, key informant interviews were conducted with 20 HCWs from 10 selected hospitals. Thematic analysis of the qualitative data was conducted using an inductive approach, with NVivo ® software facilitating systematic coding, theme development and data organisation. Results: Key factors that influenced patients to bypass included a lack of adherence to the referral system, perceptions of poor quality at PHC facilities, long waiting times, negative HCWs’ attitudes and concerns pertaining to stigma and confidentiality. Conclusion: Insights gained from this study contribute to the understanding of factors that lead patients to bypass PHC facilities. Contribution: By understanding the underlying reasons for such bypassing, policymakers and healthcare providers can develop targeted interventions to enhance the quality and utilisation of PHC services. Moreover, addressing these challenges is crucial for achieving equitable healthcare access.