WorldWideScience

Sample records for phc achieving health

  1. Preconception health and care (PHC)-a strategy for improved maternal and child health.

    Science.gov (United States)

    Berglund, Anna; Lindmark, Gunilla

    2016-06-20

    Maternal health status before pregnancy is a decisive factor for pregnancy outcomes and for risk for maternal and infant complications. Still, maternity care does not start until the pregnancy is established and in most low-income settings not until more than half of the pregnancy has passed, which often is too late to impact outcomes. In Western societies preconception care (PCC) is widely recognized as a way to optimize women's health through biomedical and behavioural changes prior to conception with the aim of improving pregnancy outcomes. But the content of PCC is inconsistent and limited to single interventions or preconception counselling to women with chronic illnesses. It has been suggested that PCC should be extended to preconception health and care (PHC), including interventions prior to pregnancy in order to optimize women's health in general, and thereby subsequent pregnancy outcomes, the well-being of the family, and the health of the future child. With this definition, almost every activity that can improve the health of girls and women can be included in the concept. In the World Health Report of 2005 a longitudinal approach to women's wellness and reproductive health was highlighted, and the World Health Organization has proposed a more comprehensive maternal and child health care, also including psychosocial issues and intimate partner violence. The present article gives an overview of the recent literature and discusses contents and delivery of PCC/PHC in Western as well as low-income countries. The article puts special emphasis on why violence against women is an issue for PHC.

  2. [Governance of PHC development in Rosario, Argentina].

    Science.gov (United States)

    Báscolo, Ernesto; Yavich, Natalia

    2010-01-01

    Describing the development of PHC policy as promoted by Rosario Municipality (Argentina). A case-study was carried out during 2007 and 2008. Data was collected from secondary and primary sources (interviews, organisational census and observations). PHC development stages were identified by recognising the social norms which produced institutional change and transformation in municipal health services structure and health care and management models. The prevailing modes of governance in each stage were reconognised and characterised (clan, hierarchy and/or incentives). Four stages were identified between 1990 and 2008: 1990-1995/hierarchical mode: primary health care level organisation autonomied from hospitals. 1995-2000/ clan mode: developing of participatory managerial boards and community participation. 2000-2004/ clan mode: maturation of the "PHC movement" in competition with hospitals. 2004-2008/ clan-hierarchical mode: "movement's" crisis and constructions of norms tending towards enhancing an integrated network. Strengthening and empowering first-level health-care produced innovation favouring: the consolidation of a "PHC movement" having strong social commitment and improved services performance. The clan governance mode (regulating collective action via voluntary adhesion to shared values) was crucial for developing PHC between 1995 and 2004. Later on, the movement's fragmentation and the challenges of integrating the health system required developing hierarchical regulation mechanisms to complement the governance clan mode regulation.

  3. PHC in Bangladesh--too much to ask?

    Science.gov (United States)

    Islam, K; Bachman, S

    1983-01-01

    In Bangladesh where the number of those without land is increasing; 30% of the budget (national) goes for "maintaining law and order'; there is massive illiteracy; the common people and more specifically, women, are not involved in decision-making. It is unrealistic to think that PHC has a chance to survive or succeed. Should Government (with all good intentions) try to run a PHC while socio-economic and political factors remain unchanged, it (PHC) will not succeed. Its fate is either a collision, in which PHC will be the victim, or a compromise of some type. In most Third World countries, it is a compromised PHC that one sees. In spite of this, we still believe that community-oriented health care can help to bring about social, economic and political changes, provided such changes are accompanied by structural reform in the political economy of the country.

  4. Impact of Québec’s healthcare reforms on the organization of primary healthcare (PHC): a 2003-2010 follow-up

    Science.gov (United States)

    2014-01-01

    Background Healthcare reforms initiated in the early 2000s in Québec involved the implementation of new modes of primary healthcare (PHC) delivery and the creation of Health and Social Services Centers (HSSCs) to support it. The objective of this article is to assess and explain the degree of PHC organizational change achieved following these reforms. Methods We conducted two surveys of PHC organizations, in 2005 and 2010, in two regions of the province of Québec, Canada. From the responses to these surveys, we derived a measure of organizational change based on an index of conformity to an ideal type (ICIT). One set of explanatory variables was contextual, related to coercive, normative and mimetic influences; the other consisted of organizational variables that measured receptivity towards new PHC models. Multilevel analyses were performed to examine the relationships between ICIT change in the post-reform period and the explanatory variables. Results Positive results were attained, as expressed by increase in the ICIT score in the post-reform period, mainly due to implementation of new types of PHC organizations (Family Medicine Groups and Network Clinics). Organizational receptivity was the main explanatory variable mediating the effect of coercive and mimetic influences. Normative influence was not a significant factor in explaining changes. Conclusion Changes were modest at the system level but important with regard to new forms of PHC organizations. The top-down decreed reform was a determining factor in initiating change whereas local coercive and normative influences did not play a major role. The exemplar role played by certain PHC organizations through mimetic influence was more important. Receptivity of individual organizations was both a necessary condition and a mediating factor in influencing change. This supports the view that a combination of top-down and bottom-up strategy is best suited for achieving substantial changes in PHC local

  5. Role of Australian primary healthcare organisations (PHCOs) in primary healthcare (PHC) workforce planning: lessons from abroad.

    Science.gov (United States)

    Naccarella, Lucio; Buchan, James; Newton, Bill; Brooks, Peter

    2011-08-01

    To review international experience in order to inform Australian PHC workforce policy on the role of primary healthcare organisations (PHCOs/Medicare Locals) in PHC workforce planning. A NZ and UK study tour was conducted by the lead author, involving 29 key informant interviews with regard to PHCOs roles and the effect on PHC workforce planning. Interviews were audio-taped with consent, transcribed and analysed thematically. Emerging themes included: workforce planning is a complex, dynamic, iterative process and key criteria exist for doing workforce planning well; PHCOs lacked a PHC workforce policy framework to do workforce planning; PHCOs lacked authority, power and appropriate funding to do workforce planning; there is a need to align workforce planning with service planning; and a PHC Workforce Planning and Development Benchmarking Database is essential for local planning and evaluating workforce reforms. With the Australian government promoting the role of PHCOs in health system reform, reflections from abroad highlight the key action within PHC and PHCOs required to optimise PHC workforce planning.

  6. "PHC leadership: are health centres in good hands? Perspectives from 3 districts in Malawi".

    Science.gov (United States)

    Hana, J; Maleta, K; Kirkhaug, R; Hasvold, T

    2012-09-01

    The study aimed to document the kinds of leadership styles are practiced at health centres (H/C) and how these styles can be explained by the contexts, characteristics of the health centre in charge (IC) and subordinate trained health staff (STHS). A well-researched leadership style model was applied, which included task, relation and change styles. This is a cross-sectional study using self-administered questionnaires in 47 H/C in 3 districts. 347 STHSs (95%) and 46 ICs (98%) responded. Questions explored background data and perceived leadership behaviour. Style items were factor analysed, and bivariate analyses and hierarchical regressions determined how styles could be explained. Two leadership styles were revealed: "Trans" style contained all relation and the majority of task and change items; "Control" style focused on health statistics (Health Management Information System), reporting and evaluation. STHS and IC had a median age/median work experience of 34/5 years and 38,5/2 years, respectively. 48% of IC reported having no management training. CHAM H/Cs had the lowest score on "Control" style. Distance to referral hospital had no impact on style scores. No contexts or STHS characteristics predicted any leadership styles. For ICs, young age and increasing work experience were significant predictors for both styles, while Nurse ICs were negative predictors for "Control style". Management training was not a significant predictor for any style. Frontline PHC leadership may be forced by situation and context to use a comprehensive style which could lack the diversity and flexibility needed for effective leadership. The missing associations between staff characteristics and leadership styles might indicate that this group is not sufficiently considered and included in leadership processes in the PHC organization. Leadership competency for the ICs seems not to be based on formal training, but substituted by young age and work experience. Health centre organization

  7. Health care achievement and challenges in the Western Cape

    African Journals Online (AJOL)

    our citizens: (I) the introduction of free primary health care. (PHC) services has made ... Representatives, House of Delegates, House of Assembly. (which operated ... produce the Provincial Health Plan with its 26 task team reports, which have ...

  8. Does the operations of the National Health Insurance Scheme (NHIS) in Ghana align with the goals of Primary Health Care? Perspectives of key stakeholders in northern Ghana.

    Science.gov (United States)

    Awoonor-Williams, John Koku; Tindana, Paulina; Dalinjong, Philip Ayizem; Nartey, Harry; Akazili, James

    2016-09-05

    In 2005, the World Health Assembly (WHA) of the World Health Organization (WHO) urged member states to aim at achieving affordable universal coverage and access to key promotive, preventive, curative, rehabilitative and palliative health interventions for all their citizens on the basis of equity and solidarity. Since then, some African countries, including Ghana, have taken steps to introduce national health insurance reforms as one of the key strategies towards achieving universal health coverage (UHC). The aim of this study was to get a better understanding of how Ghana's health insurance institutions interact with stakeholders and other health sector programmes in promoting primary health care (PHC). Specifically, the study identified the key areas of misalignment between the operations of the NHIS and that of PHC. Using qualitative and survey methods, this study involved interviews with various stakeholders in six selected districts in the Upper East region of Ghana. The key stakeholders included the National Health Insurance Authority (NHIA), district coordinators of the National Health Insurance Schemes (NHIS), the Ghana Health Service (GHS) and District Health Management Teams (DHMTs) who supervise the district hospitals, health centers/clinics and the Community-based Health and Planning Services (CHPS) compounds as well as other public and private PHC providers. A stakeholders' workshop was organized to validate the preliminary results which provided a platform for stakeholders to deliberate on the key areas of misalignment especially, and to elicit additional information, ideas and responses, comments and recommendations from respondents for the achievement of the goals of UHC and PHC. The key areas of misalignments identified during this pilot study included: delays in reimbursements of claims for services provided by health care providers, which serves as a disincentive for service providers to support the NHIS; inadequate coordination among

  9. Protecting resources for primary health care under fiscal federalism: options for resource allocation.

    Science.gov (United States)

    Okorafor, Okore A; Thomas, Stephen

    2007-11-01

    The introduction of fiscal federalism or decentralization of functions to lower levels of government is a reform not done primarily with health sector concerns. A major concern for the health sector is that devolution of expenditure responsibilities to sub-national levels of government can adversely affect the equitable distribution of financial resources across local jurisdictions. Since the adoption of fiscal federalism in South Africa, progress towards achieving a more equitable distribution of public sector health resources (financial) has slowed down considerably. This study attempts to identify appropriate resource allocation mechanisms under the current South African fiscal federal system that could be employed to promote equity in primary health care (PHC) allocations across provinces and districts. The study uses data from interviews with government officials involved in the budgeting and resource allocation process for PHC, literature on fiscal federalism and literature on international experience to inform analysis and recommendations. The results from the study identify historical incremental budgeting, weak managerial capacity at lower levels of government, poor accounting of PHC expenditure, and lack of protection for PHC funds as constraints to the realization of a more equitable distribution of PHC allocations. Based on interview data, no one resource allocation mechanism received unanimous support from stakeholders. However, the study highlights the particularly high level of autonomy enjoyed by provincial governments with regards to decision making for allocations to health and PHC services as the major constraint to achieving a more equitable distribution of PHC resources. The national government needs to have more involvement in decision making for resource allocation to PHC services if significant progress towards equity is to be achieved.

  10. PhC-4 new high-speed camera with mirror scanning

    International Nuclear Information System (INIS)

    Daragan, A.O.; Belov, B.G.

    1979-01-01

    The description of the optical system and the construction of the high-speed PhC-4 photographic camera with mirror scanning of the continuously operating type is given. The optical system of the camera is based on the foursided rotating mirror, two optical inlets and two working sectors. The PhC-4 camera provides the framing rate up to 600 thousand frames per second. (author)

  11. Far field measurements of phc led prepared by e-beam lithography

    International Nuclear Information System (INIS)

    Hronec, P.; Skriniarova, J.; Kovac, J.; Pudis, D.; Bencurova, A.; Nemec, P.

    2014-01-01

    The paper deals with optical characterization of the Al_0_._2_9_5Ga_0_._7_0_5As/GaAs multi quantum well light emitting diode (LED) structure with patterned photonic crystal (2D PhC). The 2D PhC was patterned on the top of the structure using Electron Beam Direct Write Lithography (EBDWL). The LEDs light-current characteristics were measured by using integrating sphere, where extracted light intensity increase was observed at 10 mA forward current as 24.2 %. Also far field measurements were performed at forward current of 10 mA. Comparison of reference LED and PhC LED far fields shows increase in whole emission area. As a complementary method for extracted light intensity increase evaluation, relative light intensity distributed in the far field was integrated in range of ±60 grad in both θ and φ coordinate of spherical coordinate system. This method shows increase of extracted light intensity as 35.6 %. We suggest this method as more suitable for evaluation of extracted light intensity increase because it omits emission from edges of the LED and thus light is measured only from the area where PhC is patterned. (authors)

  12. Padres hombres custodios - PHC: la paternidad, sus alcances y motivaciones

    OpenAIRE

    Fierro Barahona, José Gustavo; Ruíz Gómez, Marina Stella

    2015-01-01

    Esta investigación comprendió las concepciones sobre paternidad presentes en los padres hombres al solicitar la custodia de sus hijas e hijos menores de siete años ante el ICBF de la ciudad de Cali con un diseño cualitativo de aproximación fenomenológica, se utilizó el instrumento de entrevista en profundidad con cinco padres hombres custodios - PHC. Los resultados se presentaron en relación a las distinciones expresadas por los PHC acerca de las razones que los llevó a solicit...

  13. Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa

    Science.gov (United States)

    Daire, Judith; Gilson, Lucy

    2014-01-01

    In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager’s job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better

  14. Exploration of priority actions for strengthening the role of nurses in achieving universal health coverage

    Directory of Open Access Journals (Sweden)

    Rowaida Al Maaitah

    Full Text Available ABSTRACT Objective: to explore priority actions for strengthening the role of Advanced Practice Nurses (APNs towards the achievement of Universal Health Converge (UHC as perceived by health key informants in Jordan. Methods: an exploratory qualitative design, using a semi-structured survey, was utilized. A purposive sample of seventeen key informants from various nursing and health care sectors was recruited for the purpose of the study. Content analysis utilizing the five-stage framework approach was used for data analysis. Results: the findings revealed that policy and regulation, nursing education, research, and workforce were identified as the main elements that influence the role of APNs in contributing to the achievement of UHC. Priority actions were identified by the participants for the main four elements. Conclusion: study findings confirm the need to strengthen the role of APNs to achieve UHC through a major transformation in nursing education, practice, research, leadership, and regulatory system. Nurses should unite to come up with solid nursing competencies related to APNs, PHC, UHC, leadership and policy making to strengthen their position as main actors in influencing the health care system and evidence creation.

  15. Does identity shape leadership and management practice? Experiences of PHC facility managers in Cape Town, South Africa.

    Science.gov (United States)

    Daire, Judith; Gilson, Lucy

    2014-09-01

    In South Africa, as elsewhere, Primary Health Care (PHC) facilities are managed by professional nurses. Little is known about the dimensions and challenges of their job, or what influences their managerial practice. Drawing on leadership and organizational theory, this study explored what the job of being a PHC manager entails, and what factors influence their managerial practice. We specifically considered whether the appointment of professional nurses as facility managers leads to an identity transition, from nurse to manager. The overall intention was to generate ideas about how to support leadership development among PHC facility managers. Adopting case study methodology, the primary researcher facilitated in-depth discussions (about their personal history and managerial experiences) with eight participating facility managers from one geographical area. Other data were collected through in-depth interviews with key informants, document review and researcher field notes/journaling. Analysis involved data triangulation, respondent and peer review and cross-case analysis. The experiences show that the PHC facility manager's job is dominated by a range of tasks and procedures focused on clinical service management, but is expected to encompass action to address the population and public health needs of the surrounding community. Managing with and through others, and in a complex system, requiring self-management, are critical aspects of the job. A range of personal, professional and contextual factors influence managerial practice, including professional identity. The current largely facility-focused management practice reflects the strong nursing identity of managers and broader organizational influences. However, three of the eight managers appear to self-identify an emerging leadership identity and demonstrate related managerial practices. Nonetheless, there is currently limited support for an identity transition towards leadership in this context. Better

  16. Community participation in primary health care projects of the Muldersdrift Health and Development Programme

    Directory of Open Access Journals (Sweden)

    M. Barker

    2007-09-01

    Full Text Available After numerous teething problems (1974-1994, the Department of Nursing Education of WITS University took responsibility for the Muldersdrift Health and Development Programme (MHDP. The nursing science students explored and implemented an empowerment approach to community participation. The students worked with MHDP health workers to improve health through community participation, in combination with primary health care (PHC activities and the involvement of a variety of community groups. As the PHC projects evolved overtime, the need arose to evaluate the level of community participation and how much community ownership was present over decision-making and resources. This led to the question “What was the level of community participation in PHC projects of the MHDP?” Based on the question the following objectives were set, i.e. i to evaluate the community participation in PHC initiatives; ii to provide the project partners with motivational affirmation on the level of community participation criteria thus far achieved; iii to indicate to participants the mechanisms that should still be implemented if they wanted to advance to higher levels of community participation; iv to evaluate the MHDP’s implementation of a people-centred approach to community participation in PHC; and v the evaluation of the level of community participation in PHC projects in the MHDP. An evaluative, descriptive, contextual and quantitative research design was used. Ethical standards were adhered to throughout the study. The MHDP had a study population of twentythree (N=23 PHC projects. A purposive sample of seven PHC initiatives was chosen according to specific selection criteria and evaluated according to the “Criteria to evaluate community participation in PHC projects” instrument (a quantitative tool. Structured group interviews were done with PHC projects’ executive committee members. The Joint Management Committee’s data was collected through mailed

  17. Revisiting Public Health Challenges in the New Millennium | Anish ...

    African Journals Online (AJOL)

    Positive Health of the communities could only be brought out through the interrelationship between conventional health sector and other development sectors. It was a dream that came true when World Health Organization (WHO) accepted Primary Health Care (PHC) as the major tool to achieve its proposed goal of Health ...

  18. Health communication in primary health care -a case study of ICT development for health promotion.

    Science.gov (United States)

    Mahmud, Amina Jama; Olander, Ewy; Eriksén, Sara; Haglund, Bo Ja

    2013-01-30

    Developing Information and Communication Technology (ICT) supported health communication in PHC could contribute to increased health literacy and empowerment, which are foundations for enabling people to increase control over their health, as a way to reduce increasing lifestyle related ill health. However, to increase the likelihood of success of implementing ICT supported health communication, it is essential to conduct a detailed analysis of the setting and context prior to the intervention. The aim of this study was to gain a better understanding of health communication for health promotion in PHC with emphasis on the implications for a planned ICT supported interactive health channel. A qualitative case study, with a multi-methods approach was applied. Field notes, document study and focus groups were used for data collection. Data was then analyzed using qualitative content analysis. Health communication is an integral part of health promotion practice in PHC in this case study. However, there was a lack of consensus among health professionals on what a health promotion approach was, causing discrepancy in approaches and practices of health communication. Two themes emerged from the data analysis: Communicating health and environment for health communication. The themes represented individual and organizational factors that affected health communication practice in PHC and thus need to be taken into consideration in the development of the planned health channel. Health communication practiced in PHC is individual based, preventive and reactive in nature, as opposed to population based, promotive and proactive in line with a health promotion approach. The most significant challenge in developing an ICT supported health communication channel for health promotion identified in this study, is profiling a health promotion approach in PHC. Addressing health promotion values and principles in the design of ICT supported health communication channel could facilitate

  19. Integrated primary health care in Greece, a missing issue in the current health policy agenda: a systematic review

    Directory of Open Access Journals (Sweden)

    Christos Lionis

    2009-07-01

    Full Text Available Background: Over the past years, Greece has undergone several endeavors aimed at modernizing and improving national health care services with a focus on PHC. However, the extent to which integrated primary health care has been achieved is still questioned. Purpose: This paper explores the extent to which integrated primary health care (PHC is an issue in the current agenda of policy makers in Greece, reporting constraints and opportunities and highlighting the need for a policy perspective in developing integrated PHC in this Southern European country. Methods: A systematic review in PubMed/Medline and SCOPUS, along with a hand search in selected Greek biomedical journals was undertaken to identify key papers, reports, editorials or opinion letters relevant to integrated health care. Results: Our systematic review identified 198 papers and 161 out of them were derived from electronic search. Fifty-three papers in total served the scope of this review and are shortly reported. A key finding is that the long-standing dominance of medical perspectives in Greek health policy has been paving the way towards vertical integration, pushing aside any discussions about horizontal or comprehensive integration of care. Conclusion: Establishment of integrated PHC in Greece is still at its infancy, requiring major restructuring of the current national health system, as well as organizational culture changes. Moving towards a new policy-based model would bring this missing issue on the discussion table, facilitating further development.

  20. Knowledge of primary health care and career choice at primary health care settings among final year medical students - challenges to human resources for health in Vietnam.

    Science.gov (United States)

    Giang, Kim Bao; Minh, Hoang Van; Hien, Nguyen Van; Ngoc, Nguyen Minh; Hinh, Nguyen Duc

    2015-01-01

    There is a shortage of medical doctors in primary health care (PHC) settings in Vietnam. Evidence about the knowledge medical students have about PHC and their career decision-making is important for making policy in human resources for health. The objective of this study was to analyse knowledge and attitudes about PHC among medical students in their final year and their choice to work in PHC after graduation. A cross-sectional study was conducted among 400 final year general medical students from Hanoi Medical University. Self-administered interviews were conducted. Key variables were knowledge, awareness of the importance of PHC and PHC career choices. Descriptive and analytic statistics were performed. Students had essential knowledge of the concept and elements of PHC and were well aware of its importance. However, only one-third to one half of them valued PHC with regard to their professional development or management opportunities. Less than 1% of students would work at commune or district health facilities after graduation. This study evidences challenges related to increasing the number of medical doctors working in PHC settings. Immediate and effective interventions are needed to make PHC settings more attractive and to encourage medical graduates to start and continue a career in PHC.

  1. Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services.

    Science.gov (United States)

    Javanparast, Sara; Maddern, Janny; Baum, Fran; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Sanders, David

    2018-01-01

    Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. As part of a 5-year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one-to-one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top-down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community-controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully. Copyright © 2017 John Wiley & Sons, Ltd.

  2. Fingerprinting of petroleum hydrocarbons (PHC) and other biogenic organic compounds (BOC) in oil-contaminated and background soil samples.

    Science.gov (United States)

    Wang, Zhendi; Yang, C; Yang, Z; Hollebone, B; Brown, C E; Landriault, M; Sun, J; Mudge, S M; Kelly-Hooper, F; Dixon, D G

    2012-09-01

    Total petroleum hydrocarbons (TPH) or petroleum hydrocarbons (PHC) are one of the most widespread soil contaminants in Canada, the United States and many other countries worldwide. Clean-up of PHC-contaminated soils costs the Canadian economy hundreds of millions of dollars annually. In Canada, most PHC-contaminated site evaluations are based on the methods developed by the Canadian Council of the Ministers of the Environment (CCME). However, the CCME method does not differentiate PHC from BOC (the naturally occurring biogenic organic compounds), which are co-extracted with petroleum hydrocarbons in soil samples. Consequently, this could lead to overestimation of PHC levels in soil samples. In some cases, biogenic interferences can even exceed regulatory levels (300 μg g(-1) for coarse soils and 1300 μg g(-1) for fine soils for Fraction 3, C(16)-C(34) range, in the CCME Soil Quality Level). Resulting false exceedances can trigger unnecessary and costly cleanup or remediation measures. Therefore, it is critically important to develop new protocols to characterize and quantitatively differentiate PHC and BOC in contaminated soils. The ultimate objective of this PERD (Program of Energy Research and Development) project is to correct the misconception that all detectable hydrocarbons should be regulated as toxic petroleum hydrocarbons. During 2009-2010, soil and plant samples were collected from over forty oil-contaminated and paired background sites in various provinces. The silica gel column cleanup procedure was applied to effectively remove all target BOC from the oil-contaminated sample extracts. Furthermore, a reliable GC-MS method in combination with the derivatization technique, developed in this laboratory, was used for identification and characterization of various biogenic sterols and other major biogenic compounds in these oil-contaminated samples. Both PHC and BOC in these samples were quantitatively determined. This paper reports the characterization

  3. Evidence-informed primary health care workforce policy: are we asking the right questions?

    Science.gov (United States)

    Naccarella, Lucio; Buchan, Jim; Brooks, Peter

    2010-01-01

    Australia is facing a primary health care workforce shortage. To inform primary health care (PHC) workforce policy reforms, reflection is required on ways to strengthen the evidence base and its uptake into policy making. In 2008 the Australian Primary Health Care Research Institute funded the Australian Health Workforce Institute to host Professor James Buchan, Queen Margaret University, UK, an expert in health services policy research and health workforce planning. Professor Buchan's visit enabled over forty Australian PHC workforce mid-career and senior researchers and policy stakeholders to be involved in roundtable policy dialogue on issues influencing PHC workforce policy making. Six key thematic questions emerged. (1) What makes PHC workforce planning different? (2) Why does the PHC workforce need to be viewed in a global context? (3) What is the capacity of PHC workforce research? (4) What policy levers exist for PHC workforce planning? (5) What principles can guide PHC workforce planning? (6) What incentives exist to optimise the use of evidence in policy making? The emerging themes need to be discussed within the context of current PHC workforce policy reforms, which are focussed on increasing workforce supply (via education/training programs), changing the skill mix and extending the roles of health workers to meet patient needs. With the Australian government seeking to reform and strengthen the PHC workforce, key questions remain about ways to strengthen the PHC workforce evidence base and its uptake into PHC workforce policy making.

  4. Primary Health Care in Nigeria: Strategies and constraints in ...

    African Journals Online (AJOL)

    Subsequently, several re-organization of the Nigeria health structure to align with the new vision were made. The implementation of PHC, primarily through services provided at the primary health centres, vary based on the type of PHC facility in Nigeria. Several other PHC services within the health precinct include ...

  5. Status and progress of family health in Latin America and the Caribbean: the Ibero-American Confederation of Family Medicine (ICPM perspective

    Directory of Open Access Journals (Sweden)

    María Inez Padula Anderson

    2013-01-01

    Full Text Available In the XXI century, much of humanity does not have access to comprehensive health care, or even basic equitable health care. If studies show that countries with organized health systems based on a qualified and inclusive model of Primary Health Care (PHC and family physicians as permanent staff are achieving unquestionable results, why a large part of the countries with lower socio-economic development have not committed strongly to implement an efficient reform of their health systems based on PHC and family medicine (FM? These issues are at the core of the Latin American Confederation of Family Medicine’s concerns, an international non-profit organization composed of national associations of countries of FM from Latin America, Spain and Portugal. Its primary mission is to drive the implementation of a proper PHC system in all countries of the region and to ensure that family medicine, as a specialty, is considered critical to health systems, thereby transforming it into a public policy.

  6. Do primary health centres and hospitals contribute equally towards achievement of the transversal clinical competencies of medical students? Performance on the Objective Structured Clinical Examination (OSCE) in competency acquisition.

    Science.gov (United States)

    Soler-González, Jorge; Buti, Miquel; Boada, Jordi; Ayala, Victoria; Peñascal, Eduard; Rodriguez, Toni

    2016-01-01

    The adaptation of the educational programmes of European faculties of medicine to the European Higher Education Area guidelines has focused curricula design on competence acquisition. Competencies are defined as the achievements of a predetermined level of efficacy in real-world scenarios. Our objective was to assess whether performance on a common competence evaluation test, the Objective Structured Clinical Examination (OSCE), resulted in different scores for second-year students after a practical medical training course took place in a primary health centre (PHC) or in a hospital. A descriptive study was conducted during the 2010-2014 academic year of the OSCE test scores obtained by all second-year students. Faculty of Medicine at the University of Lleida (Catalonia, Spain). We performed a correlation analysis between students who completed their practical medical training at the PHC and hospitals utilising Student's t-test for comparison of means. 423 students who completed internships at the PHC and at hospitals obtained OSCE mean scores of 7.32 (SD; IC) (0.82; 7.18-7.47) points and 7.17 (0.83; 6.07-7.26) points, respectively (p=0.07). Second-year medical students acquired similar competency levels in the two analysed training scenarios. The two areas both serve their teaching purpose. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  7. Introducing a complex health innovation--primary health care reforms in Estonia (multimethods evaluation).

    Science.gov (United States)

    Atun, Rifat Ali; Menabde, Nata; Saluvere, Katrin; Jesse, Maris; Habicht, Jarno

    2006-11-01

    All post-Soviet countries are trying to reform their primary health care (PHC) systems. The success to date has been uneven. We evaluated PHC reforms in Estonia, using multimethods evaluation: comprising retrospective analysis of routine health service data from Estonian Health Insurance Fund and health-related surveys; documentary analysis of policy reports, laws and regulations; key informant interviews. We analysed changes in organisational structure, regulations, financing and service provision in Estonian PHC system as well as key informant perceptions on factors influencing introduction of reforms. Estonia has successfully implemented and scaled-up multifaceted PHC reforms, including new organisational structures, user choice of family physicians (FPs), new payment methods, specialist training for family medicine, service contracts for FPs, broadened scope of services and evidence-based guidelines. These changes have been institutionalised. PHC effectiveness has been enhanced, as evidenced by improved management of key chronic conditions by FPs in PHC setting and reduced hospital admissions for these conditions. Introduction of PHC reforms - a complex innovation - was enhanced by strong leadership, good co-ordination between policy and operational level, practical approach to implementation emphasizing simplicity of interventions to be easily understood by potential adopters, an encircling strategy to roll-out which avoided direct confrontations with narrow specialists and opposing stakeholders in capital Tallinn, careful change-management strategy to avoid health reforms being politicized too early in the process, and early investment in training to establish a critical mass of health professionals to enable rapid operationalisation of policies. Most importantly, a multifaceted and coordinated approach to reform - with changes in laws; organisational restructuring; modifications to financing and provider payment systems; creation of incentives to enhance

  8. Comparing Performance of Public and Cooperative Health Centers

    Directory of Open Access Journals (Sweden)

    Mostafa Farahbakhsh

    2012-04-01

    Full Text Available Background: Health cooperatives in similar structure of health network in Iran, give primary health cares to defined population with supervisory of public sector. Materials and method: This study compares health system performance between public (PHC and cooperative (CHC health centers. Results: Client's satisfaction was 4.14 in CHC and 3.9 in PHC in 5 point Likert scale. The mean for daily health services of CHC and PHC were 110.8 and 85 respectively. Conclusion: Health cooperatives are appropriate strategy for downsizing of government in health sector

  9. Primary health care service use among women who have recently left an abusive partner: income and racialization, unmet need, fits of services, and health.

    Science.gov (United States)

    Stam, Marieka T; Ford-Gilboe, Marilyn; Regan, Sandra

    2015-01-01

    Primary health care (PHC) can improve the health of women who have experienced intimate partner violence; yet, access to and fit of PHC services may be shaped by income and racialization. We examined whether income and racialization were associated with differences in PHC service use, unmet needs, fit with needs, and mental and physical health in a sample of 286 women who had separated from an abusive partner. Mothers, unemployed women, and those with lower incomes used more PHC services and reported a poorer fit of services. Poorer fit of services was related to poorer mental and physical health.

  10. Assessment of the Knowledge of Primary Health Care Staff about Primary Health Care

    OpenAIRE

    Elzubier, Ahmed G.; Bella, Hassan; Sebai, Zohair A.

    1995-01-01

    The orientation about Primary Health Care among staff working in the PHC centers was assessed. Staff members numbering 909 were studied. The main criteria for judging orientation were a working knowledge of the definition and elements of PHC in addition to knowledge of the meaning of the word Alma Ata. Differences of this knowledge depending on sex, age, spoken language, type of job, postgraduate experience, previous experience in PHC and previous training in PHC were assessed. The main findi...

  11. Effect of primary health care reforms in Turkey on health service utilization and user satisfaction.

    Science.gov (United States)

    Hone, Thomas; Gurol-Urganci, Ipek; Millett, Christopher; Başara, Berrak; Akdağ, Recep; Atun, Rifat

    2017-02-01

    Strengthening primary health care (PHC) is considered a priority for efficient and responsive health systems, but empirical evidence from low- and middle-income countries is limited. The stepwise introduction of family medicine across all 81 provinces of Turkey (a middle-income country) between 2005 and 2010, aimed at PHC strengthening, presents a natural experiment for assessing the effect of family medicine on health service utilization and user satisfaction.The effect of health system reforms, that introduced family medicine, on utilization was assessed using longitudinal, province-level data for 12 years and multivariate regression models adjusting for supply-side variables, demographics, socio-economic development and underlying yearly trends. User satisfaction with primary and secondary care services was explored using data from annual Life Satisfaction Surveys. Trends in preferred first point of contact (primary vs secondary, public vs. private), reason for choice and health services issues, were described and stratified by patient characteristics, provider type, and rural/urban settings.Between 2002 and 2013, the average number of PHC consultations increased from 1.75 to 2.83 per person per year. In multivariate models, family medicine introduction was associated with an increase of 0.37 PHC consultations per person (P < 0.001), and slower annual growth in PHC and secondary care consultations. Following family medicine introduction, the growth of PHC and secondary care consultations per person was 0.08 and 0.30, respectively, a year. PHC increased as preferred provider by 9.5% over 7 years with the reasons of proximity and service satisfaction, which increased by 14.9% and 11.8%, respectively. Reporting of poor facility hygiene, difficulty getting an appointment, poor physician behaviour and high costs of health care all declined (P < 0.001) in PHC settings, but remained higher among urban, low-income and working-age populations. © The Author 2016

  12. Better Measurement for Performance Improvement in Low- and Middle-Income Countries: The Primary Health Care Performance Initiative (PHCPI) Experience of Conceptual Framework Development and Indicator Selection.

    Science.gov (United States)

    Veillard, Jeremy; Cowling, Krycia; Bitton, Asaf; Ratcliffe, Hannah; Kimball, Meredith; Barkley, Shannon; Mercereau, Laure; Wong, Ethan; Taylor, Chelsea; Hirschhorn, Lisa R; Wang, Hong

    2017-12-01

    Policy Points: Strengthening accountability through better measurement and reporting is vital to ensure progress in improving quality primary health care (PHC) systems and achieving universal health coverage (UHC). The Primary Health Care Performance Initiative (PHCPI) provides national decision makers and global stakeholders with opportunities to benchmark and accelerate performance improvement through better performance measurement. Results from the initial PHC performance assessments in low- and middle-income countries (LMICs) are helping guide PHC reforms and investments and improve the PHCPI's instruments and indicators. Findings from future assessment activities will further amplify cross-country comparisons and peer learning to improve PHC. New indicators and sources of data are needed to better understand PHC system performance in LMICs. The Primary Health Care Performance Initiative (PHCPI), a collaboration between the Bill and Melinda Gates Foundation, The World Bank, and the World Health Organization, in partnership with Ariadne Labs and Results for Development, was launched in 2015 with the aim of catalyzing improvements in primary health care (PHC) systems in 135 low- and middle-income countries (LMICs), in order to accelerate progress toward universal health coverage. Through more comprehensive and actionable measurement of quality PHC, the PHCPI stimulates peer learning among LMICs and informs decision makers to guide PHC investments and reforms. Instruments for performance assessment and improvement are in development; to date, a conceptual framework and 2 sets of performance indicators have been released. The PHCPI team developed the conceptual framework through literature reviews and consultations with an advisory committee of international experts. We generated 2 sets of performance indicators selected from a literature review of relevant indicators, cross-referenced against indicators available from international sources, and evaluated through

  13. Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon.

    Science.gov (United States)

    Saleh, Shadi; Khodor, Rawya; Alameddine, Mohamad; Baroud, Maysa

    2016-11-10

    change efficacy; and between frequency of computer use and change efficacy. The implementation of eHealth cannot be achieved without the readiness of healthcare providers. This study demonstrates that the majority of healthcare providers at PHC centers across Lebanon are ready for eHealth implementation. The findings of this study can be considered by decision makers to enhance and scale-up the use of eHealth in PHC centers nationally. Efforts should be directed towards capacity building for healthcare providers.

  14. Barriers and facilitators to the integration of mental health services into primary health care: a systematic review protocol.

    Science.gov (United States)

    Wakida, Edith K; Akena, Dickens; Okello, Elialilia S; Kinengyere, Alison; Kamoga, Ronald; Mindra, Arnold; Obua, Celestino; Talib, Zohray M

    2017-08-25

    Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works. This review will use the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework approach to identify experiences of mental health integration into PHC; the findings will be reported using the "Best fit" framework synthesis. PubMed, EMBASE, PsycINFO, and Cochrane Central Register of Controlled trials (CENTRAL) will be searched including other sources like the WHO website and OpenGrey database. Assessment of bias and quality will be done at study level using two separate tools to check for the quality of evidence presented. Data synthesis will take on two synergistic approaches (qualitative and quantitative studies). Synthesizing evidence from countries across the globe will provide useful insights into the experiences of integrating mental health services into PHC and how the barriers and challenges have been handled. The findings will be useful to a wide array of stakeholders involved in the implementation of the mental health integration into PHC. The SPIDER framework has been chosen for this review because of its suitable application to qualitative and mixed methods research and will be used as a guide when selecting articles for inclusion. Data extracted will be synthesized using the "Best fit" framework because it has been used before and proved its suitability in producing new conceptual models for explaining decision-making and possible behaviors. Synthesizing evidence from countries across the globe

  15. Comprehensive primary health care under neo-liberalism in Australia.

    Science.gov (United States)

    Baum, Fran; Freeman, Toby; Sanders, David; Labonté, Ronald; Lawless, Angela; Javanparast, Sara

    2016-11-01

    This paper applies a critical analysis of the impact of neo-liberal driven management reform to examine changes in Australian primary health care (PHC) services over five years. The implementation of comprehensive approaches to primary health care (PHC) in seven services: five state-managed and two non-government organisations (NGOs) was tracked from 2009 to 2014. Two questions are addressed: 1) How did the ability of Australian PHC services to implement comprehensive PHC change over the period 2009-2014? 2) To what extent is the ability of the PHC services to implement comprehensive PHC shaped by neo-liberal health sector reform processes? The study reports on detailed tracking and observations of the changes and in-depth interviews with 63 health service managers and practitioners, and regional and central health executives. The documented changes were: in the state-managed services (although not the NGOs) less comprehensive service coverage and more focus on clinical services and integration with hospitals and much less development activity including community development, advocacy, intersectoral collaboration and attention to the social determinants. These changes were found to be associated with practices typical of neo-liberal health sector reform: considerable uncertainty, more directive managerial control, budget reductions and competitive tendering and an emphasis on outputs rather than health outcomes. We conclude that a focus on clinical service provision, while highly compatible with neo-liberal reforms, will not on its own produce the shifts in population disease patterns that would be required to reduce demand for health services and promote health. Comprehensive PHC is much better suited to that task. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. The development and impact of primary health care in China from 1949 to 2015: A focused review.

    Science.gov (United States)

    Li, Huazhang; Liu, Kun; Gu, Jianjun; Zhang, Yimin; Qiao, Yun; Sun, Xiaoming

    2017-07-01

    High-quality primary health care (PHC) services are associated with better health outcomes and positive health equity. Providing PHC services to all inhabitants is one of the Chinese government's health care objectives. However, an imbalance between people's increasing health needs and effective health service utilization exists in China. The objective of this review is to identify evidence for PHC development in China and to summarize the challenges as a reference for the future improvement of China's PHC system. Literature searches related to China's PHC were performed in PubMed, Web of Science, China National Knowledge Infrastructure, and Wan-fang databases. Related data were collected from the China Statistical Yearbook on Health and Family Planning 2003-2016, the China National Health Accounts Report 2015, and An Analysis Report of National Health Services Survey in China, 2013. The PHC network and the population's health have improved in China in recent years, with general practitioners as "gatekeepers" who have gradually taken the initiative to offer health services to residents. The limitation of input and shortages of resources and skilled health care providers may restrict the sustainable development of China's PHC system. Therefore, policy support from the government is necessary. Copyright © 2017 John Wiley & Sons, Ltd.

  17. Coping and compromise: a qualitative study of how primary health care providers respond to health reform in China.

    Science.gov (United States)

    Zhang, Mingji; Wang, Wei; Millar, Ross; Li, Guohong; Yan, Fei

    2017-08-04

    Health reform in China since 2009 has emphasized basic public health services to enhance the function of Community Health Services as a primary health care facility. A variety of studies have documented these efforts, and the challenges these have faced, yet up to now the experience of primary health care (PHC) providers in terms of how they have coped with these changes remains underdeveloped. Despite the abundant literature on psychological coping processes and mechanisms, the application of coping research within the context of human resources for health remains yet to be explored. This research aims to understand how PHC providers coped with the new primary health care model and the job characteristics brought about by these changes. Semi-structured interviews with primary health care workers were conducted in Jinan city of Shandong province in China. A maximum variation sampling method selected 30 PHC providers from different specialties. Thematic analysis was used drawing on a synthesis of theories related to the Job Demands-Resources model, work adjustment, and the model of exit, voice, loyalty and neglect to understand PHC providers' coping strategies. Our interviews identified that the new model of primary health care significantly affected the nature of primary health work and triggered a range of PHC providers' coping processes. The results found that health workers perceived their job as less intensive than hospital medical work but often more trivial, characterized by heavy workload, blurred job description, unsatisfactory income, and a lack of professional development. However, close relationship with community and low work pressure were satisfactory. PHC providers' processing of job demands and resources displayed two ways of interaction: aggravation and alleviation. Processing of job demands and resources led to three coping strategies: exit, passive loyalty, and compromise with new roles and functions. Primary health care providers employed coping

  18. Implementing primary health care: some problems of creating national programmes.

    Science.gov (United States)

    Vaughan, J P; Walt, G

    1984-07-01

    While there is a great deal of agreement about the principles underlying Primary Health Care (PHC), there exist many problems, political, planning and management, involved in putting the approach into effect. Some of these difficulties are discussed. It is clear that the PHC approach is essentially political; the way it is implemented in each country will reflect the political priorities and systems of that country. Moreover, ministries of health are not known for their strong position in the ministerial pecking order. Finance and planning ministeries would have to be won over to the importance of the concept of PHC to try to eexpand the health budget and to change the emphasis of existing resource allocation patterns. Costs incurred by a PHC approach ( e.g., expensive transport and communication systems), and resources needed to finance it may be available; however, they may not be channelled to the politically less articulate groups in rural areas. Political implications are not limited to national levels; considerable conflict may exist between different status groups and classes at the village level, thus sabotaging PHC plans. Professional politics will also be played at all levels. It is equally essential to recognize the historical context in which PHC is being introduced. Many countries have inherited colonial infrastructures. Changing the values, perceptions, expectations, administration and organization that accompany such systems is extremely hard, and to put PHC into effect demands radical changes. The planning difficulties which beset PHC are related to the still large private provision of social services like health, and to a flourishing traditional private sector in many developing countries. These may limit the implementation of a national health policy and PHC may thus result in a very patchy service throughout the country. The level of centralized planning will also affect resource allocation and therefore the policy, planning and implementation

  19. How decentralisation influences the retention of primary health care workers in rural Nigeria.

    Science.gov (United States)

    Abimbola, Seye; Olanipekun, Titilope; Igbokwe, Uchenna; Negin, Joel; Jan, Stephen; Martiniuk, Alexandra; Ihebuzor, Nnenna; Aina, Muyi

    2015-01-01

    In Nigeria, the shortage of health workers is worst at the primary health care (PHC) level, especially in rural communities. And the responsibility for PHC - usually the only form of formal health service available in rural communities - is shared among the three tiers of government (federal, state, and local governments). In addition, the responsibility for community engagement in PHC is delegated to community health committees. This study examines how the decentralisation of health system governance influences retention of health workers in rural communities in Nigeria from the perspective of health managers, health workers, and people living in rural communities. The study adopted a qualitative approach, and data were collected using semi-structured in-depth interviews and focus group discussions. The multi-stakeholder data were analysed for themes related to health system decentralisation. The results showed that decentralisation influences the retention of rural health workers in two ways: 1) The salary of PHC workers is often delayed and irregular as a result of delays in transfer of funds from the national to sub-national governments and because one tier of government can blame failure on another tier of government. Further, the primary responsibility for PHC is often left to the weakest tier of government (local governments). And the result is that rural PHC workers are attracted to working at levels of care where salaries are higher and more regular - in secondary care (run by state governments) and tertiary care (run by the federal government), which are also usually in urban areas. 2) Through community health committees, rural communities influence the retention of health workers by working to increase the uptake of PHC services. Community efforts to retain health workers also include providing social, financial, and accommodation support to health workers. To encourage health workers to stay, communities also take the initiative to co-finance and co

  20. Stakeholders Perception of Current Health Education Situation ...

    African Journals Online (AJOL)

    Health Education is one of the critical eight essential pillars of the primary health care (PHC) adopted world-wide by WHO member countries in 1978. After over two decades of health education to support PHC implementation, the epidemiological profile of Ghana continues to be dominated by communicable diseases, and ...

  1. Accelaration of Jamkesda (Regional Health Security Participation and Jamkesda Member Visit based on Age Group Phenomenon in Nganjuk Regency PHC, Year 2012

    Directory of Open Access Journals (Sweden)

    Mugeni Sugiharto

    2015-03-01

    ABSTRACTBackground:Introduction: Jamkesda is pro- poor government policy to fulfill their health care right base on mandate of law. Departemen of Health in Nganjuk Regency run socialization by involving all local power Hence, in 2012 Jamkesda participation would reach highest in East Java. Purpose:This resaerch aimed to identify Jamkesda participation acceleration and Jamkesda member visit based on age group phenomenon in Nganjuk Regency year 2012. Method:Descriptive research with cross sectional design. Population was Nganjuk Regency government Agency with all Jamkesda managing agencies as sample. Analysis unit was institution. Respondents were officials who managed Jamkesda.Result:Jamkesda in Nganjuk Regency was integrate to Sub Divison of Special Service an Health Costing primary task. In 2012 it showed highest Jamkesda participation in East Java. Socialization strengthening in form of social support and advocacy and media use to accelerate local health coverage and to erase Poor Notification Letter to have medication. Medication visit phenomenon was varied in number in every district, the highest was Nganjuk District (11.18%. Women (56.1% who took medication in PHC was higher than men (43,99% particularly those at 15–< 54 years old age group. The commonest disease was hypertension. Conclusion: Participation acceleration through social support and advocacy strategy is able to obtain local public support both formal and non formal for its success. Highest medication visit to PHC was Nganjuk district by women with hypertension as commonest disease they complained. Suggestion:Social support and advocacy socialization strategy can be implemented in other places with similar situation and condition Key words: Jamkesda, Socialization, Social Support, Advocacy

  2. Phytoremediation of Petroleum Hydrocarbon (PHC) Contaminated Soil by Using Mimosa pudica L. .

    Science.gov (United States)

    Budhadev, Basumatary; Rubul, Saikia; Sabitry, Bordoloi; Hari Prasad, Sarma

    2014-07-01

    The aim of this study was to evaluate the efficiency of Mimosa pudica L. that could be effective in phytoremediation of PHC-contaminated soil. Experiments were conducted in net house to determine the tolerance of this species to a heavy crude oil contaminated soil under the application of two fertilizer levels and reduction of PHC was monitored for 180 days. Assessment of plant growth, biomass and Total Oil and Grease (TOG) degradation were carried out at an interval of 60 days. In the presence of contaminants, biomass and plant height were reduced up to 27% and 10.4% respectively. Experiments with different percentages of crude oil showed that M. pudica could tolerate crude-oil contamination up to 6.2% (w/w). The estimation of TOG in soil of the tested plants revealed that M. pudica could decrease 31.7% of crude oil contaminants in low fertilizer level (200N, 100P, 100K) and 24.7% in high fertilizer level (240N, 120P, 120K). In case of unplanted pots, the reduction of TOG was 13.7% in low fertilizer level and 11.2% in high fertilizer level. This experiment has identified the suitability of a native candidate plant species for further investigation of their phytoremediation potential.

  3. Strengthening primary health care in low- and middle-income countries: generating evidence through evaluation.

    Science.gov (United States)

    Rule, John; Ngo, Duc Anh; Oanh, Tran Thi Mai; Asante, Augustine; Doyle, Jennifer; Roberts, Graham; Taylor, Richard

    2014-07-01

    Since the publication of the World Health Report 2008, there has been renewed interest in the potential of primary health care (PHC) to deliver global health policy agendas. The WHO Western Pacific Regional Strategy 2010 states that health systems in low- and middle-income countries (LMICs) can be strengthened using PHC values as core principles. This review article explores the development of an evidence-based approach for assessing the effectiveness of PHC programs and interventions in LMICs. A realist review method was used to investigate whether there is any internationally consistent approach to evaluating PHC. Studies from LMICs using an explicit methodology or framework for measuring PHC effectiveness were collated. Databases of published articles were searched, and a review of gray literature was undertaken to identify relevant reports. The review found no consistent approach for assessing the effectiveness of PHC interventions in LMICs. An innovative approach used in China, which developed a set of core community health facility indicators based on stakeholder input, does show some potential for use in other LMIC contexts. © 2013 APJPH.

  4. Advancing the application of systems thinking in health: South African examples of a leadership of sensemaking for primary health care.

    Science.gov (United States)

    Gilson, Lucy; Elloker, Soraya; Olckers, Patti; Lehmann, Uta

    2014-06-16

    New forms of leadership are required to bring about the fundamental health system changes demanded by primary health care (PHC). Using theory about complex adaptive systems and policy implementation, this paper considers how actors' sensemaking and the exercise of discretionary power currently combine to challenge PHC re-orientation in the South African health system; and provides examples of leadership practices that promote sensemaking and power use in support of PHC. The paper draws on observational, interview, and reflective data collected as part of the District Innovation and Action Learning for Health Systems Development (DIALHS) project being implemented in Cape Town, South Africa. Undertaken collaboratively between health managers and researchers, the project is implemented through cycles of action-learning, including systematic reflection and synthesis. It includes a particular focus on how local health managers can better support front line facility managers in strengthening PHC. The results illuminate how the collective understandings of staff working at the primary level - of their working environment and changes within it - act as a barrier to centrally-led initiatives to strengthen PHC. Staff often fail to take ownership of such initiatives and experience them as disempowering. Local area managers, located between the centre and the service frontline, have a vital role to play in providing a leadership of sensemaking to mediate these challenges. Founded on personal values, such leadership entails, for example, efforts to nurture PHC-aligned values and mind-sets among staff; build relationships and support the development of shared meanings about change; instil a culture of collective inquiry and mutual accountability; and role-model management practices, including using language to signal meaning. PHC will only become a lived reality within the South African health system when frontline staff are able to make sense of policy intentions and

  5. Insights of health district managers on the implementation of primary health care outreach teams in Johannesburg, South Africa: a descriptive study with focus group discussions.

    Science.gov (United States)

    Moosa, Shabir; Derese, Anselme; Peersman, Wim

    2017-01-21

    Primary health care (PHC) outreach teams are part of a policy of PHC re-engineering in South Africa. It attempts to move the deployment of community health workers (CHWs) from vertical programmes into an integrated generalised team-based approach to care for defined populations in municipal wards. There has little evaluation of PHC outreach teams. Managers' insights are anecdotal. This is descriptive qualitative study with focus group discussions with health district managers of Johannesburg, the largest city in South Africa. This was conducted in a sequence of three meetings with questions around implementation, human resources, and integrated PHC teamwork. There was a thematic content analysis of validated transcripts using the framework method. There were two major themes: leadership-management challenges and human resource challenges. Whilst there was some positive sentiment, leadership-management challenges loomed large: poor leadership and planning with an under-resourced centralised approach, poor communications both within the service and with community, concerns with its impact on current services and resistance to change, and poor integration, both with other streams of PHC re-engineering and current district programmes. Discussion by managers on human resources was mostly on the plight of CHWs and calls for formalisation of CHWs functioning and training and nurse challenges with inappropriate planning and deployment of the team structure, with brief mention of the extended team. Whilst there is positive sentiment towards intent of the PHC outreach team, programme managers in Johannesburg were critical of management of the programme in their health district. Whilst the objective of PHC reform is people-centred health care, its implementation struggles with a centralising tendency amongst managers in the health service in South Africa. Managers in Johannesburg advocated for decentralisation. The implementation of PHC outreach teams is also limited by

  6. An evaluation of the competencies of primary health care clinic nursing managers in two South African provinces.

    Science.gov (United States)

    Munyewende, Pascalia O; Levin, Jonathan; Rispel, Laetitia C

    2016-01-01

    Managerial competencies to enhance individual and organisational performance have gained currency in global efforts to strengthen health systems. Competent managers are essential in the implementation of primary health care (PHC) reforms that aim to achieve universal health coverage. To evaluate the competencies of PHC clinic nursing managers in two South African provinces. A cross-sectional study was conducted in two South African provinces. Using stratified random sampling, 111 PHC clinic nursing managers were selected. All supervisors ( n =104) and subordinate nurses ( n =383) were invited to participate in the survey on the day of data collection. Following informed consent, the nursing managers, their supervisors, and subordinate nurses completed a 40-item, 360-degree competency assessment questionnaire, with six domains: communication, leadership and management, staff management, financial management, planning and priority setting, and problem-solving. Standard deviations, medians, and inter-quartile ranges (IQRs) were computed separately for PHC nursing managers, supervisors, and subordinate nurses for competencies in the six domains. The Tinsley and Weiss index was used to assess agreement between each of the three possible pairs of raters. A 95.4% response rate was obtained, with 105 nursing managers in Gauteng and Free State completing the questionnaires. There was a lack of agreement about nursing managers' competencies among the three groups of raters. Overall, clinic nursing managers rated themselves high on the five domains of communication (8.6), leadership and management (8.67), staff management (8.75), planning and priority setting (8.6), and problem-solving (8.83). The exception was financial management with a median score of 7.94 (IQR 6.33-9.11). Compared to the PHC clinic managers, the supervisors and subordinate nurses gave PHC nursing managers lower ratings on all six competency domains, with the lowest rating for financial management

  7. An evaluation of the competencies of primary health care clinic nursing managers in two South African provinces

    Directory of Open Access Journals (Sweden)

    Pascalia O. Munyewende

    2016-12-01

    Full Text Available Background: Managerial competencies to enhance individual and organisational performance have gained currency in global efforts to strengthen health systems. Competent managers are essential in the implementation of primary health care (PHC reforms that aim to achieve universal health coverage. Objective: To evaluate the competencies of PHC clinic nursing managers in two South African provinces. Design: A cross-sectional study was conducted in two South African provinces. Using stratified random sampling, 111 PHC clinic nursing managers were selected. All supervisors (n=104 and subordinate nurses (n=383 were invited to participate in the survey on the day of data collection. Following informed consent, the nursing managers, their supervisors, and subordinate nurses completed a 40-item, 360-degree competency assessment questionnaire, with six domains: communication, leadership and management, staff management, financial management, planning and priority setting, and problem-solving. Standard deviations, medians, and inter-quartile ranges (IQRs were computed separately for PHC nursing managers, supervisors, and subordinate nurses for competencies in the six domains. The Tinsley and Weiss index was used to assess agreement between each of the three possible pairs of raters. Results: A 95.4% response rate was obtained, with 105 nursing managers in Gauteng and Free State completing the questionnaires. There was a lack of agreement about nursing managers’ competencies among the three groups of raters. Overall, clinic nursing managers rated themselves high on the five domains of communication (8.6, leadership and management (8.67, staff management (8.75, planning and priority setting (8.6, and problem-solving (8.83. The exception was financial management with a median score of 7.94 (IQR 6.33–9.11. Compared to the PHC clinic managers, the supervisors and subordinate nurses gave PHC nursing managers lower ratings on all six competency domains, with

  8. Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data.

    Science.gov (United States)

    Atun, Rifat; Gurol-Urganci, Ipek; Hone, Thomas; Pell, Lisa; Stokes, Jonathan; Habicht, Triin; Lukka, Kaija; Raaper, Elin; Habicht, Jarno

    2016-12-01

    Following independence from the Soviet Union in 1991, Estonia introduced a national insurance system, consolidated the number of health care providers, and introduced family medicine centred primary health care (PHC) to strengthen the health system. Using routinely collected health billing records for 2005-2012, we examine health system utilisation for seven ambulatory care sensitive conditions (ACSCs) (asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2 diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and by patient characteristics (gender, age, and number of co-morbidities). The data set contained 552 822 individuals. We use patient level data to test the significance of trends, and employ multivariate regression analysis to evaluate the probability of inpatient admission while controlling for patient characteristics, health system supply-side variables, and PHC use. Over the study period, utilisation of PHC increased, whilst inpatient admissions fell. Service mix in PHC changed with increases in phone, email, nurse, and follow-up (vs initial) consultations. Healthcare utilisation for diabetes, depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failure and asthma utilisation in outpatient and inpatient settings increased. Multivariate regression indicates higher probability of inpatient admission for males, older patient and especially those with multimorbidity, but protective effect for PHC, with significantly lower hospital admission for those utilising PHC services. Our findings suggest health system reforms in Estonia have influenced the shift of ACSCs from secondary to primary care, with PHC having a protective effect in reducing hospital admissions.

  9. Exploration of funding models to support hybridisation of Australian primary health care organisations.

    Science.gov (United States)

    Reddy, Sandeep

    2017-09-01

    Primary Health Care (PHC) funding in Australia is complex and fragmented. The focus of PHC funding in Australia has been on volume rather than comprehensive primary care and continuous quality improvement. As PHC in Australia is increasingly delivered by hybrid style organisations, an appropriate funding model that matches this set-up while addressing current issues with PHC funding is required. This article discusses and proposes an appropriate funding model for hybrid PHC organisations.

  10. First contact, simplified technology, or risk anticipation? Defining primary health care.

    Science.gov (United States)

    Frenk, J; González-Block, M A; Alvarez-Manilla, J M

    1990-11-01

    Elements important to defining primary health care (PHC) are discussed, with examples from Latin American countries. Topics are identified as follows: the origins and dilemmas of PHC, conflicting PHC values and practices, organizational changes and PHC, health care reforms and examples from Latin America, and the implications for medical education. The new paradigm for medical education and practice is in the classic Kuhn tradition. A paradigm for health care is an ideological model about the form, content, and organization of health care. There are rules that prescribe in a normative way how resources should be combined to produce health services. The current dominant paradigm is that of curative medicine, and the PHC paradigm assumes that a diversified health care team uses modern technology and resources to actively anticipate health damage and promote well being. The key word is anticipatory. As a consequence secondary care also needs to be redefined as actually treating the illness or damage itself. Organizations must be changed to establish this model. Contrasting primary, anticipatory health care with technical, curative medicine has been discussed over at least the past 150 years. An important development was the new model for developing countries which was a result of a Makerere, Kenya symposium on the Medicine of Poverty. The Western model of physicians acting independently and in a highly specialized fashion to address each patient's complaints was considered inappropriate. The concern must be for training and supervising auxiliaries, designing cost-effective systems, and a practice mode limited to what can actually be provided to the population. How to adapt this to existing medical systems was left undetermined. In 1978 with the WHO drive for health for all, there emerged different conceptions and models of PHC. Conceptually, PHC is realized when services are directed to identifying and modifying risk factors at the collective level, where the health

  11. Addressing the determinants of child mental health: intersectionality as a guide to primary health care renewal.

    Science.gov (United States)

    McPherson, Charmaine M; McGibbon, Elizabeth A

    2010-09-01

    Primary health care (PHC) renewal was designed explicitly to attend to the multidimensional factors impacting on health, including the social determinants of health. These determinants are central considerations in the development of integrated, cross-sectoral, and multi-jurisdictional policies such as those that inform models of shared mental health care for children. However, there are complex theoretical challenges in translating these multidimensional issues into policy. One of these is the rarely discussed interrelationships among the social determinants of health and identities such as race, gender, age, sexuality, and social class within the added confluence of geographic contexts. An intersectionality lens is used to examine the complex interrelationships among the factors affecting child mental health and the associated policy challenges surrounding PHC renewal. The authors argue that an understanding of the intersections of social determinants of health, identity, and geography is pivotal in guiding policy-makers as they address child mental health inequities using a PHC renewal agenda.

  12. Index of Access: a new innovative and dynamic tool for rural health service and workforce planning.

    Science.gov (United States)

    McGrail, Matthew R; Russell, Deborah J; Humphreys, John S

    2017-10-01

    Objective Improving access to primary health care (PHC) remains a key issue for rural residents and health service planners. This study aims to show that how access to PHC services is measured has important implications for rural health service and workforce planning. Methods A more sophisticated tool to measure access to PHC services is proposed, which can help health service planners overcome the shortcomings of existing measures and long-standing access barriers to PHC. Critically, the proposed Index of Access captures key components of access and uses a floating catchment approach to better define service areas and population accessibility levels. Moreover, as demonstrated through a case study, the Index of Access enables modelling of the effects of workforce supply variations. Results Hypothetical increases in supply are modelled for a range of regional centres, medium and small rural towns, with resulting changes of access scores valuable to informing health service and workforce planning decisions. Conclusions The availability and application of a specific 'fit-for-purpose' access measure enables a more accurate empirical basis for service planning and allocation of health resources. This measure has great potential for improved identification of PHC access inequities and guiding redistribution of PHC services to correct such inequities. What is known about the topic? Resource allocation and health service planning decisions for rural and remote health settings are currently based on either simple measures of access (e.g. provider-to-population ratios) or proxy measures of access (e.g. standard geographical classifications). Both approaches have substantial limitations for informing rural health service planning and decision making. What does this paper add? The adoption of a new improved tool to measure access to PHC services, the Index of Access, is proposed to assist health service and workforce planning. Its usefulness for health service planning is

  13. Tuberculosis knowledge, attitudes and practices of patients at primary health care facilities in a South African metropolitan: research towards improved health education.

    Science.gov (United States)

    Kigozi, N Gladys; Heunis, J Christo; Engelbrecht, Michelle C; Janse van Rensburg, André P; van Rensburg, H C J Dingie

    2017-10-10

    Health education is important to empower patients and encourage their contribution towards tuberculosis (TB) control. In South Africa, health education activities are integrated into services provided at the primary health care (PHC) level. This study was conducted in a high TB burden metropolitan area in South Africa. The objective was to assess TB-related knowledge, attitudes and infection control practices of patients attending PHC facilities. In September and October 2015, a cross-sectional survey using fieldworker-administered questionnaires was conducted among patients older than 17 years attending 40 PHC facilities in the Mangaung Metropolitan. Convenience sampling was used to select patients. Participation in the study was voluntary. Descriptive, inferential and multivariate logistic regression analyses were performed. Statistical significance was considered at alpha data were included in the analysis. Most of the patients knew that TB transmission is facilitated by crowded conditions (84.6%) and that pulmonary TB is contagious (73.0%). Surprisingly, the majority of patients also believed that one can get TB from sharing toothbrushes (85.0%) or kissing (65.0%). An overwhelming majority of patients perceived TB to be serious (89.7%), and concurred that taking treatment (97.2%) and opening windows to prevent transmission in PHC facilities (97.0%) are important. Being employed (AOR: 11.5; CI: 4.8-27.6), having received TB infection control information from a PHC facility (AOR: 2.2; CI: 1.5-3.4), and being a TB patient (AOR: 1.6; CI: 1.02-2.46) increased the likelihood of adopting good infection control practices. These findings highlight the need for health education efforts to strengthen accurate information dissemination to promote sound TB knowledge and attitudes among patients attending PHC facilities. Health education efforts should also capitalise on the positive finding of this study that information dissemination at PHC facilities increases good

  14. Primary health care progress and problems.

    Science.gov (United States)

    Favin, M; Parlato, P; Kessler, S

    1984-01-01

    The 1st generation of primary health care efforts were assessed in order to temper future efforts with implementation realities. With support from the US Agency for International Development (USAID), the American Public Health Association (APHA) studied 52 primary health care (PHC) projects from 1980-82, documenting the numerous lessons learned. The contrast between the ideology of PHC and field realities provides valuable insights which must be fed back into 2nd generation projects. The projects were in 33 developing countries in Asia, Latin America, Africa, and the Near East. Approximately 1/3 were national level efforts; one-half, variously sized regional efforts; and the remainder, small scale pilot efforts. The sources of information were project documents and interviews with individuals who knew field activities firsthand. All the projects had as their primary goal provision of low-cost health services to previously unserved rural communities, using community personnel, and strengthening community institutions. Regarding overall assessment, while data continue to be limited on the impact of the approach on health status, there are some positive indications, especially for the projects of longer duration. For example, in Nepal and Thailand, there were modest improvements in health status of the target population in 2 project areas. A project in Kitui, Kenya reported reductions in infant mortality rates. A PHC program in Panama was responsible for decreases in the incidence of diarrhea, parasites, and typhoid. Many of the projects have been successful in setting up a PHC structure that extends coverage for health measures such as immunizations, family planning, and prenatal care. Many new facilities are in place. Skills of health workers have been upgraded, and new categories of paraprofessionals have been trained. Additionally, sizable numbers of community health workers have been trained and deployed. There is some evidence that in a few cases projects have

  15. The motivational needs of primary health care nurses to acquire power as leaders in a mine clinic setting

    Directory of Open Access Journals (Sweden)

    Karien Jooste

    2017-10-01

    Full Text Available Motivation is a process that influences and directs behaviour in order to satisfy a need. It links with goal 3 of the sustainable development goals that focus on ensuring healthy lives and promoting well-being at all ages. Motivation of nurses is important in the primary health care environment of, for instance, mine settings; since low levels of motivation among Primary Health Care (PHC nurses could have a negative effect on the achievement of high standards in health service delivery. The study was conducted within the theoretical framework of McClelland's Acquired Motivation Theory which consists of three basic needs, – the need for achievement, the need for power, and the need for affiliation. One of the research questions posed was “What are the motivational needs of PHC nurses to acquire power in the workplace at mine clinic settings?” A quantitative, explorative, descriptive design was followed. The accessible population in this study was PHC nurses (N = 30 working at 13 mine clinics, that also served as the total sample. A 7 point Likert scale was used in a self-administered structured questionnaire that was developed from a literature review. Ethical considerations were adhered to and respondents gave written informed consent. Data was analysed by using descriptive and inferential statistics. TheManne Whitney test compared the mean ranks and a p-value of p < 0.05 was indicative of a significant difference between male and female groups. Validity and reliability principles were applied during the entire research process. The results indicated that PHC nurses needed acknowledgement, organisational responsibility, strategic planning and promotion, as well as support. Significant differences between gender were not found in relation to the need to acquire power.

  16. Direct soil contact values for ecological receptors exposed to weathered petroleum hydrocarbon (PHC) fraction 2.

    Science.gov (United States)

    Angell, Robin A; Kullman, Steve; Shrive, Emma; Stephenson, Gladys L; Tindal, Miles

    2012-11-01

    Ecological tier 1 Canada-wide standards (CWS) for petroleum hydrocarbon (PHC) fraction 2 (F2; >nC10-C16) in soil were derived using ecotoxicological assessment endpoints (effective concentrations [ECs]/lethal concentrations [LCs]/inhibitory concentrations, 25% [IC25s]) with freshly spiked (fresh) fine- and coarse-grained soils. These soil standards might be needlessly conservative when applied to field samples with weathered hydrocarbons. The purpose of the present study was to assess the degradation and toxicity of weathered PHC F2 in a fine-grained soil and to derive direct soil contact values for ecological receptors. Fine-grained reference soils were spiked with distilled F2 and weathered for 183 d. Toxicity tests using plants and invertebrates were conducted with the weathered F2-spiked soils. Endpoint EC/IC25s were calculated and used to derive soil standards for weathered F2 in fine-grained soil protective of ecological receptors exposed via direct soil contact. The values derived for weathered F2 were less restrictive than current ecological tier 1 CWS for F2 in soil. Copyright © 2012 SETAC.

  17. Primary health care research in Bolivia: systematic review and analysis.

    Science.gov (United States)

    Alvarez, Francisco N; Leys, Mart; Mérida, Hugo E Rivera; Guzmán, Giovanni Escalante

    2016-02-01

    Bolivia is currently undergoing a series of healthcare reforms centred around the Unified Family, Community and Intercultural Health System (SAFCI), established in 2008 and Law 475 for Provision of Comprehensive Health Services enacted in 2014 as a first step towards universal health coverage. The SAFCI model aims to establish an intercultural, intersectoral and integrated primary health care (PHC) system, but there has not been a comprehensive analysis of effective strategies towards such an end. In this systematic review, we analyse research into developing PHC in Bolivia utilizing MEDLINE, the Virtual Health Library and grey literature from Pan American Health Organization/World Health Organization's internal database. We find that although progress has been made towards implementation of a healthcare system incorporating principles of PHC, further refining the system and targeting improvements effectively will require increased research and evaluation. Particularly in the 7 years since establishment of SAFCI, there has been a dearth of PHC research that makes evaluation of such key national policies impossible. The quantity and quality of PHC research must be improved, especially quasi-experimental studies with adequate control groups. The infrastructure for such studies must be strengthened through improved financing mechanisms, expanded institutional capacity and setting national research priorities. Important for future progress are improved tracking of health indicators, which in Bolivia are often out-of-date or incomplete, and prioritization of focused national research priorities on relevant policy issues. This study aims to serve as an aid towards PHC development efforts at the national level, as well as provide lessons for countries globally attempting to build effective health systems accommodating of a multi-national population in the midst of development. © The Author 2015. Published by Oxford University Press in association with The London School

  18. Factors influencing primary health care professionals' physical activity promotion behaviors: A systematic review

    NARCIS (Netherlands)

    Huijg, J.M.; Gebhardt, W.A.; Verheijden, M.W.; Zouwe, N. van der; Vries, J.D. de; Middelkoop, B.J.C.; Crone, M.R.

    2015-01-01

    Background: Despite the promising findings related to the efficacy of interventions aimed at promoting physical activity (PA) in primary health care (PHC), the translation of these interventions to PHC practice does not always happen as desired. Purpose: To help understand why efficacious PHC-based

  19. skilled attendance: the key challenges to progress in achieving mdg

    African Journals Online (AJOL)

    NYANGO DD

    countries to address the high maternal/perinatal morbidity and mortality. ... certified Nurse-Midwives working in Primary Health Care (PHC) clinics in Nasarawa State, central Nigeria, and .... jor issues to improve women‟s reproductive health: safe motherhood, prevention of un- wanted pregnancy and prevention of HIV /.

  20. [Primary health care and the millennium development goals].

    Science.gov (United States)

    Faye, A; Bob, M; Fall, A; Fall, C

    2012-01-01

    Member countries of the World Health Organization (WHO) met in Alma Ata (8-12 September 1978) to define and advocate the implementation of primary health care (PHC) worldwide, above all, in developing countries, which had a real need to review their strategies for meeting the health needs of their populations. They did not suspect that 20 years later the vision they displayed would remain undeniably relevant. Here we examine the similarities and points of convergence of their declaration about PHC with the Millennium Development Goals that seek today to reduce poverty across the world. An exhaustive and analytic literature review was conducted to collect those similarities. Further analysis of the definitions, objectives, principles and recommendations of the Alma Ata Declaration and the Millennium Declaration reveals multiple dependencies and fundamental points of similarity between these two representations. Almost all states have pledged to achieve the eight MDG by 2015: to eradicate extreme poverty and hunger, achieve universal primary education, promote gender equality and empower women, reduce child mortality, improve maternal health, combat HIV/AIDS, malaria and other diseases, ensure environmental sustainability, and develop a global partnership for development. The Alma Ata conference defined primary health care as essential health care, based on practical methods and techniques that are both scientifically sound and socially acceptable, universally accessible to all individuals and all families of the community, through their full participation and at a cost that the community and countries can afford at all stages of their development in the spirit of self-reliance and self-determination. It is an integral part of economic and social development. The following principles are involved in the achievement of both primary health care and the MDG: social equity, community participation, and intersectorality. Public health is an essential condition of poverty

  1. A public health certificate for all medical students: concepts and strategies.

    Science.gov (United States)

    Dow Velarde, L; Kaufman, A; Wiese, W; Wallerstein, N

    2007-05-01

    The goal of integrating a Public Health Certificate (PHC) into the medical school curriculum is meant to provide basic public health skills and knowledge to all future physicians, ultimately broadening the health workforce's capacity to address community health needs. The faculty at the University of New Mexico's (UNM) School of Medicine (SOM), in collaboration with multiple community stakeholders, created a PHC equivalent to 15 graduate level units. The PHC will be required of all medical students matriculating in 2010. The authors, community leaders, university administrators, faculty, staff, and students met to address the many tasks required of such broad curricular and policy change. The tasks required piloting innovations in curriculum design and implementation, working within the bureaucratic structure, fostering collaboration, nurturing leadership skills, marketing the new ideas, and designing credible evaluation strategies. We have engaged the stakeholders; surveyed our resources; produced and implemented ongoing evaluation; examined implementation strategies; developed, implemented and pilot tested the PHC courses; and engaged faculty from the Department of Family & Community Medicine in faculty development seminars. Introduction of a PHC for all students is feasible with planning tools such as the Logic Model.

  2. Occupational Health Services Integrated in Primary Health Care in Iran.

    Science.gov (United States)

    Rafiei, Masoud; Ezzatian, Reza; Farshad, Asghar; Sokooti, Maryam; Tabibi, Ramin; Colosio, Claudio

    2015-01-01

    A healthy workforce is vital for maintaining social and economic development on a global, national and local level. Around half of the world's people are economically active and spend at least one third of their time in their place of work while only 15% of workers have access to basic occupational health services. According to WHO report, since the early 1980s, health indicators in Iran have consistently improved, to the extent that it is comparable with those in developed countries. In this paper it was tried to briefly describe about Health care system and occupational Health Services as part of Primary Health care in Iran. To describe the health care system in the country and the status of occupational health services to the workers and employers, its integration into Primary Health Care (PHC) and outlining the challenges in provision of occupational health services to the all working population. Iran has fairly good health indicators. More than 85 percent of the population in rural and deprived regions, for instance, have access to primary healthcare services. The PHC centers provide essential healthcare and public-health services for the community. Providing, maintaining and improving of the workers' health are the main goals of occupational health services in Iran that are presented by different approaches and mostly through Workers' Houses in the PHC system. Iran has developed an extensive network of PHC facilities with good coverage in most rural areas, but there are still few remote areas that might suffer from inadequate services. It seems that there is still no transparent policy to collaborate with the private sector, train managers or provide a sustainable mechanism for improving the quality of services. Finally, strengthening national policies for health at work, promotion of healthy work and work environment, sharing healthy work practices, developing updated training curricula to improve human resource knowledge including occupational health

  3. [Primary health care--the "apple of the eye" of SUS: about social representations of the protagonists of the Unified Health System].

    Science.gov (United States)

    Gomes, Karine de Oliveira; Cotta, Rosângela Minardi Mitre; Araújo, Raquel Maria Amaral; Cherchiglia, Mariângela Leal; Martins, Tatiana de Castro Pereira

    2011-01-01

    The Primary Health Care (PHC) is the first contact level with the health system. In Brazil, the Family Health Program (PSF) is the main implementation and organization strategy of the PHC. The objective of this study is to evaluate the actions and services of health offered by the PSF, starting from the social representations of the interviewee on the exclusive dimensions of PHC - attention to the first contact, longitudinality, integrality and coordination. It is a quali-quantitative research, accomplished in Cajuri, Minas Gerais State. Municipal managers, PSF professionals and pregnant women assisted by PSF were interviewed. Regarding social representations on SUS, it was observed an inadequate level of apprehension and knowledge of their principles and guidelines. As for PSF, several positive connotations were expressed and the set of perceptions of the protagonists identified it as a restructuring strategy of PHC in the municipality. In spite of this, strong influences of the biomedical model and the challenge of the integration with the other levels of attention were noticed, indicating the need of investments in the professional's training and in the organization of the other levels of attention to health.

  4. Influence Of Demographic Factors And History Of Malaria With The Incidence Malaria In MORU PHC

    Directory of Open Access Journals (Sweden)

    Sudirman Manumpa

    2017-01-01

    Full Text Available Malaria morbidity in Moru health center, with parameter Annual Parasite Incident (API, amounted to 16.9% in 2014. This figure was still high when compared to the target of eliminating malaria in Indonesia about <1% in 2030. Incidence of malaria is more common in children aged 5 months - <12 years. This high rates of malaria leads to poverty, low level of learning achievement of children and in pregnant women causing low birth weight in babies and death. The purpose of this study was to analyze the factors that influence the incidence of tertian and Tropikana malaria or combined Tropikana and tertian (mix in Moru PHC in sub-district Alor Southwestern, Alor Regency.This study used a cross-sectional design, the population of study were all patients undergoing peripheral blood examination in Moru PHC’s laboratory from June to October 2015. The number of samples in this study was 173 respondents. The sampling technique was Simple Random Sampling. Instruments of data collection were a questionnaire and observation sheet.Results of the study by Chi-Square test showed that the factors influencing the incidence of malaria were socioeconomic status (sig 0,000, education level (sig 0.001. By using multivariate analysis with logistic regression test, results were obtained the age of 5 months - <12 value (sig 0.025 and socioeconomic status (sig 0,000 influencing the incidence of malaria.Variables that affect the incidence of malaria were demographic factors such as age, education level, socioeconomic status. It is advisable to harness swamp thus improving the economic status of society and build permanent house. Keywords: incidence malaria, demographic factors, history of malaria

  5. Patients‟ perceptions of primary health care services in the Eastern ...

    African Journals Online (AJOL)

    Seeking to understand patient perspectives is an important step in the efforts to improve the quality of health care. The purpose of this study was to examine patient satisfaction with primary health care (PHC) services. A purposive sample of 19136 patients aged 18 years and above was interviewed at 266 PHC clinics in ...

  6. Protocol for a nationwide survey of primary health care in China: the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) MPP (Million Persons Project) Primary Health Care Survey.

    Science.gov (United States)

    Su, Meng; Zhang, Qiuli; Lu, Jiapeng; Li, Xi; Tian, Na; Wang, Yun; Yip, Winnie; Cheng, Kar Keung; Mensah, George A; Horwitz, Ralph I; Mossialos, Elias; Krumholz, Harlan M; Jiang, Lixin

    2017-08-28

    China has pioneered advances in primary health care (PHC) and public health for a large and diverse population. To date, the current state of PHC in China has not been subjected to systematic assessments. Understanding variations in primary care services could generate opportunities for improving the structure and function of PHC. This paper describes a nationwide PHC study (PEACE MPP Primary Health Care Survey) conducted across 31 provinces in China. The study leverages an ongoing research project, the China Patient-centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project (MPP). It employs an observational design with document acquisition and abstraction and in-person interviews. The study will collect data and original documents on the structure and financing of PHC institutions and the adequacy of the essential medicines programme; the education, training and retention of the PHC workforce; the quality of care; and patient satisfaction with care. The study will provide a comprehensive assessment of current PHC services and help determine gaps in access and quality of care. All study instruments and documents will be deposited in the Document Bank as an open-access source for other researchers. The central ethics committee at the China National Centre for Cardiovascular Disease (NCCD) approved the study. Written informed consent has been obtained from all patients. Findings will be disseminated in future peer reviewed papers, and will inform strategies aimed at improving the PHC in China. NCT02953926. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care.

    Science.gov (United States)

    Zielinski, Andrzej; Kronogård, Maria; Lenhoff, Håkan; Halling, Anders

    2009-09-18

    Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC) has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000) listed with public PHC (approx. 120,000) for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB) using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender) and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

  8. Impact of comorbidity on the individual's choice of primary health care provider

    DEFF Research Database (Denmark)

    Zielinski, Andrzej; Håkansson, Anders; Beckman, Anders

    2011-01-01

    a public instead of private PHC provider increased with higher age and comorbidity level of the individuals. It is suggested that using a measure of comorbidity can help us understand more about the chronically ill individual's choice of health care provider. This would be of importance when health care......Abstract Objective. This study examined whether age, gender, and comorbidity were of importance for an individual's choice of listing with either a public or a private primary health care (PHC) practice. Design and setting. The study was a register-based closed cohort study in one private and one...... policy-makers decide on reimbursement system or organization of PHC....

  9. Primary health care in rural Malawi - a qualitative assessment exploring the relevance of the community-directed interventions approach

    Directory of Open Access Journals (Sweden)

    Makaula Peter

    2012-09-01

    Full Text Available Abstract Background Primary Health Care (PHC is a strategy endorsed for attaining equitable access to basic health care including treatment and prevention of endemic diseases. Thirty four years later, its implementation remains sub-optimal in most Sub-Saharan African countries that access to health interventions is still a major challenge for a large proportion of the rural population. Community-directed treatment with ivermectin (CDTi and community-directed interventions (CDI are participatory approaches to strengthen health care at community level. Both approaches are based on values and principles associated with PHC. The CDI approach has successfully been used to improve the delivery of interventions in areas that have previously used CDTi. However, little is known about the added value of community participation in areas without prior experience with CDTi. This study aimed at assessing PHC in two rural Malawian districts without CDTi experience with a view to explore the relevance of the CDI approach. We examined health service providers’ and beneficiaries’ perceptions on existing PHC practices, and their perspectives on official priorities and strategies to strengthen PHC. Methods We conducted 27 key informant interviews with health officials and partners at national, district and health centre levels; 32 focus group discussions with community members and in-depth interviews with 32 community members and 32 community leaders. Additionally, official PHC related documents were reviewed. Results The findings show that there is a functional PHC system in place in the two study districts, though its implementation is faced with various challenges related to accessibility of services and shortage of resources. Health service providers and consumers shared perceptions on the importance of intensifying community participation to strengthen PHC, particularly within the areas of provision of insecticide treated bed nets, home case management for

  10. Primary health care attributes and responses to intimate partner violence in Spain.

    Science.gov (United States)

    Goicolea, Isabel; Mosquera, Paola; Briones-Vozmediano, Erica; Otero-García, Laura; García-Quinto, Marta; Vives-Cases, Carmen

    This study provides an overview of the perceptions of primary care professionals on how the current primary health care (PHC) attributes in Spain could influence health-related responses to intimate partner violence (IPV). A qualitative study was conducted using semi-structured interviews with 160 health professionals working in 16 PHC centres in Spain. Data were analysed using a qualitative content analysis. Four categories emerged from the interview analysis: those committed to the PHC approach, but with difficulties implementing it; community work relying on voluntarism; multidisciplinary team work or professionals who work together?; and continuity of care hindered by heavy work load. Participants felt that person-centred care as well as other attributes of the PHC approach facilitated detecting IPV and a better response to the problem. However, they also pointed out that the current management of the health system (workload, weak supervision and little feedback, misdistribution of human and material resources, etc.) does not facilitate the sustainability of such an approach. There is a gap between the theoretical attributes of PHC and the "reality" of how these attributes are managed in everyday work, and how this influences IPV care. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Primary health care as a philosophical and practical framework for nursing education: rhetoric or reality?

    Science.gov (United States)

    Mackey, Sandra; Hatcher, Deborah; Happell, Brenda; Cleary, Michelle

    2013-08-01

    At least three decades after primary health care (PHC) took nursing by storm it is time to re-examine the philosophical shift to a PHC framework in pre-registration nursing curricula and overview factors which may hinder or promote full integration of PHC as a course philosophy and a contemporary approach to professional practice. Whilst nurse education has traditionally focused on preparing graduates for practice in the acute care setting, there is continuing emphasis on preparing nurses for community based primary health roles, with a focus on illness prevention and health promotion. This is driven by growing evidence that health systems are not responding adequately to the needs and challenges of diverse populations, as well as economic imperatives to reduce the burden of disease associated with the growth of chronic and complex diseases and to reduce the costs associated with the provision of health care. Nursing pre-registration programs in Australia and internationally have philosophically adopted PHC as a curriculum model for preparing graduates with the necessary competencies to function effectively across a range of settings. Anecdotal evidence, however, suggests that when adopted as a program philosophy PHC is not always well integrated across the curriculum. In order to develop a strong and resilient contemporary nursing workforce prepared for practice in both acute and community settings, pre-registration nursing programs need to comprehensively consider and address the factors impacting on the curricula integration of PHC philosophy.

  12. Primary health care in the South African context – medical students ...

    African Journals Online (AJOL)

    Background Both the South African Department of Health and the University of Cape Town (UCT) have committed to the primary health care (PHC) approach, which is best captured in the Declaration of Alma Ata. If medical students are to be trained in the PHC approach, it is important that they not only have a good ...

  13. The meaning of community involvement in health: the perspective of primary health care communities

    Directory of Open Access Journals (Sweden)

    GG Mchunu

    2005-09-01

    Full Text Available The goal of this study was to establish the understanding and appreciation of the essence of PHC principles in the two Primary Health Care (PHC communities. The PHC communities in this study referred to the people who were involved in the operation of the phenomenon, that is health professionals working in the health care centers and the communities served by these health care centers. It was hoped that the study would enhance the understanding of the importance of community involvement in health (CIH in health care delivery, for both community members and health professionals. A case study method was used to conduct the study. Two community health centers in the Ethekwini health district, in Kwa Zulu Natal, were studied. One health center was urban based, the other was rural based. A sample of 31 participants participated in the study. The sample comprised of 8 registered nurses, 2 enrolled nurses, 13 community members and 8 community health workers. Data was collected using individual interviews and focus groups, and was guided by the case study protocol. The findings of the study revealed that in both communities, participants had different, albeit complementary, understanding of the term ‘Community Involvement in Health’ (CIH. Essentially, for these participants, CIH meant collaboration, co-operation and involvement in decision-making.

  14. Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care

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    Kronogård Maria

    2009-09-01

    Full Text Available Abstract Background Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Methods Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000 listed with public PHC (approx. 120,000 for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Results Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. Conclusion The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

  15. The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá-Colombia: an ecological analysis.

    Science.gov (United States)

    Mosquera, Paola A; Hernández, Jinneth; Vega, Román; Martínez, Jorge; Labonte, Ronald; Sanders, David; San Sebastián, Miguel

    2012-11-13

    Colombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC) strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá. An ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI). Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR), under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus) were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation). The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007. In both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT) vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%), IMR (19%) and acute malnutrition (7%). PHC also contributed approximately 20

  16. BURNOUT SYNDROME IN NURSES OF PRIMARY HEALTH CARE: AN INTEGRATIVE REVIEW

    Directory of Open Access Journals (Sweden)

    Magno Conceição das Merces

    2015-04-01

    Full Text Available Background and Objective: Burnout Syndrome (BS also known as burnout is described as a phenomenon composed of feelings of failure and exhaustion, caused by excessive wear and energy resources, mediated by practice and work stress. In this sense, the nurse Primary Health Care (PHC is not exempted in the development of the syndrome in question, since it is a profession that develops their work activities through direct contact with patients and families, making workloads too much which can depreciate the quality of care. This study becomes relevant because it will contribute to the PHC nurses have deeper knowledge of the BS, and few studies at this level of health care. He stood as guiding question: What is the prevalence of BS nurses in the PHC based in Brazilian literature from 2000 to 2014? And as objective to determine the prevalence of BS nurses in the PHC. Content: This is an integrative literature review. To that end, we conducted survey of manuscripts published from 2000 to 2014, using as descriptors, in combination: nurse; burnout and primary care in the Virtual Health Library (VHL. Conclusion: It is not yet possible to know the prevalence of BS nurses in the PHC due to lack of studies in the area. KEYWORDS: Nurse. Burnout, Professional. Primary Health Care.

  17. Associations of socioeconomic determinants with community clinic awareness and visitation among women: evidence from Bangladesh Demographic and Health Survey-2011.

    Science.gov (United States)

    Sarker, Mohammad Abul Bashar; Harun-Or-Rashid, Md; Reyer, Joshua A; Hirosawa, Tomoya; Yoshida, Yoshitoku; Islam, Mohammod Monirul; Siddique, Md Ruhul Furkan; Hossain, Shaila; Sakamoto, Junichi; Hamajima, Nobuyuki

    2015-10-21

    Although Bangladesh has achieved tremendous success in health care over the last four decades, it still lagged behind in the areas of maternal and child malnutrition and primary health care (PHC). To increase access to PHC, the Bangladesh government established approximately 18,000 community clinics (CCs). The purpose of this study was to examine the associations of socioeconomic determinants of women aged 12-49 years with the CCs awareness and visitation. We analyzed secondary data provided by Bangladesh Demographic and Health Survey-2011. A two-stage cluster sampling was used to collect the data. A total of 18,222 ever married women aged 12-49 years were identified from selected households and 17,842 were interviewed. The main outcome measures of our study were awareness and visitation of CCs. Bivariate logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI) to examine the associations between the awareness and visiting CCs with socioeconomic determinants. Low prevalence of awareness about CC (18 %) was observed among studied women and only 17 % of them visited CCs. Significant associations (P economic conditions, young age, and primary education. Awareness and access to CCs might be increased through community activities that involve health care workers. The government should also lower barriers to PHC access through CCs by providing adequate logistics, such as human resources and equipment.

  18. Statement of the ICN on the World Health Assembly technical discussions on strategies for Health for All in the face of rapid urbanization (May 1991).

    Science.gov (United States)

    1991-01-01

    National associations of nurses are represented by the International Council of Nurses (ICN). This ICN statement reaffirms a commitment to primary health care (PHC) and the WHO "Health for All" goals. Support for environmental and health programs in urban areas is reaffirmed, and attention is paid to the needs of the poorest and most disadvantaged people. Specific directions of the ICN include: 1) overcoming economic and social barriers in order to improve primary health care in cities (rural approaches which by-pass first level care may be successful in cities), 2) holding health care workers responsible for promoting health and environmental consciousness, and 3) involving and educating women for work in community health and environmental projects. Family health can be improved by improving literacy among women. In some developing countries, efforts have been directed to community mobilization in PHC programs. The results of such efforts have been positive for enhancing health in cities. On May 12th of every year, nurses celebrate International Nurses Day. The focus this year is on mental health. Another area of activity is involvement in interdisciplinary and government programs. One such collaborative project with the WHO AIDS groups in Africa is training trainers in workshops. The outcome is a well-informed health care population which can train other health workers and the public about HIV transmission and patient care. A project which has been ongoing for 4 years is overcoming the legal barriers which inhibit nurses from full participation in PHC. ICN recommends that health care workers be educated better in PHC and in intersectoral cooperation, community participation, and disease prevention. Healthy lifestyles, proper nutrition, and disease prevention need to be promoted in school health programs. Children can be taught to be responsible for their own health. Health education can benefit from the use of media such as radio and television. Interdisciplinary

  19. Differential utilization of primary health care services among older immigrants and Norwegians: a register-based comparative study in Norway.

    Science.gov (United States)

    Diaz, Esperanza; Kumar, Bernadette N

    2014-11-26

    Aging in an unfamiliar landscape can pose health challenges for the growing numbers of immigrants and their health care providers. Therefore, better understanding of how different immigrant groups use Primary Health Care (PHC), and the underlying factors that explain utilization is needed to provide adequate and appropriate public health responses. Our aim is to describe and compare the use of PHC between elderly immigrants and Norwegians. Registry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration database. All 50 year old or older Norwegians with both parents from Norway (1,516,012) and immigrants with both parents from abroad (89,861) registered in Norway in 2008 were included. Descriptive analyses were carried out. Immigrants were categorised according to country of origin, reason for migration and length of stay in Norway. Binary logistic regression analyses were conducted to study the utilization of PHC comparing Norwegians and immigrants, and to assess associations between utilization and both length of stay and reason for immigration, adjusting for other socioeconomic variables. A higher proportion of Norwegians used PHC services compared to immigrants. While immigrants from high-income countries used PHC less than Norwegians disregarding age (OR from 0.65 to 0.92 depending on age group), they had similar number of diagnoses when in contact with PHC. Among immigrants from other countries, however, those 50 to 65 years old used PHC services more often (OR 1.22) than Norwegians and had higher comorbidity levels, but this pattern was reversed for older adults (OR 0.56 to 0.47 for 66-80 and 80+ years respectively). For all immigrants, utilization of PHC increased with longer stay in Norway and was higher for refugees (1.67 to 1.90) but lower for labour immigrants (0.33 to 0.45) compared to immigrants for family reunification. However, adjustment for education and income levels reduced most

  20. A comparative study to analyze the cost of curative care at primary health center in Ahmedabad

    Directory of Open Access Journals (Sweden)

    Mathur Neeta

    2010-01-01

    Full Text Available Objectives: To determine the unit cost of curative care provided at Primary Health Centers (PHCs and to examine the variation in unit cost in different PHCs. Materials and Methods: The present study was carried out in three PHCs of Ahmedabad district namely Sanathal, Nandej, and Uperdal, between 1 April, 2006 and 31 March, 2007. For estimating the cost of a health program, information on all the physical and human resources that were basic inputs to the PHC services were collected and grouped into two categories, non-recurrent (capital resources vehicles, buildings, etc. and recurrent resources (salaries, drugs, vaccines, contraceptives, maintenance, etc.. To generate the required data, two types of schedules were developed, daily time schedule and PHC/SC (Subcenter information schedule. Results: The unit cost of curative care was lowest (Rs. 29.43 for the Sanathal PHC and highest (Rs. 88.26 for the Uperdal PHC, followed by the Nandej PHC with Rs. 40.88, implying severe underutilization of curative care at the Uperdal PHC. Conclusions: Location of health facilities is a problem at many places. As relocation is not possible or even feasible, strengthening of infrastructure and facilities at these centers can be taken up immediately.

  1. New graduate registered nurse transition into primary health care roles: an integrative literature review.

    Science.gov (United States)

    Murray-Parahi, Pauline; DiGiacomo, Michelle; Jackson, Debra; Davidson, Patricia M

    2016-11-01

    To summarise the literature describing new graduate nurse transition to professional practice within the primary health care (PHC) setting. There is a plethora of research literature spanning several decades about new graduate nurse transition in the acute care setting. Yet, the experiences of new graduate nurse in the PHC setting is unremarkable particularly considering the increasing demand for skilled health care workers and focus of health reform to provide care where people work and live. Electronic data bases, Academic Search Complete, EBSCO, Medline, PsycINFO, CINHAL, and ERIC were searched using a combination of terms and synonyms arising from three key concepts which identify the phenomenon; 'transition', 'new graduate registered nurse' and 'primary health care. An inclusive search strategy placed no limits on language or publication date. Of the 50 articles located and examined for relevance; 40 were sourced through databases and 10 from Google Scholar/Alerts and hand-searching references. None of the 19 articles retained for analysis addressed all key concepts. Some challenges of researching the professional transition of graduate nurses in PHC settings included, an absence of definitive transition models, a dearth of literature and deference to acute care research. Nursing in PHC settings, particularly the client's home is notably different to hospital settings because of higher levels of isolation and autonomy. Societal changes, health reform and subsequent demand for skilled workers in PHC settings has caused health care providers to question the logic that such roles are only for experienced nurses. Implications arise for education and health service providers who desire to close the theory practice gap and mitigate risk for all stakeholders when next generation nurses have limited opportunities to experience PHC roles as undergraduates and newly graduated registered nurses are already transitioning in this setting. © 2016 John Wiley & Sons Ltd.

  2. Quality of work life among primary health care nurses in the Jazan region, Saudi Arabia: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Almalki Mohammed J

    2012-09-01

    Full Text Available Abstract Background Quality of work life (QWL is defined as the extent to which an employee is satisfied with personal and working needs through participating in the workplace while achieving the goals of the organization. QWL has been found to influence the commitment and productivity of employees in health care organizations, as well as in other industries. However, reliable information on the QWL of primary health care (PHC nurses is limited. The purpose of this study was to assess the QWL among PHC nurses in the Jazan region, Saudi Arabia. Methods A descriptive research design, namely a cross-sectional survey, was used in this study. Data were collected using Brooks’ survey of quality of nursing work life and demographic questions. A convenience sample was recruited from 134 PHC centres in Jazan, Saudi Arabia. The Jazan region is located in the southern part of Saudi Arabia. A response rate of 91% (n = 532/585 was achieved (effective response rate = 87%, n = 508. Data analysis consisted of descriptive statistics, t-test and one way-analysis of variance. Total scores and subscores for QWL items and item summary statistics were computed and reported using SPSS version 17 for Windows. Results Findings suggested that the respondents were dissatisfied with their work life. The major influencing factors were unsuitable working hours, lack of facilities for nurses, inability to balance work with family needs, inadequacy of vacations time for nurses and their families, poor staffing, management and supervision practices, lack of professional development opportunities, and an inappropriate working environment in terms of the level of security, patient care supplies and equipment, and recreation facilities (break-area. Other essential factors include the community’s view of nursing and an inadequate salary. More positively, the majority of nurses were satisfied with their co-workers, satisfied to be nurses and had a sense of belonging

  3. Quality of work life among primary health care nurses in the Jazan region, Saudi Arabia: a cross-sectional study.

    Science.gov (United States)

    Almalki, Mohammed J; Fitzgerald, Gerry; Clark, Michele

    2012-09-13

    Quality of work life (QWL) is defined as the extent to which an employee is satisfied with personal and working needs through participating in the workplace while achieving the goals of the organization. QWL has been found to influence the commitment and productivity of employees in health care organizations, as well as in other industries. However, reliable information on the QWL of primary health care (PHC) nurses is limited. The purpose of this study was to assess the QWL among PHC nurses in the Jazan region, Saudi Arabia. A descriptive research design, namely a cross-sectional survey, was used in this study. Data were collected using Brooks' survey of quality of nursing work life and demographic questions. A convenience sample was recruited from 134 PHC centres in Jazan, Saudi Arabia. The Jazan region is located in the southern part of Saudi Arabia. A response rate of 91% (n = 532/585) was achieved (effective response rate = 87%, n = 508). Data analysis consisted of descriptive statistics, t-test and one way-analysis of variance. Total scores and subscores for QWL items and item summary statistics were computed and reported using SPSS version 17 for Windows. Findings suggested that the respondents were dissatisfied with their work life. The major influencing factors were unsuitable working hours, lack of facilities for nurses, inability to balance work with family needs, inadequacy of vacations time for nurses and their families, poor staffing, management and supervision practices, lack of professional development opportunities, and an inappropriate working environment in terms of the level of security, patient care supplies and equipment, and recreation facilities (break-area). Other essential factors include the community's view of nursing and an inadequate salary. More positively, the majority of nurses were satisfied with their co-workers, satisfied to be nurses and had a sense of belonging in their workplaces. Significant differences were found

  4. Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

    Science.gov (United States)

    Rabbani, Fauziah; Shipton, Leah; White, Franklin; Nuwayhid, Iman; London, Leslie; Ghaffar, Abdul; Ha, Bui Thi Thu; Tomson, Göran; Rimal, Rajiv; Islam, Anwar; Takian, Amirhossein; Wong, Samuel; Zaidi, Shehla; Khan, Kausar; Karmaliani, Rozina; Abbasi, Imran Naeem; Abbas, Farhat

    2016-09-07

    Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals

  5. Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

    Directory of Open Access Journals (Sweden)

    Fauziah Rabbani

    2016-09-01

    Full Text Available Abstract Background Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910 emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC in 1978 was a critical milestone, especially for low and middle-income countries (LMICs, conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005–2008 strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. Main text The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs. Conclusion SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of

  6. Hypertension Control and co-morbidities in primary health care centers in Riyadh

    Energy Technology Data Exchange (ETDEWEB)

    Al-Tuwijri, Abdulmohsin A [Dept. of Family Medicine, Ministry of Health, Riyadh (Saudi Arabia); Al-Rukban, Mohammed Othman [Dept. of Family and Community Medicine, Coll. of Medicine, King Saud Univ., Riyadh (Saudi Arabia)

    2006-07-01

    The prevalence of hypertension in Saudi Arabia has been assessed only in preliminary reports. The aim of this study was to determine the degree of control of blood pressure and the prevalence of common hypertension co-morbidities among hypertensive patients attending primary health care (PHC) centers in Riyadh. A cross sectional study was conducted by reviewing medical records of hypertensive patients during May and June 2001. Two hundred fifty-five medical records selected by a stratified randomization process according to the distribution of the 73 PHC centers in the city and the total number of hypertensive patients registered in the mini-clinic of each PHC-center. Trained mini-clinic nurses collected data using a data collection form developed for this purpose. Of 255 patients, 121 (47.5%) were males and 134 (52.5%) were females, the mean age was 57.2+-11.1 years and 8.3% were smokers. The majority 204 (85.7%) had greater than normal body weight. Only 101 (40.4%) had controlled systolic BP. The most common co-morbidity was diabetes mellitus found in 98 (38.4%), followed by dislipidemia in 50 (19.6%), bronchial asthma in 28 (11.0%) and renal diseases in 12 (4.7%). Except for osteoporosis, which was reported by females only (P=0.003), the occurrences of hypertensive co-morbidities did not vary from other demographic characteristics. This study demonstrated poor blood pressure control in the mini-clinics in the PHC-centers. To improve the quality of care for hypertensive patients, we recommend an improvement in PHC physician knowledge of and attitudes toward the importance of achieving targeted blood pressure levels. (author)

  7. Hypertension Control and co-morbidities in primary health care centers in Riyadh

    International Nuclear Information System (INIS)

    Al-Tuwijri, Abdulmohsin A.; Al-Rukban, Mohammed Othman

    2006-01-01

    The prevalence of hypertension in Saudi Arabia has been assessed only in preliminary reports. The aim of this study was to determine the degree of control of blood pressure and the prevalence of common hypertension co-morbidities among hypertensive patients attending primary health care (PHC) centers in Riyadh. A cross sectional study was conducted by reviewing medical records of hypertensive patients during May and June 2001. Two hundred fifty-five medical records selected by a stratified randomization process according to the distribution of the 73 PHC centers in the city and the total number of hypertensive patients registered in the mini-clinic of each PHC-center. Trained mini-clinic nurses collected data using a data collection form developed for this purpose. Of 255 patients, 121 (47.5%) were males and 134 (52.5%) were females, the mean age was 57.2+-11.1 years and 8.3% were smokers. The majority 204 (85.7%) had greater than normal body weight. Only 101 (40.4%) had controlled systolic BP. The most common co-morbidity was diabetes mellitus found in 98 (38.4%), followed by dislipidemia in 50 (19.6%), bronchial asthma in 28 (11.0%) and renal diseases in 12 (4.7%). Except for osteoporosis, which was reported by females only (P=0.003), the occurrences of hypertensive co-morbidities did not vary from other demographic characteristics. This study demonstrated poor blood pressure control in the mini-clinics in the PHC-centers. To improve the quality of care for hypertensive patients, we recommend an improvement in PHC physician knowledge of and attitudes toward the importance of achieving targeted blood pressure levels. (author)

  8. EQUIP Healthcare: An overview of a multi-component intervention to enhance equity-oriented care in primary health care settings.

    Science.gov (United States)

    Browne, Annette J; Varcoe, Colleen; Ford-Gilboe, Marilyn; Wathen, C Nadine

    2015-12-14

    The primary health care (PHC) sector is increasingly relevant as a site for population health interventions, particularly in relation to marginalized groups, where the greatest gains in health status can be achieved. The purpose of this paper is to provide an overview of an innovative multi-component, organizational-level intervention designed to enhance the capacity of PHC clinics to provide equity-oriented care, particularly for marginalized populations. The intervention, known as EQUIP, is being implemented in Canada in four diverse PHC clinics serving populations who are impacted by structural inequities. These PHC clinics serve as case studies for the implementation and evaluation of the EQUIP intervention. We discuss the evidence and theory that provide the basis for the intervention, describe the intervention components, and discuss the methods used to evaluate the implementation and impact of the intervention in diverse contexts. Research and theory related to equity-oriented care, and complexity theory, are central to the design of the EQUIP intervention. The intervention aims to enhance capacity for equity-oriented care at the staff level, and at the organizational level (i.e., policy and operations) and is novel in its dual focus on: (a) Staff education: using standardized educational models and integration strategies to enhance staff knowledge, attitudes and practices related to equity-oriented care in general, and cultural safety, and trauma- and violence-informed care in particular, and; (b) Organizational integration and tailoring: using a participatory approach, practice facilitation, and catalyst grants to foster shifts in organizational structures, practices and policies to enhance the capacity to deliver equity-oriented care, improve processes of care, and shift key client outcomes. Using a mixed methods, multiple case-study design, we are examining the impact of the intervention in enhancing staff knowledge, attitudes and practices; improving

  9. Midwives and obstetric nurses in the Brazilian Unified Health System and Primary Health Care: for a systemic and progressive incorporation

    OpenAIRE

    Armando Henrique Norman; Charles Dalcanale Tesser

    2015-01-01

    The objective of this paper is to present a proposal for a gradual and systemic incorporation of midwives and obstetric nurses into the Brazilian Unified Health System (SUS) and Primary Health Care (PHC). The proposal was born from contact with the British experience, based on midwives, which is briefly described. In Brazil, these professionals would progressively take over the prenatal, delivery and postpartum care for pregnant women of usual risk in a region, in partnership with the PHC tea...

  10. A method of teaching clinical problem-solving skills to primary health ...

    African Journals Online (AJOL)

    solving process to primary health care nurses/clinical nurse practitioners (PHC nurses). The process was developed in the Soweto PHC Nurse Training Unit over the past 30 years as a result of the changing availability and role of nurse and doctor ...

  11. Integrating acupuncture into primary health care: the experience of an educational model implemented within the Brazilian Unified Health System in Florianópolis.

    Science.gov (United States)

    Moré, Ari Ojeda Ocampo; Tesser, Charles Dalcanale; Min, Li Shih

    2016-12-01

    Primary health care (PHC) is the main entry point and the first level of contact for individuals, families and communities within the Brazilian public health system. Considering that few studies have investigated the use of acupuncture in PHC, this article presents our experience in the city of Florianópolis when integrating acupuncture into PHC using an educational programme developed to teach acupuncture to primary care physicians (PCPs). The course programme was designed using the WHO standards for acupuncture training and discussed at three consensus meetings. Between 2011 and 2014 three iterations of an introductory acupuncture course for PCPs were offered. During this period 53 physicians finished the programme. The number of acupuncture sessions in PHC rose from 1349 in 2011 to 6488 in 2015. It was observed in 2015 that 81% of the course participants working in PHC were regularly using acupuncture in their daily practice, with a mean number of sessions of 11.35 sessions per month. Moreover, collaborative work, which started during the course between the PCPs and the acupuncture specialists in secondary and tertiary public health care, helped to increase the quality of acupuncture referrals and facilitate clinical case discussions. Our experience in the city of Florianópolis shows that teaching acupuncture to PCPs is a sustainable model that can help introduce acupuncture into PHC. Furthermore it can expand access to acupuncture treatment for the population and increase the communication between PCPs and acupuncture specialists. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  12. [Nurse-led in Primary Health Care setting: a well-timed and promising organizational innovation].

    Science.gov (United States)

    Torres-Ricarte, Marc; Crusat-Abelló, Ernest; Peñuelas-Rodríguez, Silvia; Zabaleta-del-Olmo, Edurne

    2015-01-01

    At present, the severe economic crisis along with the increasing prevalence of chronic diseases is leading to different countries to consider updating their Primary Health Care (PHC) services in order to make them more efficient and reduce health inequalities. To that end, various initiatives are being carried out, such as the provision of Nurse-led services and interventions. The purpose of this article is to present the available knowledge, controversies and opportunities for Nurse-led initiatives in the setting of PHC. Nurse- led interventions or health services in PHC have proven to be equal or more effective than usual care in disease prevention, the routine follow-up of patients with chronic conditions, and first contact care for people with minor illness. However, as there are only a few health economic evaluation studies published their efficiency is still potential. In conclusion, the Nurse-led care could be an innovative organizational initiative with the potential to provide an adequate response to the contemporary health needs of the population, as well as an opportunity for the nursing profession and for PHC and health systems in general. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  13. What does primary health care cost and can we afford to find out ...

    African Journals Online (AJOL)

    Accurate information on the costs of providing priInary health care (PHC) ... if the Government's stated commitment to an adequate PHC system is to be realised. ... to generate accurate cost accounting information is a serious shortcoIDing.

  14. Preservation Health Check: Monitoring Threats to Digital Repository Content

    Science.gov (United States)

    Kool, Wouter; van der Werf, Titia; Lavoie, Brian

    2014-01-01

    The Preservation Health Check (PHC) project, undertaken as a joint effort by Open Planets Foundation (OPF) and OCLC Research, aims to evaluate the usefulness of the preservation metadata created and maintained by operational repositories for assessing basic preservation properties. The PHC project seeks to develop an implementable logic to support…

  15. Rural district hospitals - essential cogs in the district health system - and primary healthcare re-engineering.

    Science.gov (United States)

    le Roux, K W D P; Couper, I

    2015-06-01

    The re-engineering of primary healthcare (PHC) is regarded as an essential precursor to the implementation of National Health Insurance in South Africa, but improvements in the provision of PHC services have been patchy. The authors contend that the role of well- functioning rural district hospitals as a hub from which PHC services can be most efficiently managed has been underestimated, and that the management of district hospitals and PHC clinics need to be co-located at the level of the rural district hospital, to allow for proper integration of care and effective healthcare provision.

  16. Effects of a Psychological Intervention in a Primary Health Care Center for Caregivers of Dependent Relatives: A Randomized Trial

    Science.gov (United States)

    Rodriguez-Sanchez, Emiliano; Patino-Alonso, Maria C.; Mora-Simon, Sara; Gomez-Marcos, Manuel A.; Perez-Penaranda, Anibal; Losada-Baltar, Andres; Garcia-Ortiz, Luis

    2013-01-01

    Purpose: To assess, in the context of Primary Health Care (PHC), the effect of a psychological intervention in mental health among caregivers (CGs) of dependent relatives. Design and Methods: Randomized multicenter, controlled clinical trial. The 125 CGs included in the trial were receiving health care in PHC. Inclusion criteria: Identifying…

  17. Southern Cone Countries Primary Healthcare Study | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Researchers will undertake a literature review, documentary analysis, key informant interviews, focal group discussions with leading stakeholders, and surveys of PHC users and professionals. The idea is to identify opportunities for and limits to using PHC as a strategy to achieve more integrated and universal health care.

  18. Equitable resourcing of primary health care in remote communities in Australia's Northern Territory: a pilot study.

    Science.gov (United States)

    Wakerman, John; Sparrow, Lisa; Thomas, Susan L; Humphreys, John S; Jones, Mike

    2017-06-29

    Improved Primary Health Care (PHC) utilisation is central to reducing the unacceptable morbidity and mortality rates characterising populations living in remote communities. Despite poorer health, significant inequity characterises the funding of PHC services in Australia's most remote areas. This pilot study sought to ascertain what funding is required to ensure equitable access to sustainable, high quality primary health care irrespective of geographical remoteness of communities. High performing remote Primary Health Care (PHC) services were selected using improvement measures from the Australian Primary Care Collaboratives Program and validated by health experts. Eleven PHC services provided data relating to the types of services provided, level of service utilisation, human resources, operating and capital expenses. A further four services that provide visiting PHC to remote communities provided information on the level and cost of these services. Demographic data for service catchment areas (including estimated resident population, age, Indigenous status, English spoken at home and workforce participation) were obtained from the Australian Bureau of Statistics 2011 census. Formal statistical inference (p-values) were derived in the linear regression via the nonparametric bootstrap. A direct linear relationship was observed between the total cost of resident PHC services and population, while cost per capita decreased with increasing population. Services in smaller communities had a higher number of nursing staff per 1000 residents and provided more consultations per capita than those in larger communities. The number of days of visiting services received by a community each year also increased with population. A linear regression with bootstrapped statistical inference predicted a significant regression equation where the cost of resident services per annum is equal to $1,251,893.92 + ($1698.83 x population) and the cost of resident and visiting services is

  19. Building health research systems to achieve better health

    Directory of Open Access Journals (Sweden)

    González Block Miguel

    2006-11-01

    Full Text Available Abstract Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics

  20. Factors associated with patients' satisfaction in Brazilian dental primary health care.

    Science.gov (United States)

    Aldosari, Muath Abdullah; Tavares, Mary Angela; Matta-Machado, Antônio Thomaz Gonzaga; Abreu, Mauro Henrique Nogueira Guimarães

    2017-01-01

    To assess factors associated with patients' satisfaction with the treatment by dentists in primary health care (PHC) in Brazil. The dataset was part of a nationwide cross-sectional survey for evaluating PHC teams conducted by the Brazilian Ministry of Health. Patients from each of 16,202 oral health teams were interviewed. In addition to sociodemographic information, the questionnaire included information about patient experience domains: access and booking of dental appointments, bonding and accountability, welcoming of the patient, and their perception of dental facilities. The dependent variable was the answer to the question 'From 0 to 10, how would you grade your satisfaction with treatment received from the dentist?' Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios and corresponding 95% confidence interval. The mean patient satisfaction was 9.4 (±2.3). Higher patient satisfaction with PHC was associated with lower education and the patient's perception of the clinic conditions. Moreover, higher satisfaction was associated with positive reception and hospitality, enough time for treatment, and instructions that met patients' needs. Lower satisfaction with PHC was associated with patients who have jobs compared to those who do not work. Patient satisfaction is increased with friendly and understanding PHC staff. Moreover, meeting patient expectations by taking time to understand the needs and giving the right instructions is associated with higher satisfaction.

  1. PHC Leadership: Are Health Centres in Good Hands?Perspectives ...

    African Journals Online (AJOL)

    The study aimed to document the kinds of leadership styles are practiced at health centres (H/C) and how these styles can be explained by the contexts, characteristics of the health centre in charge (IC) and subordinate trained health staff (STHS). Methods A well-researched leadership style model was applied, which ...

  2. A comparative study of family functioning, health, and mental health awareness and utilization among female Bedouin-Arabs from recognized and unrecognized villages in the Negev.

    Science.gov (United States)

    Al-Krenawi, Alean; Graham, John R

    2006-02-01

    A good portion of geography is contested by the Israeli state and the country's Bedouin-Arab population. There are two categories of Bedouin villages: those areas that are "officially" recognized by the state and those that are not. In this article we determine utilization and awareness of health and mental health services among 376 Bedouin-Arab women in recognized and unrecognized villages in the Negev. Although there are differences between them, primary health care (PHC) services usually are available within recognized villages, accessible to those from unrecognized villages, and tend to precipitate user satisfaction. We conclude with various suggestions for improving health service delivery and making PHC and mental health delivery more accessible. Through this article we intend to help mental health practitioners on two levels: the policy level, regarding the design of mental health services for societies in transition, such as the Bedouin Arab, and the practical level by helping practitioners better appreciate the psychosocial status of women in Bedouin-Arab societies and the factors associated with Bedouin-Arab PHC utilization.

  3. How is Primary Health Care conceptualised in nursing in Australia? A review of the literature.

    Science.gov (United States)

    Henderson, Julie; Koehne, Kristy; Verrall, Claire; Gebbie, Kristine; Fuller, Jeffrey

    2014-07-01

    Australia, in common with many other countries, is expanding the role of Primary Health Care (PHC) to manage the growing burden of chronic disease and prevent hospitalisation. Australia's First National Primary Health Care Strategy released in 2010 places general practice at the centre of care delivery, reflecting a constitutional division of labour in which the Commonwealth government's primary means of affecting care delivery in this sector is through rebates for services delivered from the universal healthcare system Medicare. A review of Australian nursing literature was undertaken for 2006-2011. This review explores three issues in relation to these changes: How PHC is conceptualised within Australian nursing literature; who is viewed as providing PHC; and barriers and enablers to the provision of comprehensive PHC. A review of the literature suggests that the terms 'PHC' and 'primary care' are used interchangeably and that PHC is now commonly associated with services provided by practice nurses. Four structural factors are identified for a shift away from comprehensive PHC, namely fiscal barriers, educational preparation for primary care practice, poor role definition and interprofessional relationships. The paper concludes that while moves towards increasing capacity in general practice have enhanced nursing roles, current policy and the nature of private business funding alongside some medical opposition limit opportunities for Australian nurses working in general practice. © 2013 John Wiley & Sons Ltd.

  4. Effectiveness of an intervention in groups of family caregivers of dependent patients for their application in primary health centers. Study protocol

    Directory of Open Access Journals (Sweden)

    Pérez-Arechaederra Diana

    2010-09-01

    Full Text Available Abstract Background Although Primary Health Care (PHC Teams are used to deal with prevention and treatment of sanitary problems in adults with chronic diseases, they usually have a lack of experience in development of psychotherapeutic interventions. However, these interventions are the ones that achieve better results to reduce symptomatology and improve emotional state of caregivers. The study aims to evaluate the effectiveness of an intervention of psychotherapy in improving the mental health and Quality of life of caregivers. This intervention is based on theoretical approaches to care adjusted to cognitive theory, in order to be applied in primary health care centres. Methods/Design This is multicentre clinical trials study, randomized in two parallel groups, carry out in two PHC, Study population: 150 caregivers will be included by consecutive sampling and they will be randomized the half to experimental group and the other half to control group. They provide mostly all the assistance to care-dependent familiars receiving attention in PHC Centers. Measurements: Each caregiver will be evaluated on a personal interview. The caregivers' assessment protocol: 1 Assessment of different socio-demographic related to care, and caregiver's personal situation. 2Care-dependent individuals will also be assessed by Barthel Index and Pfeiffer Questionnaire (SPMSQ. 3Change in caregivers will be the principal measure: family function (Family APGAR Questionnaire, burden short questionnaire (Short Zarit Burden Interview, quality of life (Ruiz & Baca: 1993 Questionnaire, the Duke-UNK Functional Social Support Questionnaire, the General Health Questionnaire-12, and changes in Dysfunctional Thoughts about caring. 4 Intervention implementation measures will also be assessed. Intervention: A psychotherapeutic intervention will be 8 sessions of 90 minutes in groups. This intervention has been initially developed for family caregivers of patients with dementia

  5. Are primary health care providers prepared to implement an anti-smoking program in Syria?

    Science.gov (United States)

    Asfar, Taghrid; Al-Ali, Radwan; Ward, Kenneth D; Vander Weg, Mark W; Maziak, Wasim

    2011-11-01

    To document primary health care (PHC) providers' tobacco use, and how this influences their smoking cessation practices and attitudes towards tobacco-control policies. Anonymous questionnaires were distributed to PHC providers in 7 randomly selected PHC centers in Aleppo, Syria. All PHC providers completed the questionnaires (100% response rate). A quarter of these providers smoke cigarettes and more than 10% smoke waterpipes. Physicians who smoke were less likely to advise patients to quit (OR=0.29; 95% CI, 0.09-0.95), assess their motivation to quit (OR=0.13, 95% CI=0.02-0.72), or assist them in quitting (OR=0.24, 95% CI=0.06-0.99). PHC providers who smoke were less likely to support a ban on smoking in PHC settings (68.2% vs. 89.1%) and in enclosed public places (68.2% vs. 86.1%) or increases in the price of tobacco products (43.2% vs. 77.4%) (PSyria and will negatively influence implementation of anti-smoking program in PHC settings. Smoking awareness and cessation interventions targeted to PHC providers, and training programs to build providers' competency in addressing their patients' smoking is crucial in Syria. Published by Elsevier Ireland Ltd.

  6. The impact of primary healthcare in reducing inequalities in child health outcomes, Bogotá – Colombia: an ecological analysis

    Directory of Open Access Journals (Sweden)

    Mosquera Paola A

    2012-11-01

    Full Text Available Abstract Background Colombia is one of the countries with the widest levels of socioeconomic and health inequalities. Bogotá, its capital, faces serious problems of poverty, social disparities and access to health services. A Primary Health Care (PHC strategy was implemented in 2004 to improve health care and to address the social determinants of such inequalities. This study aimed to evaluate the contribution of the PHC strategy to reducing inequalities in child health outcomes in Bogotá. Methods An ecological analysis with localities as the unit of analysis was carried out. The variable used to capture the socioeconomic status and living standards was the Quality of Life Index (QLI. Concentration curves and concentration indices for four child health outcomes (infant mortality rate (IMR, under-5 mortality rate, prevalence of acute malnutrition in children under-5, and vaccination coverage for diphtheria, pertussis and tetanus were calculated to measure socioeconomic inequality. Two periods were used to describe possible changes in the magnitude of the inequalities related with the PHC implementation (2003 year before - 2007 year after implementation. The contribution of the PHC intervention was computed by a decomposition analysis carried out on data from 2007. Results In both 2003 and 2007, concentration curves and indexes of IMR, under-5 mortality rate and acute malnutrition showed inequalities to the disadvantage of localities with lower QLI. Diphtheria, pertussis and tetanus (DPT vaccinations were more prevalent among localities with higher QLI in 2003 but were higher in localities with lower QLI in 2007. The variation of the concentration index between 2003 and 2007 indicated reductions in inequality for all of the indicators in the period after the PHC implementation. In 2007, PHC was associated with a reduction in the effect of the inequality that affected disadvantaged localities in under-5 mortality (24%, IMR (19% and acute

  7. Factors influencing the introduction of physical activity interventions in primary health care: a qualitative study.

    Science.gov (United States)

    Huijg, Johanna M; van der Zouwe, Nicolette; Crone, Mathilde R; Verheijden, Marieke W; Middelkoop, Barend J C; Gebhardt, Winifred A

    2015-06-01

    The introduction of efficacious physical activity (PA) interventions in routine primary health care (PHC) is a complex process. Understanding factors influencing the process can enhance the development of successful introduction strategies. The aim of this qualitative study was to explore stakeholders' perceptions on factors influencing the introduction, i.e., adoption, implementation, and continuation, of PA interventions in PHC. Twenty-eight semistructured interviews were held with intervention managers, PHC advisors, intervention providers, and referring general practitioners of five PA interventions delivered in PHC. A theoretical framework on the introduction of innovations in health care was used to guide the data collection. Influencing factors were identified using thematic analysis. Stakeholders reported preconditions for the introduction of PA interventions in PHC (e.g., support, resources, and networks and collaborations), in addition to characteristics of PA interventions (e.g., compatibility, flexibility, and intervention materials) and characteristics of PHC professionals (e.g., knowledge, positive attitudes, and beliefs about capabilities) perceived to enhance the introduction process. Furthermore, they proposed strategies for the development of PA interventions (e.g., involvement of future stakeholders, full development, and refinement) and strategies to introduce PA interventions in PHC (e.g., training, assistance, and reinforcement). The majority of the influencing factors were discussed specifically in relation to one or two stages. This study presents an overview of factors that are perceived to influence the introduction of PA interventions in PHC. It underscores the importance of taking these factors into account when designing introduction strategies and of giving special attention to the distinct stages of the process.

  8. Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania

    Science.gov (United States)

    2013-01-01

    Background A team approach in primary care has proven benefits in achieving better outcomes, reducing health care costs, satisfying patient needs, ensuring continuity of care, increasing job satisfaction among health providers and using human health care resources more efficiently. However, some research indicates constraints in collaboration within primary health care (PHC) teams in Lithuania. The aim of this study was to gain a better understanding of the phenomenon of teamwork in Lithuania by exploring the experiences of teamwork by general practitioners (GPs) and community nurses (CNs) involved in PHC. Methods Six focus groups were formed with 29 GPs and 27 CNs from the Kaunas Region of Lithuania. Discussions were recorded and transcribed verbatim. A thematic analysis of these data was then performed. Results The analysis of focus group data identified six thematic categories related to teamwork in PHC: the structure of a PHC team, synergy among PHC team members, descriptions of roles and responsibilities of team members, competencies of PHC team members, communications between PHC team members and the organisational background for teamwork. These findings provide the basis for a discussion of a thematic model of teamwork that embraces formal, individual and organisational factors. Conclusions The need for effective teamwork in PHC is an issue receiving broad consensus; however, the process of teambuilding is often taken for granted in the PHC sector in Lithuania. This study suggests that both formal and individual behavioural factors should be targeted when aiming to strengthen PHC teams. Furthermore, this study underscores the need to provide explicit formal descriptions of the roles and responsibilities of PHC team members in Lithuania, which would include establishing clear professional boundaries. The training of team members is an essential component of the teambuilding process, but not sufficient by itself. PMID:23945286

  9. Assessing readiness to work in primary health care: the content validity of a self-check tool for physiotherapists and other health professionals.

    Science.gov (United States)

    Stewart, Jenny; Haswell, Kate

    2013-03-01

    The New Zealand Primary Health Care Strategy has emphasised the importance of well-coordinated service teams in managing complex chronic conditions. There is international evidence that physiotherapists can contribute effectively to the prevention and management of these conditions. However, there are few examples of physiotherapists in New Zealand (NZ) engaging in primary health care (PHC). It has been recognised that professional development is necessary to optimise physiotherapists' participation in PHC. The aim of this study was to both design a self-check tool that physiotherapists could use as an initial step in preparing to work in PHC and to assess the content validity of the tool. A literature review informed the development of the self-check tool. The tool was reviewed by members of the Physiotherapy New Zealand PHC working party to establish content validity. The tool was found to have excellent content validity with an overall score of 0.937, exceeding the acceptable index of 0.8. Item validity was excellent or acceptable for all except two items, which were subsequently modified in the final tool. This investigation provides initial support for the tool's potential use by physiotherapists as a means of determining their readiness to work in PHC. It could have application beyond individual professional development to the wider context of team and organisational development. Additionally, with minor modifications the tool could have broader application to other professional groups.

  10. Spatial Accessibility to Health Care Services: Identifying under-Serviced Neighbourhoods in Canadian Urban Areas.

    Directory of Open Access Journals (Sweden)

    Tayyab Ikram Shah

    Full Text Available Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods.This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population, was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons. An integrated geocoding approach was used to establish PHC locations.The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs.The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood

  11. A novel process for heavy residue hydroconversion using a recoverable pseudo-homogenous catalyst PHC system

    Energy Technology Data Exchange (ETDEWEB)

    Romocki, S.M.; Rhodey, W.G. [Mobis Energy Inc., Calgary, AB (Canada)

    2008-10-15

    This paper described a pseudo-homogenous catalyst (PHC) designed to refine heavy hydrocarbon residues containing sulfur, nitrogen, metals, and asphaltene impurities known to clog pores and deactivate traditional hydrocrackers. The heavy residue hydroconversion (HRH) process incorporated a single particle, chemically generated PHC uniformly distributed in the feed. Thermal decomposition within the reaction system of a water-in-oil emulsion containing ammonium paramolybdate was used to form molybdenum oxide, which was then sulfided within the feed in order to create an ultra-dispersed suspension of catalytically active molybdenum disulfide particles measuring between 2 and 9 nm. A proprietary online catalyst recovery and regeneration step was used to maintain high catalyst activity. The molybdenum was then recovered from a purge stream and then reintroduced to the catalyst preparation area as a catalyst precursor. After being conditioned, the feed was combined with hydrogen and a water-oil catalyst emulsion and introduced into a furnace. Heavy components were cracked, hydrogenated and converted to lighter products. The high performance catalyst system was able to convert 95 per cent of residues at pressures below 7.3 Mpa and at reaction temperatures ranging between 400 and 460 degrees C. The catalyst was tested at a pilot plant using Athabasca vacuum bottoms. It was concluded that the HRH process is now being successfully used to produce 200 barrels of heavy oil per day. Designs for commercial installations are now being prepared. 4 refs., 2 tabs., 2 figs.

  12. Primary health care, mental health, and the dietitian's role.

    Science.gov (United States)

    Davison, Karen

    2006-01-01

    Individuals with mental illness are at nutritional risk because of health, social, and economic factors. To address this problem, the Canadian Collaborative Mental Health Initiative (CCMHI) and Dietitians of Canada (DC) commissioned the development of a toolkit that outlines the role of the registered dietitian (RD) and advocates for RDs in primary health care (PHC) mental health programs. The development of the toolkit followed a four-stage process: a comprehensive literature review, a focus group discussion with a national working group, interviews with consumers about RD services, and evaluation of the toolkit. The costs of mental illness in Canada are at least US dollars 6.85 billion per year. Currently, little evidence exists on how RD services can reduce these expenses. The focus group identified accessibility as the predominant issue facing individuals with mental illness. To explain consumer experiences with RD services, a three-tier theory based on in-depth interviews was developed. Consumer experiences with RDs occur in five categories: financial concerns, perception of service, status of mental illness, engagement, and self-esteem (tier 1). These are further influenced by five individual and contextual factors, e.g., social environment, the mental illness (tier 2), which are weighed as benefits and barriers instrumental in determining actions (tier 3). The evaluation of the final draft of the RD toolkit confirmed that it reflected the visions of PHC. The toolkit is intended to act as a blueprint for action. Dietitians are encouraged to use its contents to advocate for positions in mental health PHC settings.

  13. Factors associated with patients’ satisfaction in Brazilian dental primary health care

    Science.gov (United States)

    Tavares, Mary Angela; Matta-Machado, Antônio Thomaz Gonzaga

    2017-01-01

    Objective To assess factors associated with patients’ satisfaction with the treatment by dentists in primary health care (PHC) in Brazil. Materials and methods The dataset was part of a nationwide cross-sectional survey for evaluating PHC teams conducted by the Brazilian Ministry of Health. Patients from each of 16,202 oral health teams were interviewed. In addition to sociodemographic information, the questionnaire included information about patient experience domains: access and booking of dental appointments, bonding and accountability, welcoming of the patient, and their perception of dental facilities. Statistical analysis The dependent variable was the answer to the question ‘From 0 to 10, how would you grade your satisfaction with treatment received from the dentist?’ Negative binomial regression models were used to estimate the unadjusted and adjusted rate ratios and corresponding 95% confidence interval. Results The mean patient satisfaction was 9.4 (±2.3). Higher patient satisfaction with PHC was associated with lower education and the patient’s perception of the clinic conditions. Moreover, higher satisfaction was associated with positive reception and hospitality, enough time for treatment, and instructions that met patients’ needs. Lower satisfaction with PHC was associated with patients who have jobs compared to those who do not work. Conclusion Patient satisfaction is increased with friendly and understanding PHC staff. Moreover, meeting patient expectations by taking time to understand the needs and giving the right instructions is associated with higher satisfaction. PMID:29145438

  14. Provision of antiretroviral therapy for children in Nelson Mandela Bay: Health care professionals’ challenges

    Science.gov (United States)

    2018-01-01

    Background The human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children. Aim To explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics. Setting The study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa. Methodology The researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell’s data analysis spiral. We used Lincoln and Guba’s model to ensure trustworthiness. Ethical standards were applied. Results Health care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level. Conclusion Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level. PMID:29781680

  15. Provision of antiretroviral therapy for children in Nelson Mandela Bay: Health care professionals' challenges.

    Science.gov (United States)

    Williams, Margaret; Van Rooyen, Dalena R M; Ricks, Esmeralda J

    2018-03-12

     The human immunodeficiency virus and/or acquired immune deficiency syndrome (HIV/AIDS) pandemic continues to increase in prevalence worldwide, particularly in South Africa, and includes the often overlooked paediatric population. The provision of paediatric antiretroviral treatment (ART) is as essential for children as for adults, and has numerous obstacles, not least of which is lack of decentralisation of facilities to provide essential treatment. Optimising ART, care and support for HIV-positive children, and their caregivers, at public sector primary health care (PHC) clinics is crucial to improve morbidity and mortality rates in children.  To explore the experiences of health care professionals regarding the provision of ART for children at PHC clinics.  The study was conducted in six PHC clinics in Nelson Mandela Bay Health District, Eastern Cape, South Africa.  The researchers used a qualitative, explorative, descriptive and contextual research design with in-depth interviews. We used non-probability purposive sampling. Data collected were thematically analysed using Creswell's data analysis spiral. We used Lincoln and Guba's model to ensure trustworthiness. Ethical standards were applied.  Health care professionals experienced numerous challenges, such as lack of resources, need for training, mentoring and debriefing, all related to providing decentralised ART for HIV-positive children at the PHC level.  Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.

  16. Empowerment of women and mental health promotion: a qualitative study in rural Maharashtra, India.

    Science.gov (United States)

    Kermode, Michelle; Herrman, Helen; Arole, Rajanikant; White, Joshua; Premkumar, Ramaswamy; Patel, Vikram

    2007-08-31

    The global burden of mental illness is high and opportunities for promoting mental health are neglected in most parts of the world. Many people affected by mental illness live in developing countries, where treatment and care options are limited. In this context, primary health care (PHC) programs can indirectly promote mental health by addressing its determinants i.e. by enhancing social unity, minimising discrimination and generating income opportunities. The objectives of this study were to: 1. Describe concepts of mental health and beliefs about determinants of mental health and illness among women involved with a PHC project in rural Maharashtra, India; 2. Identify perceived mental health problems in this community, specifically depression, suicide and violence, their perceived causes, and existing and potential community strategies to respond to them and; 3. Investigate the impact of the PHC program on individual and community factors associated with mental health We undertook qualitative in-depth interviews with 32 women associated with the PHC project regarding: their concepts of mental health and its determinants; suicide, depression and violence; and the perceived impact of the PHC project on the determinants of mental health. The interviews were taped, transcribed, translated and thematically analysed. Mental health and illness were understood by these women to be the product of cultural and socio-economic factors. Mental health was commonly conceptualised as an absence of stress and the commonest stressors were conflict with husbands and mother-in-laws, domestic violence and poverty. Links between empowerment of women through income generation and education, reduction of discrimination based on caste and sex, and promotion of individual and community mental health were recognised. However, mental health problems such as suicide and violence were well-described by participants. While it is essential that affordable, accessible, appropriate treatments and

  17. Upscaling the recruitment and retention of human resources for health at primary healthcare centres in Lebanon: a qualitative study.

    Science.gov (United States)

    Alameddine, Mohamad; Khodr, Hiba; Mourad, Yara; Yassoub, Rami; Abi Ramia, Jinane

    2016-05-01

    The sustainability of primary healthcare (PHC) worldwide has been challenged by a global shortage in human resources for health (HRH). This study is a unique attempt at systematically soliciting and synthesising the voice of PHC and community stakeholders on the HRH recruitment and retention strategies at the PHC sector in Lebanon, the obstacles and challenges hindering their optimisation and the recommendations to overcome such obstacles. A qualitative design was utilised, involving 22 semi-structured interviews with PHC experts in Lebanon conducted in 2013. Nvivo qualitative data analysis software was employed for the thematic analysis of data collected from interviews. Five comprehensive themes emerged: understanding PHC scope, HRH recruitment issues, HRH retention challenges, rural areas' specific challenges and stakeholders' recommendations. Analysis of stakeholders' responses revealed a lack of a unified understanding of the PHC scope impacting the capacity for appropriate HRH planning. Identified impediments to recruitment included the suboptimal supply of HRH, financial constraints and poor management. Retention difficulties were attributed to poor working environments, financial constraints and lack of professional development. There was consensus that HRH challenges faced were aggravated in rural areas, jeopardising the equitable access to PHC services of quality. Equitable access was also jeopardised by the reported shortage of female HRH in a sociocultural context where many females prefer providers of the same gender. The study sets the path towards upscaling recruitment and retention policies and practices through the endorsement of a nationally acknowledged PHC definition and scope, the sustainable development of the PHC workforce and through the implementation of targeted recruitment and retention strategies addressing rural settings and gender equity. Decision-makers and planners are urged to identify HRH as the most important input for the success

  18. Quality of work life among primary health care nurses in the Jazan region, Saudi Arabia: a cross-sectional study

    OpenAIRE

    Almalki Mohammed J; FitzGerald Gerry; Clark Michele

    2012-01-01

    Abstract Background Quality of work life (QWL) is defined as the extent to which an employee is satisfied with personal and working needs through participating in the workplace while achieving the goals of the organization. QWL has been found to influence the commitment and productivity of employees in health care organizations, as well as in other industries. However, reliable information on the QWL of primary health care (PHC) nurses is limited. The purpose of this study was to assess the Q...

  19. Capturing pan-Canadian Primary Health Care indicator data using multiple approaches for data collection.

    Science.gov (United States)

    Walker, Vicky; Sullivan-Taylor, Patricia; Webster, Greg; Macphail, Judith

    2009-01-01

    The Canadian Institute for Health Information (CIHI), in collaboration with diverse stakeholders, led the development of pan-Canadian indicators to measure primary health care. In 2006, CIHI released a set of 105 pan-Canadian Primary Health Care (PHC) indicators that were developed with the assistance of national, provincial and territorial representatives, clinicians and researchers. Additionally, data gaps were identified in a series of reports. In 2006 and 2007, CIHI assessed options for closing the data gaps so that the indicators could be measured and reported. CIHI then began a program to build the data infrastructure needed for the PHC indicators. The program included the development of content standards for electronic medical records, a prototype of a voluntary reporting system, enhancements to surveys, and the development of reports. In 2006, fewer than 10% of the 105 indicators could be calculated with existing data sources. Now, four projects have begun and over 50% of the indicators are being captured. Important relationships have been established with key collaborators. These relationships will lead to the development of a reporting system prototype and to the refinement of PHC indicators and electronic medical record (EMR) content standards. The project for pan-Canadian PHC indicators has encouraged consultation and synergy. It has motivated CIHI to establish an information program to fill data gaps and to make PHC indicators available.

  20. global health strategies versus local primary health care priorities

    African Journals Online (AJOL)

    CARE PRIORITIES - A CASE STUDY. OF NATIONAL ... development of comprehensive primary health care (pHC). The routine ..... on injection safety will be sustainable. On the negative side, ... This is mainly at management level, where time ...

  1. Primary health care and public policy.

    Science.gov (United States)

    Mangelsdorf, K L; Luna, J; Smith, H L

    1988-01-01

    The health problems of Ecuador are similar to those in other developing countries where the standard of living is low, and housing and sanitation are inadequate. Women, children, and those living in rural areas are those most severely affected. National policy has been to attempt to increase access to health care in rural areas through the construction of new facilities and the appointment of highly paid medical staff. However, little attention was paid to sociocultural factors, which caused the peasantry to reject the medical care system, or to problems of internal efficiency which inhibited utilization. Since the 1970s various national and international organizations have attempted to implement primary health care (PHC) through the use of trained community health workers (CHWs). The primary problems faced by the CHWs were shortages of medicines and supplies, an almost total lack of supervision, and lack of transportation available to take staff to isolated villages. The poor supervision is blamed for the 17% drop out rate among CHWs since 1980. Independent PHC programs have also been established in Ecuador by voluntary organizations. These work best when coordinated with governmental programs, in order to allow monitoring and to avoid the duplication of services. Problems with the establishment of PHC programs in Ecuador will continue, as the government has no clear cut policy, and difficulties financing on a broad national scale. Other problems include the absence of effective supervision and logistical support for even small pilot programs, and inconsistencies in the training and role definition for CHWs. These problems need to be met in the implementation of a national PHC policy.

  2. PRIMARY HEALTH CARE, SELECTIVE OR COMPREHENSIVE ...

    African Journals Online (AJOL)

    hi-tech

    2003-01-01

    Jan 1, 2003 ... and basic sanitation, health education in prevention and control of prevailing health ... to support introduction of a selective version of PHC in ... Governments and collaborating donor organizations could concentrate the ...

  3. Perception and Utilization of Primary Health Care Services in a Semi ...

    African Journals Online (AJOL)

    Objective: The health status of most people living in developing countries of the world remains poor. Linked to this are some factors, of which low utilization of PHC facilities remain a major issue. This study therefore aimed to determine the utilization of PHC services in a sub-urban community in a developing country in West ...

  4. Outsourcing primary health care services--how politicians explain the grounds for their decisions.

    Science.gov (United States)

    Laamanen, Ritva; Simonsen-Rehn, Nina; Suominen, Sakari; Øvretveit, John; Brommels, Mats

    2008-12-01

    To explore outsourcing of primary health care (PHC) services in four municipalities in Finland with varying amounts and types of outsourcing: a Southern municipality (SM) which contracted all PHC services to a not-for-profit voluntary organization, and Eastern (EM), South-Western (SWM) and Western (WM) municipalities which had contracted out only a few services to profit or public organizations. A mail survey to all municipality politicians (response rate 52%, N=101) in 2004. Data were analyzed using cross-tabulations, Spearman correlation and linear regression analyses. Politicians were willing to outsource PHC services only partially, and many problems relating to outsourcing were reported. Politicians in all municipalities were least likely to outsource preventive services. A multiple linear regression model showed that reported preference to outsource in EM and in SWM was lower than in SM, and also lower among politicians from "leftist" political parties than "rightist" political parties. Perceived difficulties in local health policy issues were related to reduced preference to outsource. The model explained 27% of the variance of the inclination to outsource PHC services. The findings highlight how important it is to take into account local health policy issues when assessing service-provision models.

  5. Health care financing in Nigeria: Implications for achieving universal health coverage.

    Science.gov (United States)

    Uzochukwu, B S C; Ughasoro, M D; Etiaba, E; Okwuosa, C; Envuladu, E; Onwujekwe, O E

    2015-01-01

    The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.

  6. Host plant-dependent phenotypic reversion of Ralstonia solanacearum from non-pathogenic to pathogenic forms via alterations in the phcA gene.

    Science.gov (United States)

    Poussier, Stéphane; Thoquet, Philippe; Trigalet-Demery, Danièle; Barthet, Séverine; Meyer, Damien; Arlat, Matthieu; Trigalet, André

    2003-08-01

    Ralstonia solanacearum is a plant pathogenic bacterium that undergoes a spontaneous phenotypic conversion (PC) from a wild-type pathogenic to a non-pathogenic form. PC is often associated with mutations in phcA, which is a key virulence regulatory gene. Until now, reversion to the wild-type pathogenic form has not been observed for PC variants and the biological significance of PC has been questioned. In this study, we characterized various alterations in phcA (eight IS element insertions, three tandem duplications, seven deletions and a base substitution) in 19 PC mutants from the model strain GMI1000. In five of these variants, reversion to the pathogenic form was observed in planta, while no reversion was ever noticed in vitro whatever culture media used. However, reversion was observed for a 64 bp tandem duplication in vitro in the presence of tomato root exudate. This is the first report showing a complete cycle of phenotypic conversion/reversion in a plant pathogenic bacterium.

  7. Impact of a Population Health Management Intervention on Disparities in Cardiovascular Disease Control.

    Science.gov (United States)

    James, Aisha; Berkowitz, Seth A; Ashburner, Jeffrey M; Chang, Yuchiao; Horn, Daniel M; O'Keefe, Sandra M; Atlas, Steven J

    2018-04-01

    Healthcare systems use population health management programs to improve the quality of cardiovascular disease care. Adding a dedicated population health coordinator (PHC) who identifies and reaches out to patients not meeting cardiovascular care goals to these programs may help reduce disparities in cardiovascular care. To determine whether a program that used PHCs decreased racial/ethnic disparities in LDL cholesterol and blood pressure (BP) control. Retrospective difference-in-difference analysis. Twelve thousdand five hundred fifty-five primary care patients with cardiovascular disease (cohort for LDL analysis) and 41,183 with hypertension (cohort for BP analysis). From July 1, 2014-December 31, 2014, 18 practices used an information technology (IT) system to identify patients not meeting LDL and BP goals; 8 practices also received a PHC. We examined whether having the PHC plus IT system, compared with having the IT system alone, decreased racial/ethnic disparities, using difference-in-difference analysis of data collected before and after program implementation. Meeting guideline concordant LDL and BP goals. At baseline, there were racial/ethnic disparities in meeting LDL (p = 0.007) and BP (p = 0.0003) goals. Comparing practices with and without a PHC, and accounting for pre-intervention LDL control, non-Hispanic white patients in PHC practices had improved odds of LDL control (OR 1.20 95% CI 1.09-1.32) compared with those in non-PHC practices. Non-Hispanic black (OR 1.15 95% CI 0.80-1.65) and Hispanic (OR 1.29 95% CI 0.66-2.53) patients saw similar, but non-significant, improvements in LDL control. For BP control, non-Hispanic white patients in PHC practices (versus non-PHC) improved (OR 1.13 95% CI 1.05-1.22). Non-Hispanic black patients (OR 1.17 95% CI 0.94-1.45) saw similar, but non-statistically significant, improvements in BP control, but Hispanic (OR 0.90 95% CI 0.59-1.36) patients did not. Interaction testing confirmed that disparities did not

  8. Implementing Indigenous community control in health care: lessons from Canada.

    Science.gov (United States)

    Lavoie, Josée G; Dwyer, Judith

    2016-09-01

    Objective Over past decades, Australian and Canadian Indigenous primary healthcare policies have focused on supporting community controlled Indigenous health organisations. After more than 20 years of sustained effort, over 89% of eligible communities in Canada are currently engaged in the planning, management and provision of community controlled health services. In Australia, policy commitment to community control has also been in place for more than 25 years, but implementation has been complicated by unrealistic timelines, underdeveloped change management processes, inflexible funding agreements and distrust. This paper discusses the lessons from the Canadian experience to inform the continuing efforts to achieve the implementation of community control in Australia. Methods We reviewed Canadian policy and evaluation grey literature documents, and assessed lessons and recommendations for relevance to the Australian context. Results Our analysis yielded three broad lessons. First, implementing community control takes time. It took Canada 20 years to achieve 89% implementation. To succeed, Australia will need to make a firm long term commitment to this objective. Second, implementing community control is complex. Communities require adequate resources to support change management. And third, accountability frameworks must be tailored to the Indigenous primary health care context to be meaningful. Conclusions We conclude that although the Canadian experience is based on a different context, the processes and tools created to implement community control in Canada can help inform the Australian context. What is known about the topic? Although Australia has promoted Indigenous control over primary healthcare (PHC) services, implementation remains incomplete. Enduring barriers to the transfer of PHC services to community control have not been addressed in the largely sporadic attention to this challenge to date, despite significant recent efforts in some jurisdictions

  9. The organization and financing of cervical cancer prevention carried out by midwives in primary health care.

    Science.gov (United States)

    Sobczyk, Karolina; Woźniak-Holecka, Joanna; Holecki, Tomasz; Szałabska, Dorota

    2016-01-01

    The main objective of the project was the evaluation of the organizational and financial aspects of midwives in primary health care (PHC), functioning under The Population Program for the Early Detection of Cervical Cancer two years after the implementation of new law regulations, which enable this occupational group to collect cytological material for screening. Under this project, the data of the Program's Coordinating Centre, affecting midwives' postgraduate education in the field of pap smear tests, was taken into analysis. Furthermore, The National Health Fund (NFZ) reports on contracts entered in the field of the discussed topics, taking into consideration the value of health services performed within the Program in respect of ambulatory care and primary care units. NFZ concluded contracts for the provision of PHC service with 6124 service providers in 2016, including the contracts in the field of providing health services under the cervical cancer prevention program by PHC midwifes, which were entered into by 358 institutions (5.85%). The value of the basic services under the Program, carried out under NFZ contracts in 2014, amounted to approx. PLN 12.3 million, while the value of services performed by PHC midwives represented only 0.38% of this sum. The introduction of legislative changes, allowing PHC midwives to collect cytological material for screening, did not cause, in the period of the observation on a national scale, the expected growth of availability of basic stage services within the cervical cancer prevention program.

  10. Perceptions of Indonesian general practitioners in maintaining standards of medical practice at a time of health reform.

    Science.gov (United States)

    Syah, Nur A; Roberts, Chris; Jones, Alison; Trevena, Lyndal; Kumar, Koshila

    2015-10-01

    There is little research on how GPs experience the demands of maintaining standards of medical practice in developing countries and what strategies might improve their capability to provide high-quality primary health care (PHC). This study aims to explore the underlying factors, which shape GPs' experience within the Indonesian PHC system and impact on their experience of professional practice. A grounded theory approach was applied using semi-structured interviews of 25 purposively selected GPs in West Sumatra, Indonesia. The interviews were analysed inductively through an iterative process of the interplay between empirical data, emerging analysis and theory development. Three major health care systems attribute shaped GPs' experiences of professional practice, including (i) a restricted concept of the PHC system, (ii) lack of regulation of private primary care practice conducted by GPs, midwives, nurses and specialists and (iii) low coverage and inappropriate policy of the health insurance system. The findings indicate that a major revision of current health care system is required with a focus on promoting the concept of PHC services to the population, redefining the role of the GP to deliver recognised best practice within available resources, changing the way GPs are remunerated by the public health system and the health insurance industry, policing of the regulations related to the scope of practice of other health care professionals, particularly midwives and nurses, and regulation of prescribing. GPs can be the champions of the PHC service that Indonesia needs, but it requires sustained systematic change. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Impact of performance-based financing on primary health care services in Haiti.

    Science.gov (United States)

    Zeng, Wu; Cros, Marion; Wright, Katherine D; Shepard, Donald S

    2013-09-01

    To strengthen Haiti's primary health care (PHC) system, the country first piloted performance-based financing (PBF) in 1999 and subsequently expanded the approach to most internationally funded non-government organizations. PBF complements support (training and technical assistance). This study evaluates (a) the separate impact of PBF and international support on PHC's service delivery; (b) the combined impact of PBF and technical assistance on PHC's service delivery; and (c) the costs of PBF implementation in Haiti. To minimize the risk of facilities neglecting potential non-incentivized services, the incentivized indicators were randomly chosen at the end of each year. We obtained quantities of key services from four departments for 217 health centres (15 with PBF and 202 without) from 2008 through 2010, computed quarterly growth rates and analysed the results using a difference-in-differences approach by comparing the growth of incentivized and non-incentivized services between PBF and non-PBF facilities. To interpret the statistical analyses, we also interviewed staff in four facilities. Whereas international support added 39% to base costs of PHC, incentive payments added only 6%. Support alone increased the quantities of PHC services over 3 years by 35% (2.7%/quarter). However, support plus incentives increased these amounts by 87% over 3 years (5.7%/quarter) compared with facilities with neither input. Incentives alone was associated with a net 39% increase over this period, and more than doubled the growth of services (P < 0.05). Interview findings found no adverse impacts and, in fact, indicated beneficial impacts on quality. Incentives proved to be a relatively inexpensive, well accepted and very effective complement to support, suggesting that a small amount of money, strategically used, can substantially improve PHC. Haiti's experience, after more than a decade of use, indicates that incentives are an effective tool to strengthen PHC.

  12. A Cross-Sectional Study to Examine Factors Associated with Primary Health Care Service Utilization among Older Adults in the Irbid Governorate of Jordan

    Directory of Open Access Journals (Sweden)

    Abdullah Alkhawaldeh

    2014-01-01

    Full Text Available Background. Recently, the percentage of older adults in developing countries has increased significantly. Objective. This study examined patterns and factors associated with primary health care services utilization in the past 1, 6, and 12 months. Method. A cross-sectional study design was used to collect data from 190 older adults in the Irbid governorate of Jordan. Results. Primary health care services were used by less than half of the participants in the past 1 month, by 68.4% in the past 6 months, and by 73.8% in the past 12 months. Primary health care (PHC services use was associated with age, education level, tobacco use, chronic illnesses, perceived general health status today, a physical component summary score, employment, and perceived general health status in the past 6 and 12 months. The primary predictor of PHC services use at 1, 6, and 12 months was chronic illnesses (OR=13.32, (OR=19.63, and (OR=17.91, respectively. Conclusion. Although many factors were associated with PHC service utilization, the strongest predictor of PHC service utilization was chronic illnesses.

  13. Wide variation in sexually transmitted infection testing and counselling at Aboriginal primary health care centres in Australia: analysis of longitudinal continuous quality improvement data.

    Science.gov (United States)

    Nattabi, Barbara; Matthews, Veronica; Bailie, Jodie; Rumbold, Alice; Scrimgeour, David; Schierhout, Gill; Ward, James; Guy, Rebecca; Kaldor, John; Thompson, Sandra C; Bailie, Ross

    2017-02-15

    documented delivery of STI testing and counselling services. A number of Aboriginal PHC centres are achieving high rates of STI testing and counselling, while a significant number are not. STI-related service delivery could be substantially improved through focussed efforts to support health centres with relatively lower documented evidence of adherence to best practice guidelines.

  14. Implementation of computer-based patient records in primary care: the societal health economic effects.

    OpenAIRE

    Arias-Vimárlund, V.; Ljunggren, M.; Timpka, T.

    1996-01-01

    OBJECTIVE: Exploration of the societal health economic effects occurring during the first year after implementation of Computerised Patient Records (CPRs) at Primary Health Care (PHC) centres. DESIGN: Comparative case studies of practice processes and their consequences one year after CPR implementation, using the constant comparison method. Application of transaction-cost analyses at a societal level on the results. SETTING: Two urban PHC centres under a managed care contract in Ostergötland...

  15. Factors affecting Family Medicine residents′ perception of achievement of training objectives

    Directory of Open Access Journals (Sweden)

    Ammar Radi Abu Zuhairah

    2014-01-01

    Statistical analysis: Cronbach′s alpha, analysis of variance, t-test, and univariate regression model were used. Results: Reliability of the questionnaire was found to be 75.4%. One hundred and seven residents (response rate, 83.6% had completed the questionnaire. The mean age was 29.1 ± 2.5 years, half of the residents were male, most of them (83.2% were married, and more than half (54.2% of the residents had worked in primary health care (PHC before joining the programme. Age and duration of work in PHC before joining the programme were significantly and positively associated with the outcome. In Family Medicine rotations, continuity of care, percentage of patients discussed, and number of trainers were associated with the outcome. On the other hand, percentage of patients discussed in different settings and opportunity for the residents to evaluate patients in an outpatient setting were among the factors affecting the outcome in the hospital rotations. Conclusions: Factors identified (age, duration of work in PHC, discussion, and opportunity to evaluate patients might help residents, trainers, and decision makers in ensuring residents benefit from the different rotations. Further studies to link the effect of the identified factors on resident outcome and patient care are required.

  16. Empowerment of women and mental health promotion: a qualitative study in rural Maharashtra, India

    Directory of Open Access Journals (Sweden)

    White Joshua

    2007-08-01

    Full Text Available Abstract Background The global burden of mental illness is high and opportunities for promoting mental health are neglected in most parts of the world. Many people affected by mental illness live in developing countries, where treatment and care options are limited. In this context, primary health care (PHC programs can indirectly promote mental health by addressing its determinants i.e. by enhancing social unity, minimising discrimination and generating income opportunities. The objectives of this study were to: 1. Describe concepts of mental health and beliefs about determinants of mental health and illness among women involved with a PHC project in rural Maharashtra, India; 2. Identify perceived mental health problems in this community, specifically depression, suicide and violence, their perceived causes, and existing and potential community strategies to respond to them and; 3. Investigate the impact of the PHC program on individual and community factors associated with mental health Method We undertook qualitative in-depth interviews with 32 women associated with the PHC project regarding: their concepts of mental health and its determinants; suicide, depression and violence; and the perceived impact of the PHC project on the determinants of mental health. The interviews were taped, transcribed, translated and thematically analysed. Results Mental health and illness were understood by these women to be the product of cultural and socio-economic factors. Mental health was commonly conceptualised as an absence of stress and the commonest stressors were conflict with husbands and mother-in-laws, domestic violence and poverty. Links between empowerment of women through income generation and education, reduction of discrimination based on caste and sex, and promotion of individual and community mental health were recognised. However, mental health problems such as suicide and violence were well-described by participants. Conclusion While it is

  17. Cultural and wild plant species as bio indicators and phyto-remedies of PHC contaminated soils in Russia

    International Nuclear Information System (INIS)

    Breus, I.; Larionova, N.; Semenova, E.; Breus, V.

    2005-01-01

    The biological indicators are widely used along with the chemical and physical soil characteristics for the ecological risk assessment for soils during and after anthropogenic impacts. In many cases it often happens that only biological indicators are capable of establishing the physiological activity of contaminant complex in soil and of revealing the critical levels of soil contamination. Bio-testing is often used to determine the toxicity of various environmental objects - soils, waters, sediments and wastes. Firstly bio-testing demands the selection of testable biological organisms adequate to studying objects. The test objects must be representative for a given contaminated ecosystem community which is influenced by toxicants. So one can obtain data adequate to the real situation and also minimise the mistakes during the extrapolation of data obtained in bio-testing. Among bio-testing methods the methods of soil toxicity determination using high plants gained wide distribution. And moreover, if such plants are relatively tolerant to soil contamination and can accumulate sufficient plant biomass, it is possible to expect their phyto-remediation effect, which can be realized by different mechanisms. But the experimental investigations of the plant use for soil remediation in Russia are now still under development. The aims of this work were: i) the determination and selection of informative bio-indicative parameters could be used for evaluation of PHC (petroleum hydrocarbons) - soil contamination levels; ii) the choose of test plants based on these values; and iii) the revelation of the possible phyto-remediation effects in soil contaminated with PHC.In laboratory experiments the phyto-toxicity of soil contaminated with PHC was evaluated in relation to 35 plant species and sorts traditional and non-traditional for Russia and cultivated for fodder green biomass purposes, and also for some wild plant species. The following parameters were determined in the

  18. Cultural and wild plant species as bio indicators and phyto-remedies of PHC contaminated soils in Russia

    Energy Technology Data Exchange (ETDEWEB)

    Breus, I.; Larionova, N.; Semenova, E.; Breus, V. [Kazan State Univ., Dept. of Geography and Geoecology (Russian Federation)

    2005-07-01

    The biological indicators are widely used along with the chemical and physical soil characteristics for the ecological risk assessment for soils during and after anthropogenic impacts. In many cases it often happens that only biological indicators are capable of establishing the physiological activity of contaminant complex in soil and of revealing the critical levels of soil contamination. Bio-testing is often used to determine the toxicity of various environmental objects - soils, waters, sediments and wastes. Firstly bio-testing demands the selection of testable biological organisms adequate to studying objects. The test objects must be representative for a given contaminated ecosystem community which is influenced by toxicants. So one can obtain data adequate to the real situation and also minimise the mistakes during the extrapolation of data obtained in bio-testing. Among bio-testing methods the methods of soil toxicity determination using high plants gained wide distribution. And moreover, if such plants are relatively tolerant to soil contamination and can accumulate sufficient plant biomass, it is possible to expect their phyto-remediation effect, which can be realized by different mechanisms. But the experimental investigations of the plant use for soil remediation in Russia are now still under development. The aims of this work were: i) the determination and selection of informative bio-indicative parameters could be used for evaluation of PHC (petroleum hydrocarbons) - soil contamination levels; ii) the choose of test plants based on these values; and iii) the revelation of the possible phyto-remediation effects in soil contaminated with PHC.In laboratory experiments the phyto-toxicity of soil contaminated with PHC was evaluated in relation to 35 plant species and sorts traditional and non-traditional for Russia and cultivated for fodder green biomass purposes, and also for some wild plant species. The following parameters were determined in the

  19. Crises and Resilience at the Frontline-Public Health Facility Managers under Devolution in a Sub-County on the Kenyan Coast.

    Directory of Open Access Journals (Sweden)

    Mary Nyikuri

    Full Text Available Public primary health care (PHC facilities are for many individuals the first point of contact with the formal health care system. These facilities are managed by professional nurses or clinical officers who are recognised to play a key role in implementing health sector reforms and facilitating initiatives aimed at strengthening community involvement. Little in-depth research exists about the dimensions and challenges of these managers' jobs, or on the impact of decentralisation on their roles and responsibilities. In this paper, we describe the roles and responsibilities of PHC managers-or 'in-charges' in Kenya, and their challenges and coping strategies, under accelerated devolution.The data presented in this paper is part of a wider set of activities aimed at understanding governance changes under devolution in Kenya, under the umbrella of a 'learning site'. A learning site is a long term process of collaboration between health managers and researchers deciding together on key health system questions and interventions. Data were collected through seven formal in depth interviews and observations at four PHC facilities as well as eight in depth interviews and informal interactions with sub-county managers from June 2013 to July 2014. Drawing on the Aragon framework of organisation capacity we discuss the multiple accountabilities, daily routines, challenges and coping strategies among PHC facility managers.PHC in-charges perform complex and diverse roles in a difficult environment with relatively little formal preparation. Their key concerns are lack of job clarity and preparedness, the difficulty of balancing multidirectional accountability responsibilities amidst significant resource shortages, and remuneration anxieties. We show that day-to-day management in an environment of resource constraints and uncertainty requires PHC in-charges who are resilient, reflective, and continuously able to learn and adapt. We highlight the importance of

  20. Essential attributes and qualifiers of primary health care - doi:10.5020/18061230.2012.p3

    Directory of Open Access Journals (Sweden)

    Andréa Sílvia Walter de Aguiar

    2012-11-01

    Full Text Available Historically, the primary health care (PHC has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country. Several theoretical and conceptual landmarks proposed approaches and indicators to assess and characterize the APS. In 1978, the American Institute of Medicine suggested an approach in which listed its attributes such as accessibility, integrality, coordination, continuity and responsibility. This was an important landmark in an attempt to outline a normative approach to measure it. However, most indicators and specific definition was not suggested. The selected indicators required a high level of performance, were difficult to be achieved, and focused on the capacity of services and not in its concrete realization(1.A 1996 report, from the same institution, defined PHC as the provision of integrated services and accessible by clinicians who are responsible for attending a large majority of personal care needs, developing a continued partnership with patients and working within family and community. This definition does not include the first contact and focuses on individual attention.The Canadian Medical Association, in 1996, considered the APS as a front door of the health system and community interventions included in the definition of the functions of APS. In the same year was published a Charter for General Practice / Family Medicine in Europe (Letter to General Practice / Family Medicinein Europe, which describes 12 characteristics: general, accessible, integrated,continuous, as a team, holistic, personalized, targeted for the family and the community, coordinated, confidential and protectress(2.Donabedian(3 systematized a group of important

  1. Surviving neoliberalism, maintaining values: Community health mergers in Victoria, Australia.

    Science.gov (United States)

    Roussy, Véronique; Livingstone, Charles

    2018-04-01

    Independent, not-for-profit community health services in the state of Victoria, Australia, provide one of that country's few models of comprehensive primary health care (PHC). Recent amalgamations among some such agencies created regional-sized community health organisations, in a departure from this sector's traditionally small local structure. This study explored the motivations, desired outcomes, and decision-making process behind these mergers. Qualitative exploratory study was based on 26 semistructured interviews with key informants associated with 2 community health mergers, which took place in 2014 in Victoria, Australia. Thematic data analysis was influenced by concepts derived from institutional theory. Becoming bigger by merging was viewed as the best way to respond to mounting external pressures, such as increasingly neoliberal funding mechanisms, perceived as threatening survival. Desired outcomes were driven by comprehensive PHC values, and related to creating organisational capacity to continue providing quality services to disadvantaged communities. This study offers insights into decision-making processes geared towards protecting the comprehensiveness of PHC service delivery for disadvantaged communities, ensuring financial viability, and surviving neoliberal economic policy whilst preserving communitarian values. These are relevant to an international audience, within a global context of rising health inequities, increasingly tight fiscal environments, and growing neoliberal influences on health policymaking and funding. Copyright © 2018 John Wiley & Sons, Ltd.

  2. Factors influencing primary health care professionals' physical activity promotion behaviors: a systematic review.

    Science.gov (United States)

    Huijg, Johanna M; Gebhardt, Winifred A; Verheijden, Marieke W; van der Zouwe, Nicolette; de Vries, Juriena D; Middelkoop, Barend J C; Crone, Mathilde R

    2015-02-01

    Despite the promising findings related to the efficacy of interventions aimed at promoting physical activity (PA) in primary health care (PHC), the translation of these interventions to PHC practice does not always happen as desired. To help understand why efficacious PHC-based PA interventions are not effectively translated to practice, this study systematically reviewed the literature on factors influencing PHC professionals' PA promotion practices. Literature searches were conducted in Web of Science, PubMed, and PsycINFO for peer-reviewed articles published in English from 1990 onwards. Studies were included that met the following criteria: (1) involving PHC-based PA interventions, and (2) reporting factors influencing PHC professionals' PA promotion behaviors. Two researchers independently screened studies and extracted data. A narrative synthesis using thematic analysis was conducted to identify factors. Of the 4,469 identified articles, 59 were included in the review. Factors were identified by qualitative methods, barrier/facilitator ratings, and the examination of the relationship between factors and PA promotion, and the effectiveness of introduction strategies. Many factors related to the development, delivery, and effects of the innovation, the sociopolitical and organizational culture, resources, and support, patient and PHC professional characteristics, and innovation strategies were identified as potential influences on PHC professionals' PA promotion practices. However, the lack of evidence on the relationship between factors and PA promotion indicated insufficient evidence on PA promotion determinants. This extensive overview of potential factors can inform intervention developers and implementers on which factors may play a role when introducing PA interventions in PHC. Future research should further investigate relationships between factors and PA promotion, which should be guided by qualitative in-depth knowledge on influencing factors.

  3. [Primary Health Care in Austria - Tu Felix Austria nube - Concept for networking in the primary care of Upper Austria].

    Science.gov (United States)

    Kriegel, Johannes; Rebhandl, Erwin; Hockl, Wolfgang; Stöbich, Anna-Maria

    2017-10-01

    The primary health care in rural areas in Austria is currently determined by challenges such as ageing of the population, the shift towards chronic and age-related illnesses, the specialist medical and hospital-related education and training of physicians' as well growing widespread difficulty of staffing doctor's office. The objective is to realize a general practitioner centered and team-oriented primary health care (PHC) approach by establishing networked primary health care in rural areas of Austria. Using literature research, online survey, expert interviews and expert workshops, we identified different challenges in terms of primary health care in rural areas. Further, current resources and capacities of primary health care in rural areas were identified using the example of the district of Rohrbach. Twelve design dimensions and 51 relevant measurement indicators of a PHC network were delineated and described. Based on this, 12 design approaches of PHC concept for the GP-centered and team-oriented primary health care in rural areas have been developed.

  4. Health promotion in Australian multi-disciplinary primary health care services: case studies from South Australia and the Northern Territory.

    Science.gov (United States)

    Baum, Fran; Freeman, Toby; Jolley, Gwyn; Lawless, Angela; Bentley, Michael; Värttö, Kaisu; Boffa, John; Labonte, Ronald; Sanders, David

    2014-12-01

    This paper reports on the health promotion and disease prevention conducted at Australian multi-disciplinary primary health care (PHC) services and considers the ways in which the organizational environment affects the extent and type of health promotion and disease prevention activity. The study involves five PHC services in Adelaide and one in Alice Springs. Four are managed by a state health department and two by boards of governance. The study is based on an audit of activities and on 68 interviews conducted with staff. All the sites undertake health promotion and recognize its importance but all report that this activity is under constant pressure resulting from the need to provide services to people who have health problems. We also found an increased focus on chronic disease management and prevention which prioritized individuals and behavioural change strategies rather than addressing social determinants affecting whole communities. There was little health promotion work that reflected a salutogenic approach to the creation of health. Most activity falls under three types: parenting and child development, chronic disease prevention and mental health. Only the non-government organizations reported advocacy on broader policy issues. Health reform and consequent reorganizations were seen to reduce the ability of some services to undertake health promotion. The paper concludes that PHC in Australia plays an important role in disease prevention, but that there is considerable scope to increase the amount of community-based health promotion which focuses on a salutogenic view of health and which engages in community partnerships. © The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Advancing team-based primary health care: a comparative analysis of policies in western Canada.

    Science.gov (United States)

    Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T

    2017-07-17

    We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

  6. Operational integration in primary health care: patient encounters and workflows.

    Science.gov (United States)

    Sifaki-Pistolla, Dimitra; Chatzea, Vasiliki-Eirini; Markaki, Adelais; Kritikos, Kyriakos; Petelos, Elena; Lionis, Christos

    2017-11-29

    Despite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration. The study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece. Dimensions of operational integration in PHC were selected based on the work of Kringos and colleagues. A five-point Likert-type scale, coupled with an algorithm, was used to capture and transform theoretical framework features into measurable attributes. PHC services were grouped under the main categories of chronic care, urgent/acute care, preventive care, and home care. A web-based platform was used to assess patient pathways, evaluate integration levels and propose improvement actions. Analysis relied on a comparison of actual pathways versus optimal, the latter ones having been identified through literature review. Overall integration varied among units. The majority (57%) of units corresponded to a basic level. Integration by type of PHC service ranged as follows: basic (86%) or poor (14%) for chronic care units, poor (78%) or basic (22%) for urgent/acute care units, basic (50%) for preventive care units, and partial or basic (50%) for home care units. The actual pathways across all four categories of PHC services differed from those captured in the optimum integration model. Certain similarities were observed in the operational flows between chronic care management and urgent/acute care management. Such similarities were present at the highest level of abstraction, but also in common steps along the operational flows. Existing patient care pathways were mapped and analysed, and recommendations for an optimum integration PHC model were made. The developed web

  7. primary health care in nigeria

    African Journals Online (AJOL)

    user1

    2014-07-31

    Jul 31, 2014 ... health problems in communities by providing promotive, preventive, .... determinants so as to evolve ways to solve them. It ... importance of evidence based programming through ..... against the selective PHC concept with its.

  8. Health Data Recording, Reporting and Utilization Practices Among ...

    African Journals Online (AJOL)

    Health Data Recording, Reporting and Utilization Practices Among Primary Health Care Workers in Enugu State, South Eastern Nigeria. ... of PHC workers used notepads, 52.3% used notebooks while only 47.7% used health management information system (HMIS) forms to record data. ... AJOL African Journals Online.

  9. Absolute Geostrophic Velocity Inverted from the Polar Science Center Hydrographic Climatology (PHC3.0) of the Arctic Ocean with the P-Vector Method (NCEI Accession 0156425)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The dataset (called PHC-V) comprises 3D gridded climatological fields of absolute geostrophic velocity of the Arctic Ocean inverted from the Polar science center...

  10. Gobernanza y economía política de las políticas de APS en América Latina Governance and political economy of PHC policies in Latin America

    Directory of Open Access Journals (Sweden)

    Ernesto Báscolo

    2011-06-01

    Full Text Available El desarrollo de los procesos de implementación de las políticas de APS en América Latina sigue siendo un desafío pendiente. Es necesario reconocer la economía política de los procesos de implementación de las políticas de APS desde una perspectiva de gobernanza, caracterizada por las estrategias de regulación promovidas y los procesos políticos. La promoción de valores sociales, normas organizacionales o la introducción de nuevos incentivos económicos serán componentes de diferentes modos de gobernanza promovidos en las reformas de los sistemas de salud. Se consideran los factores institucionales de los sistemas de protección social en AL, sus capacidades, limitaciones redistributivas y las disputas de economía política presentes en las estrategias de reforma, explicadas por la conflictividad entre los intereses (económicos y necesidades y valores presentes en los actores involucrados. La forma en cómo se dirimen este proceso político influye sobre los modos de regulación instalados en los procesos de implementación de las políticas de APS. La capacidad de rectoría del Estado y los niveles de segmentación de los sistemas de salud condicionan la efectividad de las estrategias de reforma para dirimir la conflictividad de las políticas implementadas.The development of implementation processes of PHC policies in Latin America, is a challenge yet to be tackled. It is necessary to acknowledge the political economy related to the implementation processes of PHC policies in Latin America from a governance perspective, characterized by the regulatory strategies used and the political processes. The promotion of social values, organizational policies or the introduction of new financial incentives are components of different forms of governance used in health system reforms. The institutional factors of social protection systems in Latin America are considered. Their potential, redistribution limitations and the political

  11. The relationship between quality of work life and turnover intention of primary health care nurses in Saudi Arabia.

    Science.gov (United States)

    Almalki, Mohammed J; FitzGerald, Gerry; Clark, Michele

    2012-09-12

    Quality of work life (QWL) has been found to influence the commitment of health professionals, including nurses. However, reliable information on QWL and turnover intention of primary health care (PHC) nurses is limited. The aim of this study was to examine the relationship between QWL and turnover intention of PHC nurses in Saudi Arabia. A cross-sectional survey was used in this study. Data were collected using Brooks' survey of Quality of Nursing Work Life, the Anticipated Turnover Scale and demographic data questions. A total of 508 PHC nurses in the Jazan Region, Saudi Arabia, completed the questionnaire (RR = 87%). Descriptive statistics, t-test, ANOVA, General Linear Model (GLM) univariate analysis, standard multiple regression, and hierarchical multiple regression were applied for analysis using SPSS v17 for Windows. Findings suggested that the respondents were dissatisfied with their work life, with almost 40% indicating a turnover intention from their current PHC centres. Turnover intention was significantly related to QWL. Using standard multiple regression, 26% of the variance in turnover intention was explained by QWL, p turnover intention, after controlling for demographic variables. Creating and maintaining a healthy work life for PHC nurses is very important to improve their work satisfaction, reduce turnover, enhance productivity and improve nursing care outcomes.

  12. Implementation of primary health care - package or process ...

    African Journals Online (AJOL)

    After establishing the commitment of the government to comprehensive primary health care (PHC), the Department of Health and provinces are now faced with the challenge of implementation. An important response has come with the recent proposed'core package of primary health care services'.' After consultation with ...

  13. PhMYB4 fine-tunes the floral volatile signature of Petunia x hybrida through PhC4H.

    Science.gov (United States)

    Colquhoun, Thomas A; Kim, Joo Young; Wedde, Ashlyn E; Levin, Laura A; Schmitt, Kyle C; Schuurink, Robert C; Clark, David G

    2011-01-01

    In Petunia × hybrida cv 'Mitchell Diploid' (MD), floral volatile benzenoid/phenylpropanoid (FVBP) biosynthesis is controlled spatially, developmentally, and daily at molecular, metabolic, and biochemical levels. Multiple genes have been shown to encode proteins that either directly catalyse a biochemical reaction yielding FVBP compounds or are involved in metabolite flux prior to the formation of FVBP compounds. It was hypothesized that multiple transcription factors are involved in the precise regulation of all necessary genes, resulting in the specific volatile signature of MD flowers. After acquiring all available petunia transcript sequences with homology to Arabidopsis thaliana R2R3-MYB transcription factors, PhMYB4 (named for its close identity to AtMYB4) was identified, cloned, and characterized. PhMYB4 transcripts accumulate to relatively high levels in floral tissues at anthesis and throughout open flower stages, which coincides with the spatial and developmental distribution of FVBP production and emission. Upon RNAi suppression of PhMYB4 (ir-PhMYB4) both petunia cinnamate-4-hydroxylase (PhC4H1 and PhC4H2) gene transcript levels were significantly increased. In addition, ir-PhMYB4 plants emit higher levels of FVBP compounds derived from p-coumaric acid (isoeugenol and eugenol) compared with MD. Together, these results indicate that PhMYB4 functions in the repression of C4H transcription, indirectly controlling the balance of FVBP production in petunia floral tissue (i.e. fine-tunes).

  14. Patients′ perception of the quality of malaria treatment in primary health care centers of Jos and Environs

    Directory of Open Access Journals (Sweden)

    N S Jimam

    2015-01-01

    Full Text Available Background: Though the fight against malaria continued to be on the increased, the disease still remains a major public health problem in many developing countries, especially in the rural areas. The extent of drug use and its effect is affected among other things by the pattern in which these drugs are prescribed by the health workers. Patients′ assessment of the quality of care depends on their ability to judge whether health care providers are adhering to the defined standard of care, hence it is necessary to assess the views of patients regarding the quality of care they received from the primary health care (PHC centers. Aim: This study aimed at evaluating consumer′s perception of the quality of malaria treatment in PHC centers of Jos and environs. Materials and Methods: Nine PHC centers were selected by multi-stage random sampling, five from Jos North and four from Jos South Local Government Areas of Plateau State. Patients of both sexes within the age range of 18 years and above who visited the PHC centers for malaria treatment were considered eligible to participate in the survey, provided that they were able to understand and respond to the interview questions. A semi-structured interviewer questionnaire which was adapted from previous health survey studies was administered to all the 249 eligible participants. The data collected were analyzed using the Statistical Package for Social Sciences (SPSS version 20.0 software programmer. Results: The result showed that there were no consistently significant differences (P > 0.05 regarding patient satisfaction between male and female patients across selected items in the various domains, that is, irrespective of respondents′ sex, their perception of the quality of health services rendered by PHCs was similar. Conclusion: It was therefore concluded that there was similar satisfaction level between the male and the female, though some key health services were not readily available in the

  15. Using diaries to explore the work experiences of primary health care nursing managers in two South African provinces

    Directory of Open Access Journals (Sweden)

    Pascalia O. Munyewende

    2014-12-01

    Full Text Available Background: South Africa is on the brink of another wave of major health system reforms that underscore the centrality of primary health care (PHC. Nursing managers will play a critical role in these reforms. Objective: The aim of the study was to explore the work experiences of PHC clinic nursing managers through the use of reflective diaries, a method hitherto under-utilised in health systems research in low- and middle-income countries. Design: During 2012, a sub-set of 22 PHC nursing managers was selected randomly from a larger nurses’ survey in two South African provinces. After informed consent, participants were requested to keep individual diaries for a period of 6 weeks, using a clear set of diary entry guidelines. Reminders consisted of weekly short message service reminders and telephone calls. Diary entries were analysed using thematic content analysis. A diary feedback meeting was held with all the participants to validate the findings. Results: Fifteen diaries were received, representing a 68% response rate. The majority of respondents (14/15 were female, each with between 5 and 15 years of nursing experience. Most participants made their diary entries at home. Diaries proved to be cathartic for individual nursing managers. Although inter-related and not mutually exclusive, the main themes that emerged from the diary analysis were health system deficiencies; human resource challenges; unsupportive management environment; leadership and governance; and the emotional impact of clinic management. Conclusions: Diaries are an innovative method of capturing the work experiences of managers at the PHC level, as they allow for confidentiality and anonymity, often not possible with other qualitative research methods. The expressed concerns of nursing managers must be addressed to ensure the success of South Africa's health sector reforms, particularly at the PHC level.

  16. The retention of health human resources in primary healthcare centers in Lebanon: a national survey.

    Science.gov (United States)

    Alameddine, Mohamad; Saleh, Shadi; El-Jardali, Fadi; Dimassi, Hani; Mourad, Yara

    2012-11-22

    Critical shortages of health human resources (HHR), associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC) sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon. A cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory). A total of 755 providers completed the questionnaire (60.5% response rate). Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit. Two out of five respondents indicated likelihood to quit their jobs within the next 1-3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%), better job opportunities outside the country (35.1%) and lack of professional development (33.7%). A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit. The study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits and allied health professionals. Particular attention should

  17. The retention of health human resources in primary healthcare centers in Lebanon: a national survey

    Directory of Open Access Journals (Sweden)

    Alameddine Mohamad

    2012-11-01

    Full Text Available Abstract Background Critical shortages of health human resources (HHR, associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon. Methods A cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory. A total of 755 providers completed the questionnaire (60.5% response rate. Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit. Results Two out of five respondents indicated likelihood to quit their jobs within the next 1–3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%, better job opportunities outside the country (35.1% and lack of professional development (33.7%. A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit. Conclusions The study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits

  18. [Scientific output on nutrition in the scope of Primary Health Care in Brazil: a review of the literature].

    Science.gov (United States)

    Canella, Daniela Silva; Silva, Ana Carolina Feldenheimer da; Jaime, Patrícia Constante

    2013-02-01

    Nutrition campaigns in Primary Health Care (PHC) play an important role in health promotion and the prevention and treatment of injuries. The scope of this paper is to chart and evaluate the scientific output of nutrition in Brazilian PHC. A search and review of the literature and papers was conducted on the PubMed and Lilacs databases, using key words related to PHC and nutrition. The studies were restricted to Brazil with the professionals or population assisted by PHC in the Brazilian Unified Health System and published prior to March 2011. The references in the selected articles were also consulted in order to identify additional studies. From the total of papers located, 68 were eligible and a further 49 were identified in the references lists, such that a total of 117 papers were analyzed. The studies reviewed were mostly original articles, using quantitative methodology, carried out by São Paulo University in that state and published from 2002 to 2011. The main issues were diagnosis seeking the evaluation of nutritional status involving children. The output in this field is growing, although there is a need to redirect the scope of future studies to a focus on intervention models and program evaluation.

  19. Supply and distribution of primary healthcare registered nurses in british columbia.

    Science.gov (United States)

    Wong, Sabrina T; Watson, Diane E; Young, Ella; Mooney, Dawn

    2009-11-01

    WHAT DID WE DO?: This study uses an existing data source to (a) describe the population and geographic distribution of registered nurses (RNs) working in primary healthcare (PHC) in British Columbia, (b) compare this workforce to PHC physicians and (c) assess the distribution of PHC-RNs relative to population health status. WHAT DID WE LEARN?: Of the 27,570 practising RNs in British Columbia in 2000, there were 3,179 (12%) in the PHC workforce. This translates into 147 people per practising RN and 1,277 people per PHC-RN. In 2000, there were 990 people per PHC physician. PHC-RNs represented 43% of the combined PHC workforce of physicians and RNs. A large proportion (47%) of PHC-RNs worked in community health centres, whereas less than 2% worked in physicians' offices. Geographic distribution of PHC-RNs is similar to the distribution of PHC physicians and is not associated with population health status. WHAT ARE THE IMPLICATIONS?: There seem to be sufficient PHC-RNs to implement policy objectives in support of interdisciplinary PHC teams, but physicians and nurses will increasingly need to practice in the same location or have access to electronic information systems to support coordination, continuity and comprehensiveness of PHC. The PHC workforce could be better deployed to align with population health status.

  20. Prevalence of Work-Related Asthma and its Impact in Primary Health Care.

    Science.gov (United States)

    Vila-Rigat, Rosa; Panadès Valls, Rafael; Hernandez Huet, Enric; Sivecas Maristany, Joan; Blanché Prat, Xavier; Muñoz-Ortiz, Laura; Torán Monserrat, Pere; Rabell Santacana, Ventura

    2015-09-01

    To determine the prevalence of occupational asthma (OA) and work-exacerbated asthma (WEA) among asthmatic patients diagnosed in Primary Health Care (PHC). To analyze the impact at PHC level caused by under-diagnosis and inappropriate referral of OA. A descriptive, cross-sectional multicenter study in patients aged between 16 and 64years diagnosed with asthma, according to their medical record; all were working or had worked, and were assigned to one of 16 PHC centers in a healthcare district. Based on the responses to the questionnaire completed at the study visit, which included a thorough review of the subject's entire working history, patients were classified into three categories by an expert in occupational asthma: OA, WEA or common asthma (CA). Three hundred and sixty-eight patients completed the questionnaire. The prevalence of OA was 18.2% (25% in men and 14.6% in women, P=.046), and 54 patients (14.7%) were classified as WEA. The proportion of patients with work-related asthma (WRA) was therefore 32.9%. Asthmatic patients with WRA took more sick leave than CA patients (P<.001). A high prevalence of WRA was found, mostly treated in PHC. Under-diagnosis of WRA is widespread in PHC. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  1. Essential attributes and qualifiers of primary health care

    Directory of Open Access Journals (Sweden)

    Andréa Silvia Walter de Aguiar

    2012-06-01

    Full Text Available Historically, the primary health care (PHC has been associated with the first level of care from a health system and characterized by the kind of professional that in it operates, where is expected a predominance of specialists in this area. However, the major limitation for this type of characterization is that the profile of professionals engaged in this service may vary from country to country.Several theoretical and conceptual landmarks proposed approaches and indicators to assess and characterize the APS. In 1978, the American Institute of Medicine suggested an approach in which listed its attributes such as accessibility, integrality, coordination, continuity and responsibility. This was an important landmark in an attempt to outline a normative approach to measure it. However, most indicators and specific definition was not suggested. The selected indicators required a high level of performance, were difficult to be achieved, and focused on the capacity of services and not in its concrete realization(1.A 1996 report, from the same institution, defined PHC as the provision of integrated services and accessible by clinicians who are responsible for attending a large majority of personal care needs, developing a continued partnership with patients and working within family and community. This definition does not include the first contact and focuses on individual attention.The Canadian Medical Association, in 1996, considered the APS as a front door of the health system and community interventions included in the definition of the functions of APS. In the same year was published a Charter for General Practice / Family Medicine in Europe (Letter to General Practice / Family Medicine in Europe, which describes 12 characteristics: general, accessible, integrated, continuous, as a team, holistic, personalized, targeted for the family and the community, coordinated, confidential and protectress(2.Donabedian(3 systematized a group of important

  2. How to achieve care coordination inside health care organizations

    DEFF Research Database (Denmark)

    Prætorius, Thim; C. Becker, Markus

    2015-01-01

    Understanding how health care organizations can achieve care coordination internally is essential because it is difficult to achieve, but essential for high quality and efficient health care delivery. This article offers an answer by providing a synthesis of knowledge about coordination from...

  3. Comparison of health conditions treated with traditional and biomedical health care in a Quechua community in rural Bolivia.

    Science.gov (United States)

    Vandebroek, Ina; Thomas, Evert; Sanca, Sabino; Van Damme, Patrick; Puyvelde, Luc Van; De Kimpe, Norbert

    2008-01-14

    The objective of the present study was to reveal patterns in the treatment of health conditions in a Quechua-speaking community in the Bolivian Andes based on plant use data from traditional healers and patient data from a primary health care (PHC) service, and to demonstrate similarities and differences between the type of illnesses treated with traditional and biomedical health care, respectively. A secondary analysis of plant use data from semi-structured interviews with eight healers was conducted and diagnostic data was collected from 324 patients in the community PHC service. Health conditions were ranked according to: (A) the percentage of patients in the PHC service diagnosed with these conditions; and (B) the citation frequency of plant use reports to treat these conditions by healers. Healers were also queried about the payment modalities they offer to their patients. Plant use reports from healers yielded 1166 responses about 181 medicinal plant species, which are used to treat 67 different health conditions, ranging from general symptoms (e.g. fever and body pain), to more specific ailments, such as arthritis, biliary colic and pneumonia. The results show that treatment offered by traditional medicine overlaps with biomedical health care in the case of respiratory infections, wounds and bruises, fever and biliary colic/cholecystitis. Furthermore, traditional health care appears to be complementary to biomedical health care for chronic illnesses, especially arthritis, and for folk illnesses that are particularly relevant within the local cultural context. Payment from patients to healers included flexible, outcome contingent and non-monetary options. Traditional medicine in the study area is adaptive because it corresponds well with local patterns of morbidity, health care needs in relation to chronic illnesses, cultural perceptions of health conditions and socio-economic aspects of health care. The quantitative analysis of plant use reports and patient

  4. The role of primary health care in patient education for diabetes control.

    Science.gov (United States)

    Koura, M R; Khairy, A E; Abdel-Aal, N M; Mohamed, H F; Amin, G A; Sabra, A Y

    2001-01-01

    The major components of diabetes management are dietary therapy, exercise and drug treatment. Therefore, education of people with diabetes is the cornerstone of management. The aim of the present work was to study the role of primary health care (PHC) in patient education for diabetes control in Alexandria. Accordingly, the knowledge and perception concerning diabetes and its management of all 88 PHC physicians and 104 nurses working in the two rural health centers and two randomly chosen urban health centers of Alexandria governorate were assessed by pre-designed self-administered questionnaire. All diabetic patients over 20 years of age attending the study health facilities over a period of two months were assessed for their knowledge and attitude concerning diabetes and self-management and asked about their degree of satisfaction with the provided PHC services by a pre-designed interview questionnaire. They amounted to 560 diabetic patients. The results revealed that the PHC physicians had sufficient knowledge about causes and complications of the disease, but insufficient knowledge about diagnosis and management, as only 10.2% & 4.5% of the physicians recognized the importance of regular exercise and patient education for diabetes management. Some misconceptions and false beliefs were observed among PHC nurses, as many of them considered diabetes a contagious disease or primarily caused by stress; that liver failure, hearing impairment and splenomegaly are among the complications of diabetes and that young age and immunodeficiency disorders are among the risk factors for developing diabetes. Moreover, most of them believed that the amount of carbohydrates given to diabetic patients should be reduced or even completely restricted; that vitamins are essential for all diabetic patients and that hot-water bottles are good for providing warmth to the diabetic feet. They also disagreed on the use of artificial sweeteners as sugar substitutes. Most of the diabetic

  5. Health promotion in primary care: How should we intervene? A qualitative study involving both physicians and patients

    Directory of Open Access Journals (Sweden)

    Cortada Josep M

    2011-03-01

    Full Text Available Abstract Background The effects of tobacco, physical exercise, diet, and alcohol consumption on morbidity and mortality underline the importance of health promotion and prevention (HPP at the primary health care (PHC level. Likewise, the deficiencies when putting such policies into practice and assessing their effectiveness are also widely recognised. The objectives of this research were: a to gain an in-depth understanding of general practitioners' (GPs and patients' perceptions about HPP in PHC, and b to define the areas that could be improved in future interventions. Methods Qualitative methodology focussed on the field of health services research. Information was generated on the basis of two GP-based and two patient-based discussion groups, all of which had previously participated in two interventions concerning healthy lifestyle promotion (tobacco and physical exercise. Transcripts and field notes were analysed on the basis of a sociological discourse-analysis model. The results were validated by triangulation between researchers. Results GPs and patients' discourses about HPP in PHC were different in priorities and contents. An overall explanatory framework was designed to gain a better understanding of the meaning of GP-patient interactions related to HPP, and to show the main trends that emerged from their discourses. GPs linked their perceptions of HPP to their working conditions and experience in health services. The dimensions in this case involved the orientation of interventions, the goal of actions, and the evaluation of results. For patients, habits were mainly related to ways of life particularly influenced by close contexts. Health conceptions, their role as individuals, and the orientation of their demands were the most important dimensions in patients' sphere. Conclusions HPP activities in PHC need to be understood and assessed in the context of their interaction with the conditioning trends in health services and patients

  6. To what extent does recurrent government health expenditure in Uganda reflect its policy priorities?

    Directory of Open Access Journals (Sweden)

    Nabyonga-Orem Juliet

    2010-10-01

    Full Text Available Abstract Background The National Health Policy 2000 - 2009 and Health sector strategic plans I & II emphasized that Primary Health Care (PHC would be the main strategy for national development and would be operationalized through provision of the minimum health care package. Commitment was to spend an increasing proportion of the health budget for the provision of the basic minimum package of health services which was interpreted to mean increasing spending at health centre level. This analysis was undertaken to gain a better understanding of changes in the way recurrent funding is allocated in the health sector in Uganda and to what extent it has been in line with agreed policy priorities. Methods Government recurrent wage and non-wage expenditures - based on annual releases by the Uganda Ministry of Finance, Planning and Economic Development were compiled for the period 1997/1998 to financial year 2007/2008. Additional data was obtained from a series of Ministry of Health annual health sector reports as well as other reports. Data was verified by key government officials in Ministry of Finance, Planning and Economic Development and Ministry of Health. Analysis of expenditures was done at sector level, by the different levels in the health care system and the different levels of care. Results There was a pronounced increase in the amount of funds released for recurrent expenditure over the review period fueled mainly by increases in the wage component. PHC services showed the greatest increase, increasing more than 70 times in ten years. At hospital level, expenditures remained fairly constant for the last 10 years with a slight reduction in the wage component. Conclusion The policy aspiration of increasing spending on PHC was attained but key aspects that would facilitate its realization were not addressed. At any given level of funding for the health sector, there is need to work out an optimal balance in investment in the different inputs to

  7. Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory

    Directory of Open Access Journals (Sweden)

    Carlfjord Siw

    2010-08-01

    Full Text Available Abstract Background Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC. The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden. Methods A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption. Results The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process. Conclusion When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the

  8. The relationship between quality of work life and turnover intention of primary health care nurses in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Almalki Mohammed J

    2012-09-01

    Full Text Available Abstract Background Quality of work life (QWL has been found to influence the commitment of health professionals, including nurses. However, reliable information on QWL and turnover intention of primary health care (PHC nurses is limited. The aim of this study was to examine the relationship between QWL and turnover intention of PHC nurses in Saudi Arabia. Methods A cross-sectional survey was used in this study. Data were collected using Brooks’ survey of Quality of Nursing Work Life, the Anticipated Turnover Scale and demographic data questions. A total of 508 PHC nurses in the Jazan Region, Saudi Arabia, completed the questionnaire (RR = 87%. Descriptive statistics, t-test, ANOVA, General Linear Model (GLM univariate analysis, standard multiple regression, and hierarchical multiple regression were applied for analysis using SPSS v17 for Windows. Results Findings suggested that the respondents were dissatisfied with their work life, with almost 40% indicating a turnover intention from their current PHC centres. Turnover intention was significantly related to QWL. Using standard multiple regression, 26% of the variance in turnover intention was explained by QWL, p 2 = .263. Further analysis using hierarchical multiple regression found that the total variance explained by the model as a whole (demographics and QWL was 32.1%, p Conclusions Creating and maintaining a healthy work life for PHC nurses is very important to improve their work satisfaction, reduce turnover, enhance productivity and improve nursing care outcomes.

  9. Comparison study for the CCME reference method for determination of PHC in soil by using internal and external standard methods and by using silica gel column cleanup and in-situ silica gel cleanup methods

    International Nuclear Information System (INIS)

    Wang, Z.; Fingas, M.; Sigouin, L.; Yang, C.; Hollebone, B.

    2003-01-01

    The assessment, cleanup, and remediation of hydrocarbon contaminated sites is covered in the Reference Method for Canada-Wide Standard for Petroleum Hydrocarbons-Tier 1 Method. It replaces several analytical methods used in the past by some laboratories and jurisdictions in Canada. The authors conducted two comparative evaluations to validate the Tier 1 Analytical Method. The first compared the Internal and External Standard Methods, and the second compared the Silica Gel Column Cleanup Method with the In-situ Silica Gel Cleanup Method. The Canadian Council of Ministers of the Environment (CCME) Tier 1 Method recommends and requires the External Standard Method to determine petroleum hydrocarbons (PHC) in soil samples. The Internal Method is widely used to quantify various organic and inorganic pollutants in environmental samples. The Tier 1 Method offers two options for the same extract cleanup. They are: Option A - In-situ Silica Gel Cleanup, and Option B - Silica Gel Column Cleanup. Linearity, precision, and PHC quantification results were the parameters considered for diesel and motor oil solutions, for diesel spiked soil samples, and for motor oil spiked soil samples. It was concluded that both the External and Internal Standard Methods for gas chromatograph (GC) determination of PHC in soil possess their own advantages. The PHC results obtained using the In-Situ Silica Gel Cleanup Method were lower than those obtained with the Silica Gel Column Cleanup Methods. The more efficient and effective sample cleanup method proved to be the Silica Gel Column Method. 13 refs., 7 tabs., 7 figs

  10. Electricity and risk of public health center had measles vaccine damage in Indonesia

    Directory of Open Access Journals (Sweden)

    Anggita Bunga Anggraini

    2016-03-01

    Full Text Available AbstrakLatar belakang: Puskesmas yang memiliki vaksin campak rusak dipengaruhi oleh beberapa faktor risiko.Oleh karena itu perlu diidentifikasi beberapa faktor risiko dominan yang mempengaruhinya.Metode: Analisis menggunakan sebagian data Riset Fasilitas Kesehatan (Rifaskes tahun 2011. Rifaskestersebut dilakukan di seluruh Puskesmas di 33 provinsi di Indonesia. Selanjutnya, pada analisis ini hanyamenggunakan data Puskesmas di provinsi yang memiliki cakupan imunisasi campak di atas angka prevalensinasional (81,6%, dan Puskesmas yang memiliki angka prevalensi campak di atas angka prevalensi nasional(1,18%. Analisis data statistik dilakukan dengan menggunakan analisis regresi logistik untuk menentukanbeberapa faktor risiko dominan yang mempengaruhi Puskesmas yang memiliki vaksin campak rusak.Hasil: Sebanyak 7 (Riau, Jakarta, Nusa Tenggara Barat, Nusa Tenggara Timur, Sulawesi Tengah, SulawesiSelatan, Gorontalo sebanyak 1259 Puskesmas memenuhi kriteria inklusi. Puskesmas yang berlokasi diperdesaan dibandingkan dengan perkotaan berisiko 3,4 kali lipat yang merupakan Puskesmas yang memilikivaksin campak rusak [rasio odds suaian (ORa = 3,37; 95% interval kepercayaan (CI = 1,34-8,26]. Selanjutnya,Puskesmas dengan ketersediaan listrik PLN kurang dari 24 jam dibandingkan dengan tersedia selama 24jam mempunyai risiko 2,1 kali lipat merupakan Puskesmas yang memiliki vaksin campak rusak (ORa =2,10; 95% CI = 1,02-4,33.Kesimpulan: Puskesmas yang mempunyai kerusakan vaksin campak yang rusak lebih banyak terjadi di Puskesmasdi perdesaan dan yang tidak tersedia listrik PLN maupun ketersediaan listrik sehari-hari kurang dari 24 jammerupakan Puskesmas yang memiliki vaksin campak rusak. (Health Science Journal of Indonesia 2015;6:116-20Kata kunci: vaksin campak rusak, Puskesmas AbstractBackground: The Public Health Center (PHC had broken measles vaccine was influenced by a numberof risk factors. Therefore, it was necessary to identify some dominant risk factors that

  11. Care coordination in primary health care: an evaluative study in a municipality in the Northeast of Brazil.

    Science.gov (United States)

    Aleluia, Italo Ricardo Santos; Medina, Maria Guadalupe; Almeida, Patty Fidelis de; Vilasbôas, Ana Luiza Queiroz

    2017-06-01

    International and Brazilian studies have highlighted the importance of the coordination of care for the organization of local health systems. This study aimed to analyze the coordination of care by Primary Health Care (PHC) in a municipal health system in the State of Bahia. This study was conducted in the lead municipality of the macro-region and involved two levels of analysis: PHC team and municipal management. Outlining conditions for the study were defined (hypertension and diabetes mellitus) and an objective image corresponding to the coordination of care was developed based on current national and international literature review. Semi-structured interviews with professionals, managers of PHC services were conducted and current documentary sources were also used. It was demonstrated that the coordination of care has not been met by municipal systems, where only 14 of the 22 proposed criteria have been met. The main difficulties and reasons were: a lack of health care protocols and the non-implementation of computer systems and telecommunication technologies. The results and the conceptual framework to assess the coordination of care are relevant contributions to this study, which can be applied to other contexts with similar characteristics.

  12. Identification of Australian Aboriginal and Torres Strait Islander Cancer Patients in the Primary Health Care Setting

    Directory of Open Access Journals (Sweden)

    Audra de Witt

    2017-08-01

    Full Text Available BackgroundAboriginal and Torres Strait Islander Australians have poorer cancer outcomes and experience 30% higher mortality rates compared to non-Indigenous Australians. Primary health care (PHC services are increasingly being recognized as pivotal in improving Indigenous cancer patient outcomes. It is currently unknown whether patient information systems and practices in PHC settings accurately record Indigenous and cancer status. Being able to identify Indigenous cancer patients accessing services in PHC settings is the first step in improving outcomes.MethodsAboriginal Medical Centres, mainstream (non-Indigenous specific, and government-operated centers in Queensland were contacted and data were collected by telephone during the period from 2014 to 2016. Participants were asked to (i identify the number of patients diagnosed with cancer attending the service in the previous year; (ii identify the Indigenous status of these patients and if this information was available; and (iii advise how this information was obtained.ResultsTen primary health care centers (PHCCs across Queensland participated in this study. Four centers were located in regional areas, three in remote areas and three in major cities. All participating centers reported ability to identify Indigenous cancer patients attending their service and utilizing electronic Patient Care Information Systems (PCIS to manage their records; however, not all centers were able to identify Indigenous cancer patients in this way. Indigenous cancer patients were identified by PHCCs using PCIS (n = 8, searching paper records (n = 1, and combination of PCIS and staff recall (n = 1. Six different types of PCIS were being utilized by participating centers. There was no standardized way to identify Indigenous cancer patients across centers. Health service information systems, search functions and capacities of systems, and staff skill in extracting data using PCIS varied between centers

  13. Primary Health Care (PHC) as the bedrock of the mdgs: community ...

    African Journals Online (AJOL)

    Recognizing the internal strength of Communities, facilitating the development of community self esteem and helping individuals believe in themselves is in conformity with the Alma Ata declaration of Primary Health Care. In Nigeria, antenatal delivery, children and postnatal experiences for women usually take place in ...

  14. The Prince Edward Island Conceptual Model for Nursing: a nursing perspective of primary health care.

    Science.gov (United States)

    Munro, M; Gallant, M; MacKinnon, M; Dell, G; Herbert, R; MacNutt, G; McCarthy, M J; Murnaghan, D; Robertson, K

    2000-06-01

    The philosophy of primary health care (PHC) recognizes that health is a product of individual, social, economic, and political factors and that people have a right and a duty, individually and collectively, to participate in the course of their own health. The majority of nursing models cast the client in a dependent role and do not conceptualize health in a social, economic, and political context. The Prince Edward Island Conceptual Model for Nursing is congruent with the international move towards PHC. It guides the nurse in practising in the social and political environment in which nursing and health care take place. This model features a nurse/client partnership, the goal being to encourage clients to act on their own behalf. The conceptualization of the environment as the collective influence of the determinants of health gives both nurse and client a prominent position in the sociopolitical arena of health and health care.

  15. Privatization of Health Care Provision in a Transition Economy: Lessons From the Republic of Macedonia

    National Research Council Canada - National Science Library

    Nordyke, Robert

    2000-01-01

    ...) under a World Bank credit. The RAND Corporation was under contract to provide technical assistance to the Government of Macedonia on aspects of the health sector financial reforms for primary health care (PHC...

  16. Achieve real gender equality for adolescent health | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2016-11-03

    Nov 3, 2016 ... Achieve real gender equality for adolescent health ... yet limited access to sexual and reproductive health services is preventing women and girls ... forms of sexual violence, trafficking, and abuse and gender discrimination.

  17. Assessing the role of appropriate primary health care on the use of dental services by Brazilian low-income preschool children.

    Science.gov (United States)

    Baldani, Márcia Helena; Rocha, Juliana Schaia; Fadel, Cristina Berger; Nascimento, Antonio Carlos; Antunes, José Leopoldo Ferreira; Moysés, Samuel Jorge

    2017-11-21

    This cross-sectional study aimed to assess the association between the quality of primary health care (PHC) and the use of dental services by preschoolers served by the Family Health Strategy (FHS), controlling for socio-demographic determinants and perceived need. The sample encompassed 438 children aged 3-5 years, enrolled in 19 FHS facilities in Ponta Grossa, Paraná State, Brazil. Individual level variables were collected by interviewing parents or caregivers at home. They answered a questionnaire on socioeconomic conditions, oral hygiene habits and use of dental services. Parental perception of child's oral health related quality of life, as perceived need, was assessed by the Brazilian version of Early Childhood Oral Health Impact Scale (ECOHIS). Normative need was assessed by oral examinations, according to guidelines standardized by the World Health Organization. The contextual level factor was defined as the extent of implementation of PHC in the facilities. Managers responded to PCATool-Brazil, a validated questionnaire which measures the extent of PHC. Dentists answered to a version of PCATool, which was adapted and pretested for dental services. Multilevel analysis, based on Andersen's behavioral model, fitted the adjustment of "having ever consulted a dentist" to contextual and individual covariates. We observed high prevalence of dental caries. Almost half of the sample had had dental appointments in life. Social gradients were observed for the use of dental services. Although it was not able to eliminate the impact of adverse social conditions, higher levels of PHC attributes in dental services favored the effective use of such services by low-income children.

  18. Paper based diagnostics for personalized health care: Emerging technologies and commercial aspects.

    Science.gov (United States)

    Mahato, Kuldeep; Srivastava, Ananya; Chandra, Pranjal

    2017-10-15

    Personalized health care (PHC) is being appreciated globally to combat clinical complexities underlying various metabolic or infectious disorders including diabetes, cardiovascular, communicable diseases etc. Effective diagnoses majorly depend on initial identification of the causes which are nowadays being practiced in disease-oriented approach, where personal health profile is often overlooked. The adoption of PHC has shown significantly improved diagnoses in various conditions including emergency, ambulatory, and remote area. PHC includes personalized health monitoring (PHM), which is its integral part and may provide valuable information's on various clinical conditions. In PHC, bio-fluids are analyzed using various diagnostic devices including lab based equipment and biosensors. Among all types of biosensing systems, paper based biosensors are commercially attracted due to its portability, easy availability, cheaper manufacturing cost, and transportability. Not only these, various intrinsic properties of paper has facilitated the development of paper based miniaturized sensors, which has recently gained ASSURED (Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment free, Deliverable to all end-users) status for point of care diagnosis in miniaturized settings. In this review, importance of paper based biosensors and their compatibility for affordable and low cost diagnostics has been elaborated with various examples. Limitations and strategies to overcome the challenges of paper biosensor have also been discussed. We have provided elaborated tables which describe the types, model specifications, sensing mechanisms, target biomarkers, and analytical performance of the paper biosensors with their respective applications in real sample matrices. Different commercial aspects of paper biosensor have also been explained using SWOT (Strength, Weakness, Opportunities, Threats) analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Health ~,ector Re,rorm~\

    African Journals Online (AJOL)

    Whereas the proposals tor H SR 1994. reallirm thc. PHC stratcgy with great emphasis on disu'ict he:ith" ... incorporated as one of the strategies tor the Health. Sector Progran;me of Work (HSPOW) 1999/2000. ..... secretariat with a vision to be a techhical r'esources by supporting 'local devel

  20. The potential for multi-disciplinary primary health care services to take action on the social determinants of health: actions and constraints.

    Science.gov (United States)

    Baum, Frances E; Legge, David G; Freeman, Toby; Lawless, Angela; Labonté, Ronald; Jolley, Gwyneth M

    2013-05-10

    The Commission on the Social Determinants of Health and the World Health Organization have called for action to address the social determinants of health. This paper considers the extent to which primary health care services in Australia are able to respond to this call. We report on interview data from an empirical study of primary health care centres in Adelaide and Alice Springs, Australia. Sixty-eight interviews were held with staff and managers at six case study primary health care services, regional health executives, and departmental funders to explore how their work responded to the social determinants of health and the dilemmas in doing so. The six case study sites included an Aboriginal Community Controlled Organisation, a sexual health non-government organisation, and four services funded and managed by the South Australian government. While respondents varied in the extent to which they exhibited an understanding of social determinants most were reflexive about the constraints on their ability to take action. Services' responses to social determinants included delivering services in a way that takes account of the limitations individuals face from their life circumstances, and physical spaces in the primary health care services being designed to do more than simply deliver services to individuals. The services also undertake advocacy for policies that create healthier communities but note barriers to them doing this work. Our findings suggest that primary health care workers are required to transverse "dilemmatic space" in their work. The absence of systematic supportive policy, frameworks and structure means that it is hard for PHC services to act on the Commission on the Social Determinants of Health's recommendations. Our study does, however, provide evidence of the potential for PHC services to be more responsive to social determinants given more support and by building alliances with communities and social movements. Further research on the value

  1. Strengthening the delivery of asthma and chronic obstructive pulmonary disease care at primary health-care facilities: study design of a cluster randomized controlled trial in Pakistan

    Directory of Open Access Journals (Sweden)

    Muhammad Amir Khan

    2015-11-01

    Full Text Available Background: Respiratory diseases, namely asthma and chronic obstructive pulmonary disease (COPD, account for one-fourth of the patients at the primary health-care (PHC facilities in Pakistan. Standard care practices to manage these diseases are necessary to reduce the morbidity and mortality rate associated with non-communicable diseases in developing countries. Objective: To develop and measure the effectiveness of operational guidelines and implementation materials, with sound scientific evidence, for expanding lung health care, especially asthma and COPD through PHC facilities already strengthened for tuberculosis (TB care in Pakistan. Design: A cluster randomized controlled trial with two arms (intervention and control, with qualitative and costing study components, is being conducted in 34 clusters; 17 clusters per arm (428 asthma and 306 COPD patients, in three districts in Pakistan from October 2014 to December 2016. The intervention consists of enhanced case management of asthma and COPD patients through strengthening of PHC facilities. The main outcomes to be measured are asthma and COPD control among the registered cases at 6 months. Cluster- and individual-level analyses will be done according to intention to treat. Residual confounding will be addressed by multivariable logistic and linear regression models for asthma and COPD control, respectively. The trial is registered with ISRCTN registry (ISRCTN 17409338. Conclusions: Currently, only about 20% of the estimated prevalent asthma and COPD cases are being identified and reported through the respective PHC network. Lung health care and prevention has not been effectively integrated into the core PHC package, although a very well-functioning TB program exists at the PHC level. Inclusion of these diseases in the already existent TB program is expected to increase detection rates and care for asthma and COPD.

  2. Occupational Influence on Women's Attitude Towards Oral Health in ...

    African Journals Online (AJOL)

    This paper investigated the influence of occupation on women's attitude towards oral health among women attending Primary Health Care (PHC) Centres in the Nkanu West Local Government Area of Enugu State of Nigeria. Three hundred and forty seven (347) women were selected from 2,608 women who formed the ...

  3. Ethiopia's urban primary health care reform: Practices, lessons, and ...

    African Journals Online (AJOL)

    Yayeh

    to assess the implementation of the pilot initiatives. ... Keywords:- Urban, health extension professionals, PHC, pilot. Background. The history of .... The FHT is divided into two sub-teams. .... helped in drawing attention to social sectors that were.

  4. Quality in primary health care services in sub-Sahara Africa: right or ...

    African Journals Online (AJOL)

    The Primary Health Care (PHC) system has been the foundation for the operation of the health system in most of Sub-Sahara Africa following the Alma Ata Declaration in 1978. Quality of care is an important determinant of health services utilization, and is a health outcome of public health importance. It is known that the ...

  5. The provision of Primary Health Care in two rural districts of the Eastern Cape Province with particular reference to human resources and accessibility

    Directory of Open Access Journals (Sweden)

    M. Thipanyana

    1998-09-01

    Full Text Available The provision of Primary Health Care Services (PHC is still a problem in developing countries like South Africa. In other countries, one finds enough human resources whilst in other countries there may be enough material resources. A both qualitative and quantitative research was conducted at Mqanduli and part of the Eastern Elliotdale districts in the Eastern Cape Province with the aim of investigating the provision of Primary health Care Services, reference was made to the availability of human resources and accessibility of PHC services.

  6. Patient satisfaction with quality of primary health care in Benghazi ...

    African Journals Online (AJOL)

    Objectives: To assess patient satisfaction with quality of PHC assessed in terms of (a) customer profile, (b) patient satisfaction, and (c) health care-seeking behavior. Methodology: A sample of nine health centers and seven polyclinics from various locations in Benghazi, Libya were selected for gathering information by ...

  7. Health for all by the year 2000: the countdown has begun.

    Science.gov (United States)

    Roy, B N

    1983-04-01

    In 1977 the World Health Assembly launched the movement for "Health for all by the year 2000." The 1st step was taken at the International Conference on Primary Health Care in Alma Alta, USSR, in 1978. The conference declared that primary health care (PHC) was the key to realizing the goal of health for all by 2000. It also emphasized the need for urgent and effective national and international action to develop and implement a PHC program throughout the world. A general review of the progress in terms of the indicators will facilitate tracing the progress and realizing the magnitude of the tasks ahead. In terms of the 1st 2 indicators, the target has been endorsed at the highest official level by parliaments or governments in most countries and the mechanism has been strengthened in most of the developing countries to involve people in the implementation of the health development programs. The trouble begins with the 3rd indicator which requires countries to spend at least 5% of the gross national product (GNP) on health. For most of the developing countries where health development is inextricably linked with socioeconomic development, investing 5% of the GNP on health is difficult. It is almost an impossibility for the least developed countries (LDCs). The position of the developing countries like India, though somewhat better than that of the LDCs, is not very encouraging either. In India's 6th Plan the allocation on health as percentage of total allocation in the budget was 2.40 in 1978-79 and 2.10 in 1979-80. India's position with regard to the 4th global indicator, requiring that a reasonable percentage of national health expenditure be devoted to the local health care, is not yet satisfactory though considerable efforts have been made in this area. In regard to the 5th indicator, namely, equitable distribution of resources on various population groups or geographical areas, the desired standard has not been achieved. A most important indicator, indicator 7

  8. Motivation for primary health care in Machinga district

    African Journals Online (AJOL)

    This article describes work which has taken place in Liwonde ... workers on linked issues of Health, Literacy and. Agriculture. ... make cooperation with Liwonde P.H.C. Unit the centre of their ... topic should become the focus of the first dramatic ...

  9. Utilization of oral health services by mothers of preschool children in ...

    African Journals Online (AJOL)

    Objective: To determine oral health services utilization by mothers of pre school children in Jos North Local Government Area, Plateau State, Nigeria Design: Cross-sectional study. Setting: Four Primary Health Care (PHC) Clinics in Jos North Local Government Area Participants: 200 mothers of pre school children

  10. Mitigating India's health woes: Can health insurance be a remedy to achieve universal health coverage?

    Directory of Open Access Journals (Sweden)

    B Savitha

    2016-01-01

    Full Text Available A low level of public investments in preventive health facilities and medical care facilities and health professionals has given rise to poor health status for an average Indian. Insufficient government funding for health care, inadequate and ineffective health financing mechanisms, poor delivery of health care, especially in public facilities, and excessive reliance on unregulated high-cost private providers have contributed to the poor accomplishment of Millennium Development Goals, especially in the informal sector. Sustainable Development Goals (SDGs consider health to be one of the important objectives to be achieved by all the nations in the world. This paper reappraises the current status, unmet needs, challenges, and the way forward to implement and achieve universal health coverage (UHC in India by thrusting the focus on three elements (pillars of universal access to health services. Despite seven decades of independence, India does still face the formidable challenge of providing health services to its population at an affordable cost. One of the major obstacles in reaching universal coverage and universal health entitlement of every Indian citizen has been the absence of effective health financing mechanism that promotes affordable access to weaker and vulnerable sections of the society. In this respect, health insurance certainly does have the potential to expedite the process of UHC if various stakeholders work in cohesion under the government stewardship. In rural India, the health infrastructure and workforce are inadequate to serve the unserved and underserved population. Hence, the government should invest in public health facilities while promoting pan-India health insurance to ensure and guarantee easy access and affordability for its citizens. The way forward should not only be centered on financial protection, but also to have renewed emphasis on restructuring the health-care system, ensuring the adequate availability of

  11. Modelos tecnoassistenciais e atuação do psiquiatra no campo da atenção primária à saúde no contexto atual do Sistema Único de Saúde, Brasil Technical model and performance of the psychiatrist in the field of primary health care (PHC in the current context of the Unified Health System (SUS, Brazil

    Directory of Open Access Journals (Sweden)

    Ana Maria Cortez Vannucchi

    2012-01-01

    Full Text Available Este estudo escolheu como tema o trabalho do psiquiatra no campo da Atenção Primária à Saúde (APS, com foco na Unidade Básica de Saúde (UBS e no Núcleo de Apoio à Saúde da Família (NASF. Os dados foram obtidos por meio de entrevistas e observação participativa e trabalhados à luz da análise de conteúdo. Os modelos em saúde mental na APS em São Paulo vieram desde a inserção de psiquiatras nas UBS até, mais recentemente, no NASF. Há fragilidade na articulação dos serviços e na definição do papel do psiquiatra. Sua formação não contempla habilidades para atuação na APS e para utilização da ferramenta do apoio matricial. A atual política pública para a atenção à saúde mental na APS tem-se concentrado no NASF; porém, é insuficiente para atender a maioria dos transtornos mentais. São necessárias formação para atuação na APS, melhores condições de trabalho, articulação dos serviços e participação contínua do psiquiatra na APS.The approach is Primary Health Care psychiatrist's work. We used qualitative methodology and have conducted interviews and participative observation. Data analysis has been done by content analysis. In São Paulo, the inclusion of psychiatrists at the PHC is by the PHC Center, and the family health support center (NASF. There is a fragile articulation of the network and difficulties in establishing enhancing the psychiatrist role. The training does not include the work at the APS, particularly working with matrix-based strategy. Hegemonic policy has been focused on the NASF, which is insufficient to meet the needs of ongoing psychiatric care of most patients with mental disorders. Besides the need of training for working at the APS, it has been necessary to offer better working conditions for the professionals at this level of attention and to articulate resources of mental health for a better care of mental health and a better performance of the psychiatrist.

  12. Capitation-Based Financing Hampers the Provision of Preventive Services in Primary Health Care.

    Science.gov (United States)

    Sándor, János; Kósa, Karolina; Papp, Magor; Fürjes, Gergő; Kőrösi, László; Jakovljevic, Mihajlo; Ádány, Róza

    2016-01-01

    Mortality caused by non-communicable diseases has been extremely high in Hungary, which can largely be attributed to not performed preventive examinations (PEs) at the level of primary health care (PHC). Both structures and financial incentives are lacking, which could support the provision of legally defined PEs. A Model Programme was launched in Hungary in 2012 to adapt the recommendations for PHC of the World Health Organization. A baseline survey was carried out to describe the occurrence of not performed PEs. A sample of 4320 adults representative for Hungary by age and gender was surveyed. Twelve PEs to be performed in PHC as specified by a governmental decree were investigated and quantified. Not performed PEs per person per year with 95% confidence intervals were computed for age, gender, and education strata. The number of not performed PEs for the entire adult population of Hungary was estimated and converted into expenses according to the official reimbursement costs of the National Health Insurance Fund. The rate of service use varied between 16.7 and 70.2%. There was no correlation between the unit price of examinations and service use (r = 0.356; p = 0.267). The rate of not performed PEs was not related to gender, but older age and lower education proved to be risk factors. The total number of not performed PEs was over 17 million in the country. Of the 31 million euros saved by not paying for PEs, the largest share was not spent on those in the lowest educational category. New preventive services offered in the reoriented PHC model program include systematic and scheduled health examination health promotion programs at community settings, risk assessment followed by individual or group care, and/or referral and chronic care. The Model Programme has created a pressure for collaborative work, consultation, and engagement at each level, from the GPs and health mediators up to the decision-making level. It channeled the population into preventive

  13. Desarrollo de competencias en atención primaria de salud Development of primary health care competencies

    Directory of Open Access Journals (Sweden)

    Carme Nebot Adell

    2009-08-01

    Full Text Available Given that the lack of qualified human resources devoted to primary health care (PHC is one of the reasons why Alma Ata goals are as yet unattained, PAHO/WHO sponsored the design and implementation of a virtual course for training health care professionals at this level. The course was designed around competencies identified as being necessary for renewing primary care, founded on the premise that providing quality, sustainable services amenable to the public must emanate from professionals who lead the change process at all levels in the system. In this first phase, instruction is aimed at PHC leaders, managers, and other decision makers. The course is offered through the Virtual Public Health Campus and is 27 weeks long.

  14. [A pilot project of the integration of oro-dental care into the primary health care system in Cameroon].

    Science.gov (United States)

    Ngapeth-Etoundi, M; Ekoto, E

    2001-06-01

    The objective of this work is to analyse the situation of the Oral Health Care (OHC) of the population of operational district health unit in Primary Health Care (PHC) and finally integrate the component of OHC. Indeed in many countries in Africa, the World Health Organisation (WHO), in accord with the countries, have set up the policy of PHC. The agreement is that the component of OHC was neglected for quite sometimes in Cameroon. It's for this reason that a pilot project was initiated as a model so that it would be extended to all districts in this country. The method consist in investigation into the prevalence by means of questionnaire and clinical examination of the population of varied age; 900 persons were examined in the Sangmelina health district in order to master the situation of OHC. Oral dental hygiene: 70.5% of the population had a tooth brush, 79% declared they brush their teeth, The state of periodontal tissue: 75% had debris, 70% calculus, 60.7% gingivitis, The prevalence of caries: 66.9% (91.9% had between 21 and 32 teeth), 44.8% follon teeth, 50.8% of this population needed artificial teeth. The situation of the OHC in the health district of Sangmelina requires an effective prevention, consequently the importance of including this situation in PHC program of the said district.

  15. Positive practice environments influence job satisfaction of primary health care clinic nursing managers in two South African provinces.

    Science.gov (United States)

    Munyewende, Pascalia Ozida; Rispel, Laetitia Charmaine; Chirwa, Tobias

    2014-05-15

    Nurses constitute the majority of the health workforce in South Africa and they play a major role in providing primary health care (PHC) services. Job satisfaction influences nurse retention and successful implementation of health system reforms. This study was conducted in light of renewed government commitment to reforms at the PHC level, and to contribute to the development of solutions to the challenges faced by the South African nursing workforce. The objective of the study was to determine overall job satisfaction of PHC clinic nursing managers and the predictors of their job satisfaction in two South African provinces. During 2012, a cross-sectional study was conducted in two South African provinces. Stratified random sampling was used to survey a total of 111 nursing managers working in PHC clinics. These managers completed a pre-tested Measure of Job Satisfaction questionnaire with subscales on personal satisfaction, workload, professional support, training, pay, career prospects and standards of care. Mean scores were used to measure overall job satisfaction and various subscales. Predictors of job satisfaction were determined through multiple logistic regression analysis. A total of 108 nursing managers completed the survey representing a 97% response rate. The mean age of respondents was 49 years (SD = 7.9) and the majority of them (92%) were female. Seventy-six percent had a PHC clinical training qualification. Overall mean job satisfaction scores were 142.80 (SD = 24.3) and 143.41 (SD = 25.6) for Gauteng and Free State provinces respectively out of a maximum possible score of 215. Predictors of job satisfaction were: working in a clinic of choice (RRR = 3.10 (95% CI: 1.11 to 8.62, P = 0.030)), being tired at work (RRR = 0.19 (95% CI: 0.08 to 0.50, P = 0.001)) and experience of verbal abuse (RRR = 0.18 (95% CI: 0.06 to 0.55, P = 0.001). Allowing nurses greater choice of clinic to work in, the prevention of violence

  16. Positive practice environments influence job satisfaction of primary health care clinic nursing managers in two South African provinces

    Science.gov (United States)

    2014-01-01

    Background Nurses constitute the majority of the health workforce in South Africa and they play a major role in providing primary health care (PHC) services. Job satisfaction influences nurse retention and successful implementation of health system reforms. This study was conducted in light of renewed government commitment to reforms at the PHC level, and to contribute to the development of solutions to the challenges faced by the South African nursing workforce. The objective of the study was to determine overall job satisfaction of PHC clinic nursing managers and the predictors of their job satisfaction in two South African provinces. Methods During 2012, a cross-sectional study was conducted in two South African provinces. Stratified random sampling was used to survey a total of 111 nursing managers working in PHC clinics. These managers completed a pre-tested Measure of Job Satisfaction questionnaire with subscales on personal satisfaction, workload, professional support, training, pay, career prospects and standards of care. Mean scores were used to measure overall job satisfaction and various subscales. Predictors of job satisfaction were determined through multiple logistic regression analysis. Results A total of 108 nursing managers completed the survey representing a 97% response rate. The mean age of respondents was 49 years (SD = 7.9) and the majority of them (92%) were female. Seventy-six percent had a PHC clinical training qualification. Overall mean job satisfaction scores were 142.80 (SD = 24.3) and 143.41 (SD = 25.6) for Gauteng and Free State provinces respectively out of a maximum possible score of 215. Predictors of job satisfaction were: working in a clinic of choice (RRR = 3.10 (95% CI: 1.11 to 8.62, P = 0.030)), being tired at work (RRR = 0.19 (95% CI: 0.08 to 0.50, P = 0.001)) and experience of verbal abuse (RRR = 0.18 (95% CI: 0.06 to 0.55, P = 0.001). Conclusion Allowing nurses greater choice of clinic

  17. The integrated project: a promising promotional strategy for primary health care.

    Science.gov (United States)

    Daniel, C; Mora, B

    1985-10-01

    The integrated project using parasite control and nutrition as entry points for family planning practice has shown considerable success in promoting health consciousness among health workers and project beneficiaries. This progress is evident in the Family Planning, Parasite Control and Nutrition (FAPPCAN) areas. The project has also mobilized technical and financial support from the local government as well as from private and civic organizations. The need for integration is underscored by the following considerations: parasite control has proved to be effective for preventive health care; the integrated project uses indigenous community health workers to accomplish its objectives; the primary health care (PHC) movement depends primarily on voluntary community participation and the integrated project has shown that it can elicit this participation. The major health problems in the Philippines are: a prevalence of communicable and other infectious diseases; poor evironmental sanitation; malnutrition; and a rapid population growth rate. The integrated program utilizes the existing village health workers in identifying problems related to family planning, parasite control and nutrition and integrates these activities into the health delivery system; educates family members on how to detect health and health-related problems; works out linkages with government agencies and the local primary health care committee in defining the scope of health-related problems; mobilizes community members to initiate their own projects; gets the commitment of village officials and committe members. The integrated project operates within the PHC. A health van with a built-in video playback system provides educational and logistical support to the village worker. The primary detection and treatment of health problems are part of the village health workers' responsibilities. Research determines the project's capability to reactivate the village primary health care committees and sustain

  18. Conceptualising health services in terms of level and location of care

    African Journals Online (AJOL)

    location of care, are complex combinations of services. They encompass all levels of care ... expression in the recently published ANC health plan. This more comprehensive ..... business of training PHC providers and basic specialists as.

  19. A Blueprint for Innovation to Achieve Health System Transformation.

    Science.gov (United States)

    Snowdon, Anne W

    2017-01-01

    Global health systems are challenged by escalating costs and growing demands for care created by the demands of aging populations and rising rates of chronic illness which place unsustainable pressure on health systems to meet population health needs. To overcome these challenges, transformational change is needed to strengthen health system performance and sustainability. Innovation is widely viewed as the strategy to drive transformational change in health systems; yet to date, innovation has lacked a clearly defined focus or agenda to achieve transformation. An actionable innovation agenda is needed to achieve transformational change for health systems. The key conditions for success as an innovation strategy are examined, including clearly defined innovation objectives, key milestones, and actionable steps every system stakeholder must pursue in order to guide the innovation agenda and ultimately accelerate the transformational changes needed for a sustainable healthcare system that delivers value to populations.

  20. Great expectations for the World Health Organization: a Framework Convention on Global Health to achieve universal health coverage.

    Science.gov (United States)

    Ooms, G; Marten, R; Waris, A; Hammonds, R; Mulumba, M; Friedman, E A

    2014-02-01

    Establishing a reform agenda for the World Health Organization (WHO) requires understanding its role within the wider global health system and the purposes of that wider global health system. In this paper, the focus is on one particular purpose: achieving universal health coverage (UHC). The intention is to describe why achieving UHC requires something like a Framework Convention on Global Health (FCGH) that have been proposed elsewhere,(1) why WHO is in a unique position to usher in an FCGH, and what specific reforms would help enable WHO to assume this role. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  1. Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa.

    Science.gov (United States)

    Mathibe, Maphuthego D; Hendricks, Stephen J H; Bergh, Anne-Marie

    2015-10-02

    Primary Health Care (PHC) clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. Workload, staff development and support for integration affected clinicians' performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.

  2. Differences in primary health care use among sub-Saharan African immigrants in Norway: a register-based study.

    Science.gov (United States)

    Diaz, Esperanza; Mbanya, Vivian N; Gele, Abdi A; Kumar, Bernadette

    2017-07-28

    Immigrants' utilization of primary health care (PHC) services differs from that of the host populations. However, immigrants are often classified in broad groups by continent of origin, and the heterogeneity within the same continent may hide variation in use among immigrant groups at a national level. Differences in utilization of PHC between sub-Saharan African immigrants have not received much attention. Registry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration. African immigrants and their descendants registered in Norway in 2008 (36,366 persons) where included in this study. Using χ 2 test and logistic regression models, we assessed the differences in the use of PHC, including general practitioner (GP) and emergency room (ER) services, and the distribution of morbidity burden for immigrants from Somalia, Ethiopia, Eritrea, and Gambia. For the analyses, we used the number of visits and medical diagnoses from each consultation registered by the physician. Among the total studied population, 66.1% visited PHC within 1 year. The diagnoses registered were similar for all four immigrants groups, regardless of country of origin. Compared to immigrants from Somalia, the age and sex adjusted odds ratios (OR) for use of GP were significantly lower for Ethiopians (OR 0.91; 0.86-0.97), Eritreans (OR 0.85; 0.79-0.91), and Gambians (OR 0.88; 0.80-0.97). Similarly, we also observed lower use of ER among Ethiopians (OR 0.88; 0.81-0.95), Eritreans (OR 0.56; 0.51-0.62) and Gambians (OR 0.81; 0.71-0.92). However, immigrants from Somalia reduced their use of PHC with longer duration of stay in Norway. Differences between groups persisted after further adjustment for employment status. Despite the similarities in diagnoses among the sub-Saharan African immigrant groups in Norway, their use of PHC services differs by country of origin and length of stay. It is important to assess the reasons for the differences

  3. Primary health care facility infrastructure and services and the ...

    African Journals Online (AJOL)

    ... Research Council ae Currently from Cape Peninsula University of Technology ... Keywords: primary health care facilities; nutritional status; children; caregivers' rural; South Africa ... underlying causes of malnutrition in children, while poor food quality, .... Information on PHC facility infrastructure and services was obtained.

  4. Primary health care: a necessity in developing countries?

    Directory of Open Access Journals (Sweden)

    Evaezi Okpokoro

    2013-12-01

    Full Text Available Resource limited countries continue to be plagued with rising prevalence of malaria, tuberculosis, HIV/AIDS as well as other emerging diseases despite the huge financial support provided by bilateral and multilateral agencies to combat these diseases. While progress may have been made in reducing the global burden caused by these diseases on one hand, there has also been a weakening of the primary health care facility on the other hand which was the hallmark to the Alma Ata declaration of 1978. More attention has been placed on our global health needs while the diverse health needs of every community have been neglected. This fatal neglect at the community level highlights the need for the provision of specialize primary health care (PHC facilities which should not only be affordable, accessible and available, but be appropriate to the priority health needs of the community, especially at the rural level. Hence specialized PHC facilities will be tailored to meet the most pressing health needs of the communities it covers among other diseases. Consequently, this innovative approach will not only strengthen the primary health care system by improving wellbeing especially at the rural level but will also improve the outcome of vertical program at communities where it is most needed.

  5. Superlattice photonic crystal as broadband solar absorber for high temperature operation.

    Science.gov (United States)

    Rinnerbauer, Veronika; Shen, Yichen; Joannopoulos, John D; Soljačić, Marin; Schäffler, Friedrich; Celanovic, Ivan

    2014-12-15

    A high performance solar absorber using a 2D tantalum superlattice photonic crystal (PhC) is proposed and its design is optimized for high-temperature energy conversion. In contrast to the simple lattice PhC, which is limited by diffraction in the short wavelength range, the superlattice PhC achieves solar absorption over broadband spectral range due to the contribution from two superposed lattices with different cavity radii. The superlattice PhC geometry is tailored to achieve maximum thermal transfer efficiency for a low concentration system of 250 suns at 1500 K reaching 85.0% solar absorptivity. In the high concentration case of 1000 suns, the superlattice PhC absorber achieves a solar absorptivity of 96.2% and a thermal transfer efficiency of 82.9% at 1500 K, amounting to an improvement of 10% and 5%, respectively, versus the simple square lattice PhC absorber. In addition, the performance of the superlattice PhC absorber is studied in a solar thermophotovoltaic system which is optimized to minimize absorber re-emission by reducing the absorber-to-emitter area ratio and using a highly reflective silver aperture.

  6. National health policies: sub-Saharan African case studies (1980-1990).

    Science.gov (United States)

    Dugbatey, K

    1999-07-01

    Four countries, Botswana, Cote d'Ivoire, Ghana and Zimbabwe, were chosen as cases to study the impact of national health policies on national health status in sub-Saharan Africa. Through a conceptual framework that covers health problem identification, policy formulation and implementation procedures, the study examined national translations of Primary Health Care (PHC) and Health for All by the Year 2000 (HFA/2000) strategies. A series of government measures, taken between 1980-1986 for health policy development and implementation in these countries, were treated as policy determinants of national health outcomes for the period ending 1990. The impact of these determinants on national health status was then analyzed through a comparative description and documentation of observable patterns and trends in infant mortality rates (IMR), under-5 mortality rates (U5MR) and life expectancy. Policy guidelines from PHC and HFA/2000 were used in conjunction with the respective per capita Gross National Products to categorize the four cases. Based on these guidelines, Botswana was ranked high, both in terms of policy development and the level of economic development, while Zimbabwe ranked high in terms of policy development but relatively low in economic terms. Cote d'Ivoire ranked high on economic development but low with regard to its policy framework. Ghana was at the other end of the spectrum, ranking low both in terms of its policy development and its economic performance. The comparative analysis revealed that Botswana and Zimbabwe performed better than Cote d'Ivoire and Ghana on the three outcome indicators. Despite Cote d'Ivoire's superior level of economic development, its health status fell behind that of Zimbabwe and even Ghana. The study concluded that policies formulated and implemented in accordance with key PHC principles could account for improvements in national health status. Since the end of the study period (1990), there have been significant political

  7. Primary health care management challenges for childhood atopic ...

    African Journals Online (AJOL)

    Kaarina Frieda Meintjes

    primary health care (PHC) management of their children's atopic eczema in a Gauteng district. A qualitative, explorative, descriptive, contextual embedded single case study design ... direct observation until saturation occurred; analysed according to Tesch's ..... needed, it was provided by the researcher as part of the pro-.

  8. Policy environment for prevention, control and management of cardiovascular diseases in primary health care in Kenya.

    Science.gov (United States)

    Asiki, Gershim; Shao, Shuai; Wainana, Carol; Khayeka-Wandabwa, Christopher; Haregu, Tilahun N; Juma, Pamela A; Mohammed, Shukri; Wambui, David; Gong, Enying; Yan, Lijing L; Kyobutungi, Catherine

    2018-05-09

    In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya. A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews. A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014-2030), The Kenya Health Sector Strategic and Investment Plan (2014-2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015-2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012-2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents. This review revealed

  9. The motivational needs of primary health care nurses to acquire ...

    African Journals Online (AJOL)

    Karien Jooste

    for a significant part of service delivery in the health system. Professional nurses' .... motivational needs of PHC nurses to acquire power in the workplace at mine clinic .... recognition through rewards and status (Jooste, 2009, p. 165). 10.1.1.

  10. Stakeholders' Perspectives on Strategies for the Recruitment and Retention of Primary Health Care Employees in Qatar: A Qualitative Approach.

    Science.gov (United States)

    Alameddine, Mohamad; Yassoub, Rami; Mourad, Yara; Khodr, Hiba

    2017-01-01

    This study explores the recruitment and retention conditions influencing primary health care (PHC) human resources for health (HRH) in Qatar and suggests strategies for their improvement. A qualitative design employing semistructured key informant interviews with PHC stakeholders in Qatar was utilized. Key interviewees were originally recognized, and snowball sampling was used to identify additional interviewees until reaching saturation point. Interview scripts were transcribed and then analyzed thematically using the Nvivo software package. Thematic analysis precipitated a number of themes. Under recruitment, the centrality of enhancing collaboration with academic institutions, enhancing extrinsic benefits, and strengthening human resources recruitment and management practices. Dedicated support needs to be provided to expatriate HRH especially in regard to housing services, children schooling, and streamlining administrative processes for relocation. Findings revealed that job security, continuous professional development, objective performance appraisal systems, enhanced job transparency, and remuneration are key retention concerns. The study provides a number of recommendations for the proper recruitment and retention of HRH. Health planners and decision makers must take these recommendations into consideration to ensure the presence of a competent and sustainable HRH in the PHC sector in the future.

  11. GIS-based accessibility analysis: An approach to determine public primary health care demand in South Africa

    CSIR Research Space (South Africa)

    Mokgalaka, H

    2013-11-01

    Full Text Available The spatial realities and dynamics of a changing population with changing health care needs require regular and logical methods to evaluate and assist in primary health care (PHC) planning. Geographical access is an important aspect in the planning...

  12. Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision.

    Science.gov (United States)

    Fusheini, Adam; Eyles, John

    2016-10-07

    Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy. We utilize a review of relevant documents, conducted between September 2014 and December 2015 of district health systems (DHS) and UHC and their ideological underpinnings, to explore the opportunities and challenges, of the district health system in achieving UHC in South Africa. Review of data from the NHI pilot districts suggests that as South Africa embarks on reforms toward UHC, there is a need for a minimal universal coverage and emphasis on district particularity and positive discrimination so as to bridge health inequities. The disparities across districts in relation to health profiles/demographics, health delivery performance, management of health institutions or district management capacity, income levels/socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities. We conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously

  13. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South AfricaExperiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

    Directory of Open Access Journals (Sweden)

    Dudu G. Sokhela

    2013-07-01

    Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans.Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service.Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed.Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

  14. Job satisfaction among primary health care physicians and nurses in Al-madinah Al-munawwara.

    Science.gov (United States)

    Al Juhani, Abdullah M; Kishk, Nahla A

    2006-01-01

    Job satisfaction is the affective orientation that an employee has towards his work. Greater physician satisfaction is associated with greater patient adherence and satisfaction. Nurses' job satisfaction, have great impact on the organizational success. Knowing parts of job dissatisfaction among physicians and nurses is important in forming strategies for retaining them in primary health care (PHC) centers. Therefore, this study aimed at assessing the level of job satisfaction among PHC physicians and nurses in Al- Madina Al- Munawwara. Also, to explore the relationship of their personal and job characteristics with job satisfaction. A descriptive cross- sectional epidemiological approach was adopted. A self completion questionnaire was distributed to physicians and nurses at PHC centers. A multi-dimensional job scale adopted by Traynor and Wade (1993) was modified and used. The studied sample included 445 health care providers, 23.6% were physicians and 76.4% were nurses. Job dissatisfaction was highly encountered where 67.1% of the nurses & 52.4% of physicians were dissatisfied. Professional opportunities, patient care and financial reward were the most frequently encountered domains with which physicians were dissatisfied. The dissatisfying domains for majority of nurses were professional opportunities, workload and appreciation reward. Exploring the relation between demographic and job characteristics with job satisfaction revealed that older, male, non-Saudi, specialists physicians had insignificantly higher mean score of job satisfaction than their counterparts. While older, female, non-Saudi, senior nurses had significantly higher mean score than their counterparts. It is highly recommended to reduce workload for nurses and provision of better opportunities promotional for PHC physicians and nurses.

  15. Assessment of primary health care in a rural health centre in Enugu South east Nigeria.

    Science.gov (United States)

    M Chinawa, Josephat; T Chinawa, Awoere

    2015-01-01

    Primary health care (PHC) is a vital in any community. Any health centre with a well implemented PHC program can stand the test of time in curbing under five mortality and morbidity. This study was therefore aimed at assessing the activities in a health centre located in a rural area in Enugu state and to determine the pattern and presentation of various diseases in the health centre. This is retrospective study undertaken in a primary health care centre in Abakpa Nike in Enugu east LGA of Enugu State of Nigeria from December 2011 to December 31(st) 2013. Data retrieved were collected with the aid of a structured study proforma and analyzed using SPSS Version 18. Total number of children that attended immunization program in the health centre over 20 months period was 25,438 (12,348 males and 13090 females), however only 17745 children (7998 males and 9747 females) were actually registered in the hospital records. None of the children was immunized for DPT2 and OPV(0) and HBV(1) in the course of this study. The dropout rate using DPT1, 2 and 3 (DPT1-DPT2/DPT3) was very high (494%). The mean immunization coverage rate was 8.3%. Family planning activities, integrated management of childhood illnesses program were also carried out in the health centre but at very low level. The major fulcrum of events in the health centre which include immunization coverage, IMCI, and management of common illnesses were simply non operational. However the health centre had a well knitted referral system.

  16. Chilean midwives and midwifery students' views of women's midlife health-care needs.

    Science.gov (United States)

    Binfa, Lorena; Pantoja, Loreto; Gonzalez, Hilda; Ransjö-Arvidson, Anna-Berit; Robertson, Eva

    2011-08-01

    to determine Chilean midwives' views with regard to Chilean women's health-care needs in midlife. The aim was also to explore Chilean midwifery students' views on the clinical care provided to women in midlife. a qualitative study using focus group discussions and narratives which were analysed using thematic manifest and latent content analysis. 10 different primary health care (PHC) centres in Santiago, Chile. 22 midwives, working in PHC clinics and 13 (n = 13) midwifery students with PHC clinical experience, attending their fourth or fifth year of midwifery education at the School of Midwifery in Santiago. the midwives felt that women in midlife have special health-care service needs. They also considered themselves to be the most appropriate health staff to provide health care for women in midlife, but recognised that they lacked competence in attending psychological and social health-care needs of women in midlife such as violence, abuse and sexuality issues. The midwifery students remarked that many midwives focused their attention on fulfilling the biomedical requirements. Even if the midwives had knowledge about recent research on menopause, they had difficulties in approaching this issue and including it in their counselling. Some students also questioned the sometimes disrespectful attitude shown, especially towards Peruvian immigrants and women with psychosocial problems. the findings suggest that midwives need more education about women's health-care needs in midlife, and that more focus should be placed on the psychosocial aspects of midwifery. More reflections about the quality of the client-provider relationship in clinical practice are needed. Gender issues, the structure of power relationships, and empowerment should be incorporated and critically discussed during midwifery education and training, and also in clinics. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. Health-related quality of life deficits associated with varying degrees of disease severity in type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Majumdar Sumit R

    2003-12-01

    Full Text Available Abstract Background Diabetes is a chronic medical condition accompanied by a considerable health-related quality of life (HRQL burden. The purpose of this analysis was to use generic measures of HRQL to describe HRQL deficits associated with varying degrees of severity of type 2 diabetes. Methods The RAND-12 physical and mental health composites (PHC and MHC, respectively and Health Utilities Index Mark 3 (HUI3 were self-completed by 372 subjects enrolled in a prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities. Analysis of covariance was used to assess differences in HRQL according to disease severity and control of blood glucose. Disease severity was defined in terms of treatment intensity, emergency room visits and absenteeism from work specifically attributable to diabetes. To control for potential confounding, the analysis was adjusted for important sociodemographic and clinical characteristics. Results The PHC and MHC were significantly lower for individuals treated with insulin as compared to diet alone (PHC: 41.01 vs 45.11, MHC: 43.23 vs 47.00, p Conclusions We concluded that generic measures of HRQL captured deficits associated with more severe disease in type 2 diabetes.

  18. Effect of education of primary health care workers on HIV-related oral lesions in Nairobi East district

    Directory of Open Access Journals (Sweden)

    Lucina N. Koyio

    2012-04-01

    Full Text Available Background. An estimated 90% of HIV-infected people are likely to develop oral lesions in the course of HIV infection. Oro-pharyngeal candidiasis (OPC, an early marker for HIV-infection, can be diagnosed during an oral examination (OE. Primary healthcare (PHC providers in Kenya are neither trained nor sufficiently equipped to perform this simple, cheap and non-invasive examination. The PHC system in Kenya offers an opportunity to integrate early recognition and management of oral lesions into general health care. This study aims to estimate the effect of a multifaceted intervention for PHC providers in training them to perform an OE. Specifically, our primary objective is to establish whether the intervention is effective in increasing: i the frequency of early detection of HIV-related oral lesions; and ii referral rates for HIV-testing. Design and methods. The study has been designed in two parts: a retrospective clinical data record study and a prospective cohort study with pre-post control group design, carried out in 2 administrative divisions in Nairobi East district. The intervention group will receive one day of training on recognition of HIV-related oral lesions and other common oral conditions. Reminder sessions will be held at individual health facilities. Routine tally sheets will be used to record all patients with HIV-related oral lesions, dental caries and periodontal disease. A convenience sample of all the PHC in a division will be used. It will not be possible to blind investigators or assessors. Expected impact of the study for Public Health. Early recognition and treatment of HIV infection influences long-term survival rates and will reduce healthcare expenditure.

  19. Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa

    Directory of Open Access Journals (Sweden)

    Maphuthego D. Mathibe

    2015-10-01

    Full Text Available Background: Primary Health Care (PHC clinicians and patients are major role players in the South African antiretroviral treatment programme. Understanding their perceptions and experiences of integrated care and the management of people living with HIV and AIDS in PHC facilities is necessary for successful implementation and sustainability of integration. Objective: This study explored clinician perceptions and patient experiences of integration of antiretroviral treatment in PHC clinics. Method: An exploratory, qualitative study was conducted in four city of Tshwane PHC facilities. Two urban and two rural facilities following different models of integration were included. A self-administered questionnaire with open-ended items was completed by 35 clinicians and four focus group interviews were conducted with HIV-positive patients. The data were coded and categories were grouped into sub-themes and themes. Results: Workload, staff development and support for integration affected clinicians’ performance and viewpoints. They perceived promotion of privacy, reduced discrimination and increased access to comprehensive care as benefits of service integration. Delays, poor patient care and patient dissatisfaction were viewed as negative aspects of integration. In three facilities patients were satisfied with integration or semi-integration and felt common queues prevented stigma and discrimination, whilst the reverse was true in the facility with separate services. Single-month issuance of antiretroviral drugs and clinic schedule organisation was viewed negatively, as well as poor staff attitudes, poor communication and long waiting times. Conclusion: Although a fully integrated service model is preferable, aspects that need further attention are management support from health authorities for health facilities, improved working conditions and appropriate staff development opportunities.

  20. Health promotion services for patients having non-comminicable diseases: Feedback from patients and health care providers in Cape Town, South Africa

    Directory of Open Access Journals (Sweden)

    Parker Whadi-ah

    2012-07-01

    Full Text Available Abstract Background Due to a paucity of data regarding the availability and efficacy of equipment, health promotion methods and materials currently used by health professionals for the management of patients with non-communicable diseases (NCDs at primary health care (PHC facilities in Cape Town, an audit was undertaken. Methods A multi-centre cross-sectional study was undertaken to interview patients (n = 580 with NCDs at 30 PHC facilities. A questionnaire was used to obtain information on preferences for health promotion methods for lifestyle modification. Individual semi-structured interviews were conducted with selected health professionals (n = 14 and captured using a digital recorder. Data were transferred to the Atlas ti software programme and analysed using a thematic content analysis approach. Results Blood pressure measurement (97.6% was the most common diagnostic test used, followed by weight measurement (88.3%, urine (85.7% and blood glucose testing (80.9%. Individual lifestyle modification counselling was the preferred health education method of choice for the majority of patients. Of the 64% of patients that selected chronic clubs/support groups as a method of choice, only a third rated this as their first choice. Pamphlets, posters and workshops/group counselling sessions were the least preferred methods with only 9%, 13% and 11% of patients choosing these as their first choice, respectively. In an individual counselling setting 44.7% of patients reported that they would prefer to be counselled by a doctor, followed by a nurse (16.9%, health educator (8.8% and nutrition advisor (4.8%. Health professionals identified numerous barriers to education and counselling. These can be summarised as a lack of resources, including time, space and equipment; staff-related barriers such as staff shortage and staff turnover; and patient-related barriers such as patient load and patient non-compliance. Conclusion The majority of patients

  1. Violence against health workers in Family Medicine Centers

    OpenAIRE

    Al-Turki, Nouf; Afify, Ayman AM; AlAteeq, Mohammed

    2016-01-01

    Nouf Al-Turki,1 Ayman AM Afify,1 Mohammed AlAteeq2 1Family Medicine Department, Prince Sultan Military Medical City, 2Department of Family Medicine and PHC, King Abdul-Aziz Medical City, National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia Background: Health care violence is a significant worldwide problem with negative consequences on both the safety and well-being of health care workers as well as workplace activities. Reports examining health care violence in Saudi Arabia are lim...

  2. Reconsidering the popularity of primary health centers in India: a case study from rural Maharashtra.

    Science.gov (United States)

    Kamat, V R

    1995-07-01

    Most evaluations of India's primary health care (PHC) program have been critical of the ways government primary health centers have been functioning. It has been commonly noted that utilization of health services is poor and community participation in the PHC outreach program low. Additionally, medical officers and health center staff are often accused of being negligent in their duties. In this paper I argue that it is worthwhile examining how a popular primary health center functions in a context marked by a growing demand for Western medicines. Attention is drawn to the ingenious ways in which health personnel respond to client demands and government medicine shortages. The case of a popular primary health center in rural Maharashtra is presented. This health center is both the site of public and private health care. Discussed is the manner in which rural populations in India maximize available health care options given time, cash and transportation constraints. Current thinking about community health financing is considered in light of existing health care utilization patterns, community evaluation of free services, perceptions of entitlement and the likely response of practitioners to such schemes.

  3. GIS-based accessibility analysis- a mixed method approach to determine public primary health care demand in South Africa

    CSIR Research Space (South Africa)

    Mokgalaka, H

    2013-11-01

    Full Text Available The spatial realities and dynamics of a changing population with changing health care needs require regular and logical methods to evaluate and assist in primary health care (PHC) planning. Geographical access is an important aspect in the planning...

  4. Staff perceptions of addressing lifestyle in primary health care: a qualitative evaluation 2 years after the introduction of a lifestyle intervention tool

    Directory of Open Access Journals (Sweden)

    Carlfjord Siw

    2012-10-01

    Full Text Available Abstract Background Preventive services and health promotion in terms of lifestyle counselling provided through primary health care (PHC has the potential to reduce morbidity and mortality in the population. Health professionals in general are positive about and willing to develop a health-promoting and/or preventive role. A number of obstacles hindering PHC staff from addressing lifestyle issues have been identified, and one facilitator is the use of modern technology. When a computer-based tool for lifestyle intervention (CLT was introduced at a number of PHC units in Sweden, this provided an opportunity to study staff perspectives on the subject. The aim of this study was to explore PHC staff’s perceptions of handling lifestyle issues, including the consultation situation as well as the perceived usefulness of the CLT. Methods A qualitative study was conducted after the CLT had been in operation for 2 years. Six focus group interviews, one at each participating unit, including a total of 30 staff members with different professions participated. The interviews were designed to capture perceptions of addressing lifestyle issues, and of using the CLT. Interview data were analysed using manifest content analysis. Results Two main themes emerged from the interviews: a challenging task and confidence in handling lifestyle issues. The first theme covered the categories responsibilities and emotions, and the second theme covered the categories first contact, existing tools, and role of the CLT. Staff at the units showed commitment to health promotion/prevention, and saw that patients, caregivers, managers and politicians all have responsibilities regarding the issue. They expressed confidence in handling lifestyle-related conditions, but to a lesser extent had routines for general screening of lifestyle habits, and found addressing alcohol the most problematic issue. The CLT, intended to facilitate screening, was viewed as a complement, but was not

  5. Health and Academic Achievement: Cumulative Effects of Health Assets on Standardized Test Scores Among Urban Youth in the United States*

    Science.gov (United States)

    Ickovics, Jeannette R.; Carroll-Scott, Amy; Peters, Susan M.; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

    2014-01-01

    Background The Institute of Medicine (2012) concluded that we must “strengthen schools as the heart of health.” To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement, and (2) examine cumulative effects of these assets on academic achievement. Methods Participants include 940 students (grades 5 and 6) from 12 schools randomly selected from an urban district. Data include physical assessments, fitness testing, surveys, and district records. Fourteen health indicators were gathered including physical health (eg, body mass index [BMI]), health behaviors (eg, meeting recommendations for fruit/vegetable consumption), family environment (eg, family meals), and psychological well-being (eg, sleep quality). Data were collected 3-6 months prior to standardized testing. Results On average, students reported 7.1 health assets out of 14. Those with more health assets were more likely to be at goal for standardized tests (reading/writing/mathematics), and students with the most health assets were 2.2 times more likely to achieve goal compared with students with the fewest health assets (both p student health may also improve academic achievement, closing equity gaps in both health and academic achievement. PMID:24320151

  6. Safe Injection Practices in Primary Health Care Settings of Naxalbari Block, Darjeeling District, West Bengal.

    Science.gov (United States)

    Chaudhuri, Sudip Banik; Ray, Kuntala

    2016-01-01

    Unsafe injection can transmit many diseases to patients, injection providers and healthy people of community. To find out critical steps whether executed according to recommended best practice methods, availability of equipments in health facilities for safe injection practices and some important steps of waste disposal methods. This facility-based cross-sectional observational study was conducted among 30 Auxiliary nurse midwives (ANM) & 27 nursing staffs (NS) to assess certain aspects of their practice while administrating injection and disposal of the disposables. Health facilities were also observed to asses necessary equipments of safe injection and waste disposal methods. Among the health workers 93.3% ANM and 100% NS took sterile syringe from sterile unopened packet, all of the study subjects washed hand before giving injection, 13.3% of ANMs and 8% of NS are fully vaccinated against Hep B, 53.3% of ANM and all NS are practices non recapping. Only 13.33% sub centres along with PHC & BPHC had at least one puncture resistant leak proof container, 86.7% sub centres, PHC are free from loose needles. Transport for off side treatment is the method of waste disposal in case of 73.3% cases sub centres, PHC & BPHC. There is need to educate, train and motivate service providers in proper methods of giving injection along with improve the adequacy of supply of required equipments.

  7. Quality of care offered to children attending primary health care ...

    African Journals Online (AJOL)

    Caregivers experienced long waiting times (mean 135 (standard deviation 72) minutes). Many routine examination ... health needs meaningfully. A deliberate and radical restructuring of PHC for children, with clearly defined and monitored standard clinical practice routines and norms, is required to change the status quo.

  8. Self-perception of leadership styles and behaviour in primary health care.

    Science.gov (United States)

    Jodar I Solà, Glòria; Gené I Badia, Joan; Hito, Pilar Delgado; Osaba, M Antonia Campo; Del Val García, Jose Luís

    2016-10-12

    The concept of leadership has been studied in various disciplines and from different theoretical approaches. It is a dynamic concept that evolves over time. There are few studies in our field on managers' self-perception of their leadership style. There are no pure styles, but one or another style is generally favoured to a greater or lesser degree. In the primary health care (PHC) setting, managers' leadership style is defined as a set of attitudes, behaviours, beliefs and values. The objectives of this study were to describe and learn about the self-perception of behaviours and leadership styles among PHC managers; to determine the influence of the leadership style on job satisfaction, efficiency, and willingness to work in a team; and to determine the relationship between transformational and transactional styles according age, gender, profession, type of manager years of management experience, and the type of organization. To describe leadership styles as perceived by PHC managers, a cross sectional study was performed using an 82 items-self-administered Multifactor Leadership Questionnaire (MLQ). This questionnaire measures leadership styles, attitudes and behaviour of managers. The items are grouped into three first order variables (transformational, transactional and laissez-faire) and ten second order variables (which discriminate leader behaviours). Additionally, the questionnaire evaluates organizational consequences such as extra-effort, efficiency and satisfaction. One hundred forty responses from 258 managers of 133 PHC teams in the Barcelona Health Area (response rate: 54.26 %). Most participants were nurses (61.4 %), average age was 49 years and the gender predominantly female (75 %). Globally, managers assessed themselves as equally transactional and transformational leaders (average: 3.30 points). Grouped by profession, nurses (28.57 % of participants) showed a higher transactional leadership style, over transformational leadership style

  9. Integrating an infectious disease programme into the primary health care service: a retrospective analysis of Chagas disease community-based surveillance in Honduras.

    Science.gov (United States)

    Hashimoto, Ken; Zúniga, Concepción; Nakamura, Jiro; Hanada, Kyo

    2015-03-24

    Integration of disease-specific programmes into the primary health care (PHC) service has been attempted mostly in clinically oriented disease control such as HIV/AIDS and tuberculosis but rarely in vector control. Chagas disease is controlled principally by interventions against the triatomine vector. In Honduras, after successful reduction of household infestation by vertical approach, the Ministry of Health implemented community-based vector surveillance at the PHC services (health centres) to prevent the resurgence of infection. This paper retrospectively analyses the effects and process of integrating a Chagas disease vector surveillance system into health centres. We evaluated the effects of integration at six pilot sites in western Honduras during 2008-2011 on; surveillance performance; knowledge, attitude and practice in schoolchildren; reports of triatomine bug infestation and institutional response; and seroprevalence among children under 15 years of age. The process of integration of the surveillance system was analysed using the PRECEDE-PROCEED model for health programme planning. The model was employed to systematically determine influential and interactive factors which facilitated the integration process at different levels of the Ministry of Health and the community. Overall surveillance performance improved from 46 to 84 on a 100 point-scale. Schoolchildren's attitude (risk awareness) score significantly increased from 77 to 83 points. Seroprevalence declined from 3.4% to 0.4%. Health centres responded to the community bug reports by insecticide spraying. As key factors, the health centres had potential management capacity and influence over the inhabitants' behaviours and living environment directly and through community health volunteers. The National Chagas Programme played an essential role in facilitating changes with adequate distribution of responsibilities, participatory modelling, training and, evaluation and advocacy. We found that Chagas

  10. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa.

    Science.gov (United States)

    Sokhela, Dudu G; Makhanya, Nonhlanhla J; Sibiya, Nokuthula M; Nokes, Kathleen M

    2013-07-05

    Comprehensive Primary Health Care (PHC), based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients' experiences led to satisfaction or dissatisfaction with the Fast Queue service. A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources. Effective health communication strategies contribute to positive

  11. Experiences of Fast Queue health care users in primary health care facilities in eThekwini district, South Africa

    Directory of Open Access Journals (Sweden)

    Dudu G. Sokhela

    2013-07-01

    Full Text Available Background: Comprehensive Primary Health Care (PHC, based on the principles of accessibility, availability, affordability, equity and acceptability, was introduced in South Africa to address inequalities in health service provision. Whilst the Fast Queue was instrumental in the promotion of access to health care, a major goal of the PHC approach, facilities were not prepared for the sudden influx of clients. Increased access resulted in long waiting times and queues contributing to dissatisfaction with the service which could lead to missed appointments and non-compliance with established treatment plans. Objectives: Firstly to describe the experiences of clients using the Fast Queue strategy to access routine healthcare services and secondly, to determine how the clients’ experiences led to satisfaction or dissatisfaction with the Fast Queue service. Method: A descriptive qualitative survey using content analysis explored the experiences of the Fast Queue users in a PHC setting. Setting was first identified based on greatest number using the Fast Queue and geographic diversity and then a convenience sample of health care users of the Fast Queue were sampled individually along with one focus group of users who accessed the Queue monthly for medication refills. The same interview guide questions were used for both individual interviews and the one focus group discussion. Five clinics with the highest number of attendees during a three month period and a total of 83 health care users of the Fast Queue were interviewed. The average participant was female, 31 years old, single and unemployed. Results: Two themes with sub-themes emerged: health care user flow and communication, which highlights both satisfaction and dissatisfaction with the fast queue and queue marshals, could assist in directing users to the respective queues, reduce waiting time and keep users satisfied with the use of sign posts where there is a lack of human resources

  12. The Bangladesh paradox: exceptional health achievement despite economic poverty.

    Science.gov (United States)

    Chowdhury, A Mushtaque R; Bhuiya, Abbas; Chowdhury, Mahbub Elahi; Rasheed, Sabrina; Hussain, Zakir; Chen, Lincoln C

    2013-11-23

    Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternity-related services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health--ie, positives such as women's empowerment, widespread education, and mitigation of the effect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh offers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints. Copyright © 2013 Elsevier Ltd. All rights reserved.

  13. Using social determinants of health to link health workforce diversity, care quality and access, and health disparities to achieve health equity in nursing.

    Science.gov (United States)

    Williams, Shanita D; Hansen, Kristen; Smithey, Marian; Burnley, Josepha; Koplitz, Michelle; Koyama, Kirk; Young, Janice; Bakos, Alexis

    2014-01-01

    It is widely accepted that diversifying the nation's health-care workforce is a necessary strategy to increase access to quality health care for all populations, reduce health disparities, and achieve health equity. In this article, we present a conceptual model that utilizes the social determinants of health framework to link nursing workforce diversity and care quality and access to two critical population health indicators-health disparities and health equity. Our proposed model suggests that a diverse nursing workforce can provide increased access to quality health care and health resources for all populations, and is a necessary precursor to reduce health disparities and achieve health equity. With this conceptual model as a foundation, we aim to stimulate the conceptual and analytical work-both within and outside the nursing field-that is necessary to answer these important but largely unanswered questions.

  14. Achieving universal health coverage in small island states: could importing health services provide a solution?

    Science.gov (United States)

    Walls, Helen; Smith, Richard

    2018-01-01

    Background Universal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health services, rather than focus on domestic production. This paper provides empirical analysis of the potential impact of this option. Methods Analysis was based on publicly accessible data for 14 SIDS, covering health-related travel and health indicators for the period 2003–2013, together with in-depth review of medical travel schemes for the two highest importing SIDS—the Maldives and Tuvalu. Findings Medical travel from SIDS is accelerating. The SIDS studied generally lacked health infrastructure and technologies, and the majority of them had lower than the recommended number of physicians in a country, which limits their capacity for achieving UHC. Tuvalu and the Maldives were the highest importers of healthcare and notably have public schemes that facilitate medical travel and help lower the out-of-pocket expenditure on medical travel. Although different in approach, design and performance, the medical travel schemes in Tuvalu and the Maldives are both examples of measures used to increase access to health services that cannot feasibly be provided in SIDS. Interpretation Our findings suggest that importing health services (through schemes to facilitate medical travel) is a potential mechanism to help achieve universal healthcare for SIDS but requires due diligence over cost, equity and quality control. PMID:29527349

  15. The contracting round: achieving health gain or financial balance?

    Science.gov (United States)

    McCarthy, M

    1998-12-01

    In the 1991 National Health Service reforms, health authorities became responsible for the health of their resident population, and they contract for health services from NHS providers - trusts and primary care services. A case study in Camden and Islington, an inner London health district, during 1996-1997 shows that contracting was directed more towards achieving financial balance than health objectives. Reasons include the inflationary effect of competition within an internal market, the power of administrators in decision-making within the health authority, and lack of adequate financial accounting in the NHS to relate costs to health outcomes. The introduction of programme budgets for districts would provide more cost-effective use of the nation's resources.

  16. Building equitable health systems in Latin America | CRDI - Centre ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    One publication was “Notes for studying primary care within the context of segmented health systems” (article in Spanish with English abstract), which was published in 2010 in Revista de Salud Pública. The paper identifies trends and compares the implementation and performance of PHC in each Southern Cone country, ...

  17. Prospects for a genuine revival of primary health care--through the visible hand of social justice rather than the invisible hand of the market: Part II.

    Science.gov (United States)

    Katz, Alison Rosamund

    2010-01-01

    This second part of a two-part article explores the prospects for genuine revival of primary health care (PHC) as announced by the WHO in 2008, with reference, briefly, to Global Health Watch 2, published by the People's Health Movement, Medact, and Equity Gauge Alliance, and, in more depth, to the positions of social and people's movements most closely aligned with the original values and principles of Alma-Ata and the structural foundations of the PHC project. The author argues that the social justice struggle for health cannot be limited to curbing capitalism's excesses. The multiple crises of today--in energy, water, food, the environment, finance, science, information, and democracy--must be recognized as capitalist crises and addressed as such. Particular attention is given to ideology, including the distortion of human nature and society under neoliberal capitalism, and to moral foundations of Health for All. Not only must the invisible hand of the market be replaced by the visible hand of social justice, but the single ideology proclaiming the "end of history" and, by implication, the end of politics and political struggle must be exposed and rejected as neoliberal, totalitarian propaganda. In line with the spirit and intention of the U.N. Charter, PHC remains a political project for a fair and safe world in which Health for All is both possible and necessary.

  18. Achieving and Sustaining Universal Health Coverage: Fiscal Reform of the National Health Insurance in Taiwan.

    Science.gov (United States)

    Lan, Jesse Yu-Chen

    2017-12-01

    The paper discusses the expansion of the universal health coverage (UHC) in Taiwan through the establishment of National Health Insurance (NHI), and the fiscal crisis it caused. Two key questions are addressed: How did the NHI gradually achieve universal coverage, and yet cause Taiwanese health spending to escalate to fiscal crisis? What measures have been taken to reform the NHI finance and achieve moderate success to date? The main argument of this paper is that the Taiwanese Government did try to implement various reforms to save costs and had moderate success, but the path-dependent process of reform does not allow increasing contribution rates significantly and thereby makes sustainability challenging.

  19. Technical efficiency of rural primary health care system for diabetes treatment in Iran: a stochastic frontier analysis.

    Science.gov (United States)

    Qorbani, Mostafa; Farzadfar, Farshad; Majdzadeh, Reza; Mohammad, Kazem; Motevalian, Abbas

    2017-01-01

    Our aim was to explore the technical efficiency (TE) of the Iranian rural primary healthcare (PHC) system for diabetes treatment coverage rate using the stochastic frontier analysis (SFA) as well as to examine the strength and significance of the effect of human resources density on diabetes treatment. In the SFA model diabetes treatment coverage rate, as a output, is a function of health system inputs (Behvarz worker density, physician density, and rural health center density) and non-health system inputs (urbanization rate, median age of population, and wealth index) as a set of covariates. Data about the rate of self-reported diabetes treatment coverage was obtained from the Non-Communicable Disease Surveillance Survey, data about health system inputs were collected from the health census database and data about non-health system inputs were collected from the census data and household survey. In 2008, rate of diabetes treatment coverage was 67% (95% CI: 63%-71%) nationally, and at the provincial level it varied from 44% to 81%. The TE score at the national level was 87.84%, with considerable variation across provinces (from 59.65% to 98.28%).Among health system and non-health system inputs, only the Behvarz density (per 1000 population)was significantly associated with diabetes treatment coverage (β (95%CI): 0.50 (0.29-0.70), p  < 0.001). Our findings show that although the rural PHC system can considered efficient in diabetes treatment at the national level, a wide variation exists in TE at the provincial level. Because the only variable that is predictor of TE is the Behvarz density, the PHC system may extend the diabetes treatment coverage by using this group of health care workers.

  20. Assessment of the coordination of integrated health service delivery networks by the primary health care: COPAS questionnaire validation in the Brazilian context.

    Science.gov (United States)

    Rodrigues, Ludmila Barbosa Bandeira; Dos Santos, Claudia Benedita; Goyatá, Sueli Leiko Takamatsu; Popolin, Marcela Paschoal; Yamamura, Mellina; Deon, Keila Christiane; Lapão, Luis Miguel Veles; Santos Neto, Marcelino; Uchoa, Severina Alice da Costa; Arcêncio, Ricardo Alexandre

    2015-07-22

    Health systems organized as networks and coordinated by the Primary Health Care (PHC) may contribute to the improvement of clinical care, sanitary conditions, satisfaction of patients and reduction of local budget expenditures. The aim of this study was to adapt and validate a questionnaire - COPAS - to assess the coordination of Integrated Health Service Delivery Networks by the Primary Health Care. A cross sectional approach was used. The population was pooled from Family Health Strategy healthcare professionals, of the Alfenas region (Minas Gerais, Brazil). Data collection was performed from August to October 2013. The results were checked for the presence of floor and ceiling effects and the internal consistency measured through Cronbach alpha. Construct validity was verified through convergent and discriminant values following Multitrait-Multimethod (MTMM) analysis. Floor and ceiling effects were absent. The internal consistency of the instrument was satisfactory; as was the convergent validity, with a few correlations lower then 0.30. The discriminant validity values of the majority of items, with respect to their own dimension, were found to be higher or significantly higher than their correlations with the dimensions to which they did not belong. The results showed that the COPAS instrument has satisfactory initial psychometric properties and may be used by healthcare managers and workers to assess the PHC coordination performance within the Integrated Health Service Delivery Network.

  1. An Assessment of the Potentials for Retention of Primary Health ...

    African Journals Online (AJOL)

    This work is distributed under the terms of the Creative Commons Attribution ... health personnel especially at the PHC level is an ... burnout. Also, a study amongst registered nurses in a nursing home in the USA suggested that ..... performance eliminating stagnation from career ... like Nigeria, stress and burnout is high;.

  2. Health transformation plan: Goals achievement in Nemazee hospital

    Directory of Open Access Journals (Sweden)

    Ali Akbar Ahmadi

    2016-01-01

    Full Text Available Introduction: The main purpose of this study was to assess fulfillment of goals about “Health Transformation Plan (HTP of Ministry of Health, Treatment and Medical Education” from the perspective of managers, which is as one of the most important management challenges in the Health System Reform Plan. These goals included six packages determined by the Ministry of Health, Treatment and Medical Education, the fulfillment of each of which one was evaluated separately as sub-goals in the current study. Finally, the rank of each package in comparison to other packages was determined and presented, using means rank test (Friedman test. Method: This study was conducted using a questionnaire in which comments of the senior and middle managers of Nemazee hospital were collected as the research data. Due to the fact that about one year has passed since the beginning of implementation of HTP and since there were no documented methods or questionnaires, the researcher designed a self-made questionnaire. The basis of designing the questionnaire was the set of guidelines developed for Health System Reform Plan. These guidelines include goals that a hospital should achieve during implementation of Health System Reform Plan. After sharing these goals with senior and middle managers of Nemazee hospital (as the place of research, they were converted to a questionnaire including 20 questions. The questionnaire included the goals that must be achieved in Nemazee hospital of Shiraz during the implementation of the plan. After designing the questionnaire, a preliminary test was taken to assess the reliability. Results: Cronbach’s alpha coefficient (0.88 showed a high rate of reliability in the above questionnaire. After the final data collection, the questionnaire was tested in a sample of 100 senior and middle managers; the results showed that about six packages were specified by the Ministry of Health, Treatment and Medical Education. The majority of

  3. The roles of veterinary, medical and environmental professionals to achieve ONE HEALTH

    Directory of Open Access Journals (Sweden)

    Mahendra Pal

    2014-12-01

    Full Text Available According to the WHO- “Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity”. The good health is the fundamental right of all the people on earth. The concept of ‘One Medicine’ coined by Calvin W. Schwabe evolves towards ’One Health’ which comprises collaborative efforts of multiple disciplines to achieve perfect health of people, animals, and our environment. ‘One Health’ deals with the challenges at the intersection of animal, human and environment health including the infectious diseases, the global food crises, and climate change due to global warming. The cordial and active association of various disciplines such as medicine, veterinary, public health, environment, wildlife, ecology, and food hygiene is highly emphasized in order to achieve the goal of ‘One Health’. This mini-review describes brief history of ‘one health’, the roles of veterinary, medical and environmental professionals, and developing collaboration with various concern professionals to achieve ‘one health’. In addition, the selected achievements of ‘one health’ in the past 10 years have been described along with the challenges ahead for the successful implementation of such concept.

  4. Can biosimilars help achieve the goals of US health care reform?

    Science.gov (United States)

    Boccia, Ralph; Jacobs, Ira; Popovian, Robert; de Lima Lopes, Gilberto

    2017-01-01

    The US Patient Protection and Affordable Care Act (ACA) aims to expand health care coverage, contain costs, and improve health care quality. Accessibility and affordability of innovative biopharmaceuticals are important to the success of the ACA. As it is substantially more difficult to manufacture them compared with small-molecule drugs, many of which have generic alternatives, biologics may increase drug costs. However, biologics offer demonstrated improvements in patient care that can reduce expensive interventions, thus lowering net health care costs. Biosimilars, which are highly similar to their reference biologics, cost less than the originators, potentially increasing access through reduced prescription drug costs while providing equivalent therapeutic results. This review evaluates 1) the progress made toward enacting health care reform since the passage of the ACA and 2) the role of biosimilars, including the potential impact of expanded biosimilar use on access, health care costs, patient management, and outcomes. Barriers to biosimilar adoption in the USA are noted, including low awareness and financial disincentives relating to reimbursement. The evaluated evidence suggests that the ACA has partly achieved some of its aims; however, the opportunity remains to transform health care to fully achieve reform. Although the future is uncertain, increased use of biosimilars in the US health care system could help achieve expanded access, control costs, and improve the quality of care.

  5. Provision of antiretroviral therapy for children in Nelson Mandela Bay: Health care professionals’ challenges

    Directory of Open Access Journals (Sweden)

    Margaret Williams

    2018-03-01

    Conclusion: Capacitation of the health care system, integration of services, competent management and visionary leadership to invoke a collaborative interdisciplinary team approach is required to ensure that HIV is treated as a chronic disease at the PHC clinic level.

  6. Health care waste management in community-based care: experiences of community health workers in low resource communities in South Africa

    Directory of Open Access Journals (Sweden)

    Lydia Hangulu

    2017-05-01

    Full Text Available Abstract Background In South Africa, community health workers (CHWs working in community-based care (CBC programmes provide care to patients most of whom are living with HIV/AIDS and tuberculosis (TB. Although studies have shown that the caregiving activities provided by the CHWs generate health care waste (HCW, there is limited information about the experiences of CHWs on health care waste management (HCWM in CBC. This study explored HCWM in CBC in Durban, South Africa from the perspectives CHWs. Methods We used three ethnographic approaches to collect data: focus group discussions, participant observations and informal discussions. Data was collected from 85 CHWs working in 29 communities in the Durban metropolis, South Africa. Data collection took place from July 2013 to August 2014. Results CHWs provided nursing care activities to patients many of whom were incontinent or bedridden. Some the patients were living with HIV/AIDS/TB, stroke, diabetes, asthma, arthritis and high blood pressure. These caregiving activities generate sharps and infectious waste but CHWs and family members did not segregate HCW according to the risk posed as stipulated by the HCWM policy. In addition, HCW was left with domestic waste. Major barriers to proper HCWM identified by CHWs include, lack of assistance from family members in assisting patients to use the toilet or change diapers and removing HCW from homes, irregular waste collection by waste collectors, inadequate water for practicing hygiene and sanitation, long distance between the house and the toilets and poor conditions of communal toilets and pit latrines. As a result of these barriers, HCW was illegally dumped along roads or in the bush, burnt openly and buried within the yards. Liquid HCW such as vomit, urine and sputum were disposed in open spaces near the homes. Conclusion Current policies on primary health care (PHC and HCWM in South Africa have not paid attention to HCWM. Findings suggest the

  7. Integrated HIV-Care Into Primary Health Care Clinics and the Influence on Diabetes and Hypertension Care: An Interrupted Time Series Analysis in Free State, South Africa Over 4 Years.

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    Rawat, Angeli; Uebel, Kerry; Moore, David; Yassi, Annalee

    2018-04-15

    Noncommunicable diseases (NCDs), specifically diabetes and hypertension, are rising in high HIV-burdened countries such as South Africa. How integrated HIV care into primary health care (PHC) influences NCD care is unknown. We aimed to understand whether differences existed in NCD care (pre- versus post-integration) and how changes may relate to HIV patient numbers. Public sector PHC clinics in Free State, South Africa. Using a quasiexperimental design, we analyzed monthly administrative data on 4 indicators for diabetes and hypertension (clinic and population levels) during 4 years as HIV integration was implemented in PHC. Data represented 131 PHC clinics with a catchment population of 1.5 million. We used interrupted time series analysis at ±18 and ±30 months from HIV integration in each clinic to identify changes in trends postintegration compared with those in preintegration. We used linear mixed-effect models to study relationships between HIV and NCD indicators. Patients receiving antiretroviral therapy in the 131 PHC clinics studied increased from 1614 (April 2009) to 57, 958 (April 2013). Trends in new diabetes patients on treatment remained unchanged. However, population-level new hypertensives on treatment decreased at ±30 months from integration by 6/100, 000 (SE = 3, P < 0.02) and was associated with the number of new patients with HIV on treatment at the clinics. Our findings suggest that during the implementation of integrated HIV care into PHC clinics, care for hypertensive patients could be compromised. Further research is needed to understand determinants of NCD care in South Africa and other high HIV-burdened settings to ensure patient-centered PHC.

  8. Applying knowledge translation tools to inform policy: the case of mental health in Lebanon.

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    Yehia, Farah; El Jardali, Fadi

    2015-06-06

    Many reform efforts in health systems fall short because the use of research evidence to inform policy remains scarce. In Lebanon, one in four adults suffers from a mental illness, yet access to mental healthcare services in primary healthcare (PHC) settings is limited. Using an "integrated" knowledge framework to link research to action, this study examines the process of influencing the mental health agenda in Lebanon through the application of Knowledge Translation (KT) tools and the use of a KT Platform (KTP) as an intermediary between researchers and policymakers. This study employed the following KT tools: 1) development of a policy brief to address the lack of access to mental health services in PHC centres, 2) semi-structured interviews with 10 policymakers and key informants, 3) convening of a national policy dialogue, 4) evaluation of the policy brief and dialogue, and 5) a post-dialogue survey. Findings from the key informant interviews and a comprehensive synthesis of evidence were used to develop a policy brief which defined the problem and presented three elements of a policy approach to address it. This policy brief was circulated to 24 participants prior to the dialogue to inform the discussion. The policy dialogue validated the evidence synthesized in the brief, whereby integrating mental health into PHC services was the element most supported by evidence as well as participants. The post-dialogue survey showed that, in the following 6 months, several implementation steps were taken by stakeholders, including establishing national taskforce, training PHC staff, and updating the national essential drug list to include psychiatric medications. Relationships among policymakers, researchers, and stakeholders were strengthened as they conducted their own workshops and meetings after the dialogue to further discuss implementation, and their awareness about and demand for KT tools increased. This case study showed that the use of KT tools in Lebanon to

  9. Social determinants of health, inequality and social inclusion among people with disabilities.

    Science.gov (United States)

    Fiorati, Regina Celia; Elui, Valeria Meirelles Carril

    2015-01-01

    to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life. qualitative study with data collected through open interviews concerning the participants' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas' Theory of Communicative Action. the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation. there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion.

  10. Inclusion of the equity focus and social determinants of health in health care education programmes in Colombia: a qualitative approach.

    Science.gov (United States)

    Hernández-Rincón, Erwin H; Pimentel-González, Juan P; Orozco-Beltrán, Domingo; Carratalá-Munuera, Concepción

    2016-06-01

    The Pan American Health Organization (PAHO) and the Colombian Ministry of Health and Social Protection have determined a need for an approach to include Equity Focus (EF) and Social Determinants of Health (SDH) in health training programmes in Colombia. We studied the incorporation of EF and SDH in the curricula of several universities in Colombia to identify opportunities to strengthen their inclusion. Qualitative methodology was performed in two stages: (i) initial exploration (self-administered questionnaires and review of curricula) and (ii) validation of the information (semi-structured interviews). The inclusion of the EF and SDH in university curricula is regarded as an opportunity to address social problems. This approach addresses a broad cross-section of the curriculum, especially in the subjects of public health and Primary Health Care (PHC), where community outreach generates greater internalization by students. The dominance of the biomedical model of study plans and practice scenarios focusing on disease and little emphasis on community outreach are factors that limit the inclusion of the approach. The inclusion of EF and SDH in university curricula in Colombia has primarily focused on increasing the knowledge of various subjects oriented towards understanding the social dynamics or comprehensiveness of health and disease and, in some programmes, through practical courses in community health and PHC. Increased integration of EF and SDH in subjects or modules with clinical orientation is recommended. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  11. Role of GIS in social sector planning: can developing countries benefit from the examples of primary health care (PHC) planning in Britain?

    Science.gov (United States)

    Ishfaq, Mohammad; Lodhi, Bilal Khan

    2012-04-01

    Social sector planning requires rational approaches where community needs are identified by referring to relative deprivation among localities and resources are allocated to address inequalities. Geographical information system (GIS) has been widely argued and used as a base for rational planning for equal resource allocation in social sectors around the globe. Devolution of primary health care is global strategy that needs pains taking efforts to implement it. GIS is one of the most important tools used around the world in decentralization process of primary health care. This paper examines the scope of GIS in social sector planning by concentration on primary health care delivery system in Pakistan. The work is based on example of the UK's decentralization process and further evidence from US. This paper argues that to achieve benefits of well informed decision making to meet the communities' needs GIS is an essential tool to support social sector planning and can be used without any difficulty in any environment. There is increasing trend in the use of Health Management Information System (HMIS) in Pakistan with ample internet connectivity which provides well established infrastructure in Pakistan to implement GIS for health care, however there is need for change in attitude towards empowering localities especially with reference to decentralization of decision making. This paper provides GIS as a tool for primary health care planning in Pakistan as a starting point in defining localities and preparing locality profiles for need identification that could help developing countries in implementing the change.

  12. Universal health coverage and the health Sustainable Development Goal: achievements and challenges for Sri Lanka.

    Science.gov (United States)

    de Silva, Amala; Ranasinghe, Thushara; Abeykoon, Palitha

    2016-09-01

    With state-funded health care that is free at the point of delivery, a sound primary health-care policy and widespread health-care services, Sri Lanka seems a good example of universal health coverage. Yet, health transition and disparities in provision and financing threaten this situation. Sri Lanka did well on the Millennium Development Goal health indicators, but the Sustainable Development Goal (SDG) for health has a wider purview, which is to "ensure healthy lives and promote well-being for all at all ages". The gender gap in life expectancy and the gap between life expectancy and healthy life expectancy make achievement of the health SDG more challenging. Although women and children do well overall, the comparative health disadvantage for men in Sri Lanka is a cause for concern. From a financing perspective, high out-of-pocket expenditure and high utilization of the private sector, even by those in the lowest income quintile, are concerns, as is the emerging "third tier", where some individuals accessing state health care that is free at the point of delivery actually bear some of the costs of drugs, investigations and surgery. This cost sharing is resulting in catastrophic health expenditure for individuals, and delays in and non-compliance with treatment. These concerns about provision and financing must be addressed, as health transition will intensify the morbidity burden and loss of well-being, and could derail plans to achieve the health SDG.

  13. [Actively promote nutrition and health surveillance, achieve the national nutrition and health goals].

    Science.gov (United States)

    Ding, Gangqiang; Zhao, Wenhua; Chen, Junshi

    2016-03-01

    The results of Chinese Nutrition and Health Surveillance (2010-2012) showed that the anemia prevalence in China reduced significantly compared with 2002, and people's nutrition and health status have improved. Unbalanced diet still exist, such as low intake of vegetables and fruits, and high intake of salt. The serum total cholesterol level and the prevalence of hypercholesterolemia and borderline high cholesterolemia were high among urban adults, and more attention should be paid for high serum total cholesterol level among older adults. These results are significant to the development of nutrition and health intervention strategy, carry out nutrition intervention and the achievement of national nutrition and health goals.

  14. Market reforms and public incentives: finding a balance in the Republic of Macedonia.

    Science.gov (United States)

    Nordyke, Robert J; Peabody, John W

    2002-03-01

    The Republic of Macedonia is undertaking sweeping reforms of its health sector. Funded by a World Bank credit, the reforms seek to improve the efficiency and quality of primary health care (PHC) by significantly strengthening the role of the market in health care provision. On the supply-side, one of the key reform proposals is to implement a capitation payment system for PHC physicians. By placing individual physicians on productivity-based contracts, these reforms will effectively marketize all PHC provision. In addition, the Ministry of Health is considering the sale or concessions of public PHC clinics to private groups, indicating the government's commitment to marketization of health care provision. Macedonia is in a unique position to develop a new role for the private sector in PHC provision. The private provision of outpatient care was legalized soon after independence in 1991; private physicians now account for nearly 10% of all physicians and 22% of PHC physicians. If the reforms are fully realized, all PHC physicians-over 40% of all physicians-will be financially responsible for their clinical practices. This study draws on Macedonia's experience with limited development of private outpatient care starting in 1991 and the reform proposals for PHC, finding a network of policies and procedures throughout the health sector that negatively impact private and public sector provision. An assessment of the effects that this greater policy environment has on private sector provision identifies opportunities to strategically enhance the reforms. With respect to established market economies, the study finds justification for a greater role for government intervention in private health markets in transition economies. In addition to micro-level payment incentives and administrative controls, marketization in Central and Eastern Europe requires an examination of insurance contracting procedures, quality assurance practices, public clinic ownership, referral

  15. Effects of increased nurses' workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province.

    Science.gov (United States)

    Shihundla, Rhulani C; Lebese, Rachel T; Maputle, Maria S

    2016-05-13

    Recording of information on multiple documents increases professional nurses' responsibilities and workload during working hours. There are multiple registers and books at Primary Health Care (PHC) facilities in which a patient's information is to be recorded for different services during a visit to a health professional. Antenatal patients coming for the first visit must be recorded in the following documents: tick register; Prevention of Mother-ToChild Transmission (PMTCT) register; consent form for HIV and AIDS testing; HIV Counselling and Testing (HCT) register (if tested positive for HIV and AIDS then this must be recorded in the Antiretroviral Therapy (ART) wellness register); ART file with an accompanying single file, completion of which is time-consuming; tuberculosis (TB) suspects register; blood specimen register; maternity case record book and Basic Antenatal Care (BANC) checklist. Nurses forget to record information in some documents which leads to the omission of important data. Omitting information might lead to mismanagement of patients. Some of the documents have incomplete and inaccurate information. As PHC facilities in Vhembe District render twenty four hour services through a call system, the same nurses are expected to resume duty at 07:00 the following morning. They are expected to work effectively and when tired a nurse may record illegible information which may cause problems when the document is retrieved by the next person for continuity of care. The objective of this study was to investigate and describe the effects of increased nurses' workload on quality documentation of patient information at PHC facilities in Vhembe District, Limpopo Province. The study was conducted in Vhembe District, Limpopo Province, where the effects of increased nurses' workload on quality documentation of information is currently experienced. The research design was explorative, descriptive and contextual in nature. The population consisted of all nurses who

  16. Health and Academic Achievement: Cumulative Effects of Health Assets on Standardized Test Scores among Urban Youth in the United States

    Science.gov (United States)

    Ickovics, Jeannette R.; Carroll-Scott, Amy; Peters, Susan M.; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

    2014-01-01

    Background: The Institute of Medicine (2012) concluded that we must "strengthen schools as the heart of health." To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement,…

  17. KINERJA PUSKESMAS MENURUT PANDANGAN KONSUMEN

    Directory of Open Access Journals (Sweden)

    Evie Sopacua

    2012-11-01

    Full Text Available Performance of the Public Health Centre (PHC is still an issue that their services was not satisfying their consumers. This study analyzed the PHC's performance based on the consumer's view. This study was done in 8 PHC, 4 in East Java Province, 2 in West Java Province and the rest in East Nusa Tenggara Province which was choosen through purposif sampling. Study population were patients which come at the Health Centre and analysis unit is the PHC. Variable in this study are the dimension of the PHC's performance which include the services, provider attitudes and the PHC's condition. Data was collected using questionaires and secondary data. Data analysis was done using the quadrant of consumer's importance and expectation on the performance dimensions which are average value of  Y dan X. The result showed that based on consumer's view, the PHC performance that was not as they expected were services in ticket counter and policlinic, the provider's attitude which serve at the ticket counter and the nurse at the policlinic, also the condition of the waiting room. This dimension of performance need to be strenghthened because they are service quality factors and couldbe the mix marketing factors of the PHC. Therefor the study recommended that the mindset of PHC's personnels be directed to be an entrepreneur to serve in quality as expected by consumers. Key words: performance, public health center, consumer's view

  18. Social determinants of health, inequality and social inclusion among people with disabilities1

    Science.gov (United States)

    Fiorati, Regina Celia; Elui, Valeria Meirelles Carril

    2015-01-01

    OBJECTIVE: to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life. METHOD: qualitative study with data collected through open interviews concerning the participants' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas' Theory of Communicative Action. RESULTS: the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation. CONCLUSION: there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion. PMID:26039305

  19. Public Health Achievements and Challenges: Symposium of the University of Mostar Faculty of Health Studies.

    Science.gov (United States)

    Ravlija, Jelena; Vasilj, Ivan; Babic, Dragan; Marijanovic, Inga

    2017-05-01

    Public health is an important area of health care that reflects the readiness of the state and society to provide the welfare of all citizens through the promotion of health and the preservation of a healthy environment - factors that directly affect the health of the population. The field of public health is very broad and its concept is changing over time, being defined in a narrower and wider sense. In short, public health is a science and practice that aims at ensuring the conditions in which people can preserve and improve their health and prevent health damage. The third millennium brings its specifics, needs and priorities according to challenges public health is faced by in the twenty-first century: the economic crisis, rising inequality, population aging, rising rates of chronic diseases, migration, urbanization, ecosystem change, climate change, etc. The role of public health is to protect, improve health, prevent diseases and injuries. Such a public health approach implies a multisectoral work focusing on "wider health determinants", and within this activity experts from various medical and non-medical profiles, whose field of public health is concerned, can be found. The development of inter-departmental co-operation skills contributes to a better understanding of health professionals and professionals of other profiles, and facilitates common, synergistic actions in addressing public health problems in the community. Symposium on Public Health Achievements and Challenges organized by the University of Mostar Faculty of Health Studies is just another indication of the obligation, the need and the desire for professional and scientific contribution to the fight for better health. Our faculty has so far organized other numerous symposia, and the aim of this symposium is to present public health achievements and challenges in our surrounding in order to protect, improve health, prevent diseases and injuries in a modern way.

  20. Engaging Communities in Commodity Stock Monitoring Using Telecommunication Technology in Primary Health Care Facilities in Rural Nigeria

    Directory of Open Access Journals (Sweden)

    Ugo Okoli

    2015-10-01

    Full Text Available Background: With several efforts being made by key stakeholders to bridge the gap between beneficiaries and their having full access to free supplies, frequent stock-out, pilfering, collection of user fees for health commodities, and poor community engagement continue to plague the delivery of health services at the primary health care (PHC level in rural Nigeria. Objective: To assess the potential in the use of telecommunication technology as an effective way to engage members of the community in commodity stock monitoring, increase utilization of services, as well as promote accountability and community ownership. Methods: The pilot done in 8 PHCs from 4 locations within Nigeria utilized telecommunication technologies to exchange information on stock monitoring. A triangulated technique of data validation through cross verification from 3 subsets of respondents was used: 160 ward development committee (WDC members, 8 officers-in-charge (OICs of PHCs, and 383 beneficiaries (health facility users participated. Data collection made through a call center over a period of 3 months from July to September 2014 focused on WDC participation in inventory of commodities and type and cost of maternal, neonatal, and child health services accessed by each beneficiary. Results: Results showed that all WDCs involved in the pilot study became very active, and there was a strong cooperation between the OICs and the WDCs in monitoring commodity stock levels as the OICs participated in the monthly WDC meetings 96% of the time. A sharp decline in the collection of user fees was observed, and there was a 10% rise in overall access to free health care services by beneficiaries. Conclusion: This study reveals the effectiveness of mobile phones and indicates that telecommunication technologies can play an important role in engaging communities to monitor PHC stock levels as well as reduce the incidence of user fees collection and pilfering of commodities (PHC level in

  1. Patient satisfaction with quality of primary health care in Benghazi, Libya.

    Science.gov (United States)

    Salam, Asharaf Abdul; Alshekteria, Amina Abdulla; Abd Alhadi, Hana; Ahmed, Mariam; Mohammed, Anees

    2010-10-21

    The Libyan National Health System (LNHS) is debated for the paradox of its performance versus impact. It has poor performance, but the national health statistics are good and competitive. There are concerted efforts to manage health care services and to regain the lost trust. A primary health care (PHC) system that focuses on preventive and promotive care is the core focus of LNHS efforts. To assess patient satisfaction with quality of PHC assessed in terms of (a) customer profile, (b) patient satisfaction, and (c) health care-seeking behavior. A sample of nine health centers and seven polyclinics from various locations in Benghazi, Libya were selected for gathering information by structured face-to-face interviews. A total of 310 beneficiaries were interviewed by using an Arabic translation of the Charleston Psychiatric Outpatient Satisfaction Scale. The beneficiaries appear to be quite satisfied with the quality of services. Geographical zone, marital status of beneficiary, and type of facility are satisfaction-related factors. There are preferences for facilities located within the City Centre over those located elsewhere. There is also an interaction effect of the geographical zone and the type of facility in creating differences in satisfaction. A customer-friendly facility concept that emphasizes reception, physician interaction, and cordiality shall add value. Polyclinics require more attention as does the Al Slawy area. A few utility services might also be considered.

  2. How institutional forces, ideas and actors shaped population health planning in Australian regional primary health care organisations.

    Science.gov (United States)

    Javanparast, Sara; Freeman, Toby; Baum, Fran; Labonté, Ronald; Ziersch, Anna; Mackean, Tamara; Reed, Richard; Sanders, David

    2018-03-20

    Worldwide, there are competing norms driving health system changes and reorganisation. One such norm is that of health systems' responsibilities for population health as distinct from a focus on clinical services. In this paper we report on a case study of population health planning in Australian primary health care (PHC) organisations (Medicare Locals, 2011-2015). Drawing on institutional theory, we describe how institutional forces, ideas and actors shaped such planning. We reviewed the planning documents of the 61 Medicare Locals and rated population health activities in each Medicare Local. We also conducted an online survey and 50 interviews with Medicare Local senior staff, and an interview and focus group with Federal Department of Health staff. Despite policy emphasis on population health, Medicare Locals reported higher levels of effort and capacity in providing clinical services. Health promotion and social determinants of health activities were undertaken on an ad hoc basis. Regulatory conditions imposed by the federal government including funding priorities and time schedules, were the predominant forces constraining population health planning. In some Medicare Locals, this was in conflict with the normative values and what Medicare Locals felt ought to be done. The alignment between the governmental and the cultural-cognitive forces of a narrow biomedical approach privileged clinical practice and ascribed less legitimacy to action on social determinants of health. Our study also shed light on the range of PHC actors and how their agency influenced Medicare Locals' performance in population health. The presence of senior staff or community boards with a strong commitment to population health were important in directing action towards population health and equity. There are numerous institutional, normative and cultural factors influencing population health planning. The experience of Australian Medicare Locals highlights the difficulties of planning in

  3. Antenatal emotional wellbeing screening in Aboriginal and Torres Strait Islander primary health care services in Australia.

    Science.gov (United States)

    Gausia, Kaniz; Thompson, Sandra; Nagel, Tricia; Rumbold, Alice; Connors, Christine; Matthews, Veronica; Boyle, Jacqueline; Schierhout, Gill; Bailie, Ross

    2013-12-01

    The aim of this study was to examine the extent to which antenatal emotional wellbeing (EW) assessments are undertaken in primary health care (PHC) centres and factors associated with completion of EW screening. Medical records of 797 pregnant women from 36 PHC centres in five states (NSW, QLD, SA, WA and NT) were audited. Overall, 85% of the women were Aboriginal. The proportion of women with documented screening for EW varied from 5 to 38% between states (mean 17%). Aboriginal women were four times more likely (adjusted Odds Ratio (OR = 4.13, 95% CI = 2.46-6.92) to not be screened for antenatal EW than non-Aboriginal women. Aboriginality, lack of counselling on financial support were independently linked with no screening of EW. Provision of training for health service providers and further research on appropriate screening tools for Aboriginal women are needed to help redress this gap.

  4. Antibiotic prescription practices in six primary health centers in South Sumatra

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    Sjamsuir Munaf

    2005-03-01

    Full Text Available Drug utilization study, especially antibiotic usage in therapy of mild acute upper respiratory infections and acute diarrheas has been conducted in six Primary Health Center (PHC in urban, suburban and rural area in the Province of South Sumatra.  We conducted systematic random sampling during which 15% of patients in each PHC were taken. We collected information about drug utilization from medical record of out patient in each PHC for three months period (January to March 1997. We recorded the characteristics of patients, the diagnosis, the number and type of drug (including injection used. The number of cases studied was 1781, with the average number of drug per prescription being 2.7; the percentage of cases receiving an injection was 43%, and the percentage of cases receiving antibiotic was 48%. Sixty-four percent of 1277 acute respiratory tract infections (common cold, and 79% of 140 cases of acute diarrhea received antibiotic. This study showed that there is overuse or inappropriate use of drugs, especially antibiotic for acute nonspecific diarrhea and mild acute respiratory tract infections. (Med J Indones 2005; 14: 44-9Keywords: drug utilization study, antibiotic use, acute upper respiratory infection, acute diarrhea

  5. Economic Activities, Illness Pattern and Utilisation of Health Care Facilities in the Rural Population of Kwazulu-Natal, South Africa

    Science.gov (United States)

    2009-01-01

    ABSTRACT Background The study was undertaken among the rural and black communities of the Uthungulu health district of the KwaZulu-Natal province, South Africa. Method A cross-sectional community-based descriptive study was conducted. A multi-stage sampling strategy was adopted to obtain a representative sample of the communities. Results The mean age of the population was 27 years and majority was female (54%). Among the adult population only 30% were educated, 19% were engaged in some form of economic activities while 9% were in the formal employment sector. The average monthly income per household was R1 301 (95% CI, R1 283; R1 308). The illnesses were reported by 27% of the total population over a period of one month. Notably higher rates of female individuals (29%) were sick compared to males (24%, p < 0.001). The rates of illnesses among adult females (39%) were also significantly higher than among males (31%, p < 0.009). Most of them (69%) attended primary health care (PHC) clinics for medical services, while 67% reported chronic conditions. Age (OR = 1.4), gender (OR = 0.711), education (OR = 0.64) and economic activities (OR = 1.9) were found to be associated with being ill or not. Conclusion The rural black communities are underdeveloped and deprived, which results in higher prevalence of illnesses; however, the utilisation of PHC facilities is comparatively higher than in the rest of the province and other parts of the country. Interventions to improve community health care services among the deprived population should be focused through public health strategies such as all-encompassing PHC that includes health promotion, education and basic essential amenities.

  6. Violence against Primary Health Care Workers in Al-Hassa, Saudi Arabia

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    El-Gilany, Abdel-Hady; El-Wehady, Adel; Amr, Mostafa

    2010-01-01

    This self-report questionnaire study was carried out in Al-Hassa, Saudi Arabia to highlight the magnitude, predictors, and circumstances of workplace violence against primary health care (PHC) workers. A total of 1,091 workers completed a self-administered questionnaire. About 28% were exposed to at least one violent event during the past year.…

  7. Health care reform and job satisfaction of primary health care physicians in Lithuania

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    Blazeviciene Aurelija

    2005-03-01

    Full Text Available Abstract Background The aim of this research paper is to study job satisfaction of physicians and general practitioners at primary health care institutions during the health care reform in Lithuania. Methods Self-administrated anonymous questionnaires were distributed to all physicians and general practitioners (N = 243, response rate – 78.6%, working at Kaunas primary health care level establishments, in October – December 2003. Results 15 men (7.9% and 176 women (92.1% participated in the research, among which 133 (69.6% were GPs and 58 (30.4% physicians. Respondents claimed to have chosen to become doctors, as other professions were of no interest to them. Total job satisfaction of the respondents was 4.74 point (on a 7 point scale. Besides 75.5% of the respondents said they would not recommend their children to choose a PHC level doctor's profession. The survey also showed that the respondents were most satisfied with the level of autonomy they get at work – 5.28, relationship with colleagues – 5.06, and management quality – 5.04, while compensation (2.09, social status (3.36, and workload (3.93 turned to be causing the highest dissatisfaction among the respondents. The strongest correlation (Spearmen's ratio was observed between total job satisfaction and such factors as the level of autonomy – 0.566, workload – 0.452, and GP's social status – 0.458. Conclusion Total job satisfaction of doctors working at primary health care establishments in Lithuania is relatively low, and compensation, social status, and workload are among the key factors that condition PHC doctors' dissatisfaction with their job.

  8. The introduction of Greek Central Health Fund: Has the reform met its goal in the sector of Primary Health Care or is there a new model needed?

    Science.gov (United States)

    Polyzos, Nikos; Karakolias, Stefanos; Dikeos, Costas; Theodorou, Mamas; Kastanioti, Catherine; Mama, Kalomira; Polizoidis, Periklis; Skamnakis, Christoforos; Tsairidis, Charalampos; Thireos, Eleutherios

    2014-11-25

    The National Organization for Healthcare Provision (EOPYY) originates from the recent reform in Greek healthcare, aiming amidst economic predicament, at the rationalization of health expenditure and reactivation of the pivotal role of Primary Health Care (PHC). Health funding (public/private) mix is examined, alongside the role of pre-existing health insurance funds. The main pursuit of this paper is to evaluate whether EOPYY has met its goals. The article surveys for best practices in advanced health systems and similar sickness funds. The main benchmarks focus on PHC provision and providers' reimbursement. It then turns to an analysis of EOPYY, focusing on specific questions and searching the relevant databases. It compares the best practice examples to the EOPYY (alongside further developments set by new legislation in L 4238/14), revealing weaknesses relevant to non-integrated PHC network, unbalanced manpower, non-gatekeeping, under-financing and other funding problems caused by the current crisis. Finally, a new model of medical procedures cost accounting was tested in health centers. An alternative operation of EOPYY functioning primarily as an insurer whereas its proprietary units are integrated with these of the NHS is proposed. The paper claims it is critical to revise the current induced demand favorable reimbursement system, via per capita payments for physicians combined with extra pay-for-performance payments, while cost accounting corroborates a prospective system for NHS's and EOPYY's units, under a combination of global budgets and Ambulatory Patient Groups (APGs) Self-critical points on the limitations of results due to lack of adequate data (not) given by EOPYY are initially raised. Then the issue concerning the debate between 'copying' benchmarks and 'a la cart' selectively adopting and adapting best practices from wider experience is discussed, with preference to the latter. The idea of an 'a la cart' choice of international examples is proposed

  9. SCI peer health coach influence on self-management with peers: a qualitative analysis.

    Science.gov (United States)

    Skeels, S E; Pernigotti, D; Houlihan, B V; Belliveau, T; Brody, M; Zazula, J; Hasiotis, S; Seetharama, S; Rosenblum, D; Jette, A

    2017-11-01

    A process evaluation of a clinical trial. To describe the roles fulfilled by peer health coaches (PHCs) with spinal cord injury (SCI) during a randomized controlled trial research study called 'My Care My Call', a novel telephone-based, peer-led self-management intervention for adults with chronic SCI 1+ years after injury. Connecticut and Greater Boston Area, MA, USA. Directed content analysis was used to qualitatively examine information from 504 tele-coaching calls, conducted with 42 participants with SCI, by two trained SCI PHCs. Self-management was the focus of each 6-month PHC-peer relationship. PHCs documented how and when they used the communication tools (CTs) and information delivery strategies (IDSs) they developed for the intervention. Interaction data were coded and analyzed to determine PHC roles in relation to CT and IDS utilization and application. PHCs performed three principal roles: Role Model, Supporter, and Advisor. Role Model interactions included CTs and IDSs that allowed PHCs to share personal experiences of managing and living with an SCI, including sharing their opinions and advice when appropriate. As Supporters, PHCs used CTs and IDSs to build credible relationships based on dependability and reassuring encouragement. PHCs fulfilled the unique role of Advisor using CTs and IDSs to teach and strategize with peers about SCI self-management. The SCI PHC performs a powerful, flexible role in promoting SCI self-management among peers. Analysis of PHC roles can inform the design of peer-led interventions and highlights the importance for the provision of peer mentor training.

  10. Prevalence of subclinical hypothyroidism in adults visiting primary health-care setting in Riyadh.

    Science.gov (United States)

    Al Eidan, Eidan; Ur Rahman, Saeed; Al Qahtani, Saeed; Al Farhan, Ali I; Abdulmajeed, Imad

    2018-01-01

    Background and objectives : Subclinical hypothyroidism is an asymptomatic condition with normal thyroxin and raised thyroid stimulating hormone (TSH) level. The objective of the study was to determine the prevalence of subclinical hypothyroidism in primary health care (PHC) settings in Riyadh and explore the relationship of TSH level with age, gender, family history, body mass index, and co-morbid conditions. Subjects and methods : A cross-sectional study of adult visitors to nine satellites PHC clinics in military housing in Riyadh was carried out. TSH concentration and free T4 levels were measured. Data were collected by nurses and physicians during routine clinical practice in primary care. Descriptive analysis was performed on all variables in study, and relationships were explored using chi-square, t -test, analysis of variance, and linear regression. Results : A total of 340 out of 394 participants in the study gave blood samples. Subclinical hyperthyroidism was identified in 2.1% ( p  = .001) and subclinical hypothyroidism in 10.3% ( p  = .001) of the PHC visitors. TSH levels were found to be significantly higher ( p  = .047) in elderly population of ≥60 years and those with family history of thyroid disease. Non-significant upward trends were noted in TSH levels with hyperlipidemia and increasing blood pressure. No overt hyperthyroidism or hypothyroidism was found in our study sample. Conclusion : Subclinical hypothyroidism has a prevalence of 10% of adults visiting PHC's. TSH levels are higher in the elderly, which warrants screening of those aged 60 years and above.

  11. Critiquing the response to the Ebola epidemic through a Primary Health Care Approach.

    Science.gov (United States)

    Scott, Vera; Crawford-Browne, Sarah; Sanders, David

    2016-05-17

    The 2014/2015 West Africa Ebola epidemic has caused the global public health community to engage in difficult self-reflection. First, it must consider the part it played in relation to an important public health question: why did this epidemic take hold and spread in this unprecedented manner? Second, it must use the lessons learnt to answer the subsequent question: what can be done now to prevent further such outbreaks in the future? These questions remain relevant, even as scientists announce that the Guinea Phase III efficacy vaccine trial shows that rVSV-EBOV (Merck, Sharp & Dohme) is highly efficacious in individuals. This is a major breakthrough in the fight against Ebola virus disease (EVD). It does not replace but may be a powerful adjunct to current strategies of EVD management and control. We contribute to the current self-reflection by presenting an analysis using a Primary Health Care (PHC) approach. This approach is appropriate as African countries in the region affected by EVD have recommitted themselves to PHC as a framework for organising health systems and the delivery of health services. The approach suggests that, in an epidemic made complex by weak pre-existing health systems, lack of trust in authorities and mobile populations, a broader approach is required to engage affected communities. In the medium-term health system development with attention to primary level services and community-based programmes to address the major disease burden of malaria, diarrhoeal disease, meningitis, tuberculosis and malnutrition is needed. This requires the development of local management and an investment in human resources for health. Crucially this has to be developed ahead of, and not in parallel with, future outbreaks. In the longer-term a commitment is required to address the underlying social determinants which make these countries so vulnerable, and limit their capacity to respond effectively to, epidemics such as EVD. The PHC approach offers an

  12. Critiquing the response to the Ebola epidemic through a Primary Health Care Approach

    Directory of Open Access Journals (Sweden)

    Vera Scott

    2016-05-01

    Full Text Available Abstract Background The 2014/2015 West Africa Ebola epidemic has caused the global public health community to engage in difficult self-reflection. First, it must consider the part it played in relation to an important public health question: why did this epidemic take hold and spread in this unprecedented manner? Second, it must use the lessons learnt to answer the subsequent question: what can be done now to prevent further such outbreaks in the future? These questions remain relevant, even as scientists announce that the Guinea Phase III efficacy vaccine trial shows that rVSV-EBOV (Merck, Sharp & Dohme is highly efficacious in individuals. This is a major breakthrough in the fight against Ebola virus disease (EVD. It does not replace but may be a powerful adjunct to current strategies of EVD management and control. Discussion We contribute to the current self-reflection by presenting an analysis using a Primary Health Care (PHC approach. This approach is appropriate as African countries in the region affected by EVD have recommitted themselves to PHC as a framework for organising health systems and the delivery of health services. The approach suggests that, in an epidemic made complex by weak pre-existing health systems, lack of trust in authorities and mobile populations, a broader approach is required to engage affected communities. In the medium-term health system development with attention to primary level services and community-based programmes to address the major disease burden of malaria, diarrhoeal disease, meningitis, tuberculosis and malnutrition is needed. This requires the development of local management and an investment in human resources for health. Crucially this has to be developed ahead of, and not in parallel with, future outbreaks. In the longer-term a commitment is required to address the underlying social determinants which make these countries so vulnerable, and limit their capacity to respond effectively to, epidemics

  13. Economic activities, illness pattern and utilisation of health care facilities in the rural population of KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Monjurul Hoque

    2009-06-01

    Method: A cross-sectional community-based descriptive study was conducted. A multi-stage sampling strategy was adopted to obtain a representative sample of the communities. Results: The mean age of the population was 27 years and majority was female (54%. Among the adult population only 30% were educated, 19% were engaged in some form of economic activities while 9% were in the formal employment sector. The average monthly income per household was R1 301 (95% CI, R1 283; R1 308. The illnesses were reported by 27% of the total population over a period of one month. Notably higher rates of female individuals (29% were sick compared to males (24%, p < 0.001. The rates of illnesses among adult females (39% were also significantly higher than among males (31%, p < 0.009. Most of them (69% attended primary health care (PHC clinics for medical services, while 67% reported chronic conditions. Age (OR = 1.4, gender (OR = 0.711, education (OR = 0.64 and economic activities (OR = 1.9 were found to be associated with being ill or not. Conclusion: The rural black communities are underdeveloped and deprived, which results in higher prevalence of illnesses; however, the utilisation of PHC facilities is comparatively higher than in the rest of the province and other parts of the country. Interventions to improve community health care services among the deprived population should be focused through public health strategies such as all-encompassing PHC that includes health promotion, education and basic essential amenities.

  14. Revitalising primary healthcare requires an equitable global economic system - now more than ever.

    Science.gov (United States)

    Sanders, David; Baum, Fran E; Benos, Alexis; Legge, David

    2011-08-01

    The promised revitalisation of primary healthcare (PHC) is happening at a time when the contradictions and unfairness of the global economic system have become clear, suggesting that the current system is unsustainable. In the past two decades, one of the most significant impediments to the implementation of comprehensive PHC has been neoliberal economic policies and their imposition globally. This article questions what will be required for PHC to flourish. PHC incorporates five key principles: equitable provision of services, comprehensive care, intersectoral action, community involvement and appropriate technology. This article considers intersectoral action and comprehensiveness and their potential to be implemented in the current global environment. It highlights the constraints to intersectoral action through a case study of nutrition in the context of globalisation of the food chain. It also explores the challenges to implementing a comprehensive approach to health that are posed by neoliberal health sector reforms and donor practices. The paper concludes that even well-designed health systems based on PHC have little influence over the broader economic forces that shape their operation and their ability to improve health. Reforming these economic forces will require greater regulation of the national and global economic environment to emphasise people's health rather than private profit, and action to address climate change. Revitalisation of PHC and progress towards health equity are unlikely without strong regulation of the market. The further development and strengthening of social movements for health will be key to successful advocacy action.

  15. Prevalence and determinants of antenatal depression among women attending primary health care centers in Western Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Jamala A. Bawahab

    2017-12-01

    Full Text Available Objectives: To measure the prevalence of antenatal depression among pregnant women attending the primary health care (PHC antenatal care clinics in Jeddah, Saudi Arabia and to determine associated factors. Methods: Following a cross-sectional study design, 320 pregnant women attending the antenatal care clinics in the Ministry of Health PHC Centers in Jeddah, Saudi Arabia between January 1st 2017 and February 15th 2017 were interviewed. A self-administered questionnaire used for data collection asked about socio-demographic variables and included the Edinburgh Postnatal Depression Scale. Results: The most common contributor was the harming herself (mean±SD, 2.7±0.60. Factors significantly associated with depression among participants were the number of daughters, previous diagnosis of depression, and financial problems. Conclusions: The prevalence of antepartum depression among pregnant women in Jeddah is 57.5%, and the greatest contributor is the thought of harming herself.

  16. What research impacts do Australian primary health care researchers expect and achieve?

    Directory of Open Access Journals (Sweden)

    Reed Richard L

    2011-11-01

    Full Text Available Abstract Background Funding for research is under pressure to be accountable in terms of benefits and translation of research findings into practice and policy. Primary health care research has considerable potential to improve health care in a wide range of settings, but little is known about the extent to which these impacts actually occur. This study examines the impact of individual primary health care research projects on policy and practice from the perspective of Chief Investigators (CIs. Methods The project used an online survey adapted from the Buxton and Hanney Payback Framework to collect information about the impacts that CIs expected and achieved from primary health care research projects funded by Australian national competitive grants. Results and Discussion Chief Investigators (CIs provided information about seventeen completed projects. While no CI expected their project to have an impact in every domain of the framework used in the survey, 76% achieved at least half the impacts they expected. Sixteen projects had published and/or presented their work, 10 projects included 11 doctorate awards in their research capacity domain. All CIs expected their research to lead to further research opportunities with 11 achieving this. Ten CIs achieved their expectation of providing information for policy making but only four reported their research had influenced policy making. However 11 CIs achieved their expectation of providing information for organizational decision making and eight reported their research had influenced organizational decision making. Conclusion CIs reported that nationally funded primary health care research projects made an impact on knowledge production, staff development and further research, areas within the realm of influence of the research team and within the scope of awareness of the CIs. Some also made an impact on policy and organizational decision-making, and on localized clinical practice and service

  17. How to achieve a collaborative approach in health promotion: preferences and ideas of users of mental health services.

    Science.gov (United States)

    Pals, Regitze Anne Saurbrey; Hempler, Nana Folmann

    2018-02-12

    Collaborative approaches to consensus building or decision-making are beneficial in health-promoting activities targeting users of mental health services (users). However, little is known about how to achieve a collaborative approach in practice. The purpose of this study was to explore: (1) users' preferences and ideas related to achieving a collaborative approach in health-related communication and (2) perspectives of healthcare and social work professionals and family members on users' ideas and preferences. Data were collected through interactive workshops with users (n = 15), professionals (n = 21) and users' family members (n = 12). Data were analysed using systematic text condensation. Users provided three recommendations for establishing a collaborative approach in communication about health: (1) involving users in deciding the agenda and setting for health-promoting activities; (2) exchanging knowledge between users and professionals about health and values; and (3) exploring users' motivation for change. Users and professionals had diverging perceptions of the value of establishing a collaborative approach. Professionals regarded relationship building and health promotion as separate phenomena, whereas users perceived relationship building as inherently health promoting. Family members of users requested specific guidance and support with regard to clarifying and fulfilling the best possible support role as a family member. The findings suggest that a collaborative approach in health promotion may be difficult to achieve without a focus on professional development for healthcare and social work professionals. © 2018 Nordic College of Caring Science.

  18. The social paediatrics initiative: a RICHER model of primary health care for at risk children and their families.

    Science.gov (United States)

    Wong, Sabrina T; Lynam, M Judith; Khan, Koushambhi B; Scott, Lorine; Loock, Christine

    2012-10-04

    The Responsive Interdisciplinary Child-Community Health Education and Research (RICHER) initiative is an intersectoral and interdisciplinary community outreach primary health care (PHC) model. It is being undertaken in partnership with community based organizations in order to address identified gaps in the continuum of health services delivery for 'at risk' children and their families. As part of a larger study, this paper reports on whether the RICHER initiative is associated with increased: 1) access to health care for children and families with multiple forms of disadvantage and 2) patient-reported empowerment. This study provides the first examination of a model of delivering PHC, using a Social Paediatrics approach. This was a mixed-methods study, using quantitative and qualitative approaches; it was undertaken in partnership with the community, both organizations and individual providers. Descriptive statistics, including logistic regression of patient survey data (n=86) and thematic analyses of patient interview data (n=7) were analyzed to examine the association between patient experiences with the RICHER initiative and parent-reported empowerment. Respondents found communication with the provider clear, that the provider explained any test results in a way they could understand, and that the provider was compassionate and respectful. Analysis of the survey and in-depth interview data provide evidence that interpersonal communication, particularly the provider's interpersonal style (e.g., being treated as an equal), was very important. Even after controlling for parents' education and ethnicity, the provider's interpersonal style remained positively associated with parent-reported empowerment (p<0.01). This model of PHC delivery is unique in its purposeful and required partnerships between health care providers and community members. This study provides beginning evidence that RICHER can better meet the health and health care needs of people, especially

  19. The social paediatrics initiative: a RICHER model of primary health care for at risk children and their families

    Directory of Open Access Journals (Sweden)

    Wong Sabrina T

    2012-10-01

    Full Text Available Abstract Background The Responsive Interdisciplinary Child-Community Health Education and Research (RICHER initiative is an intersectoral and interdisciplinary community outreach primary health care (PHC model. It is being undertaken in partnership with community based organizations in order to address identified gaps in the continuum of health services delivery for ‘at risk’ children and their families. As part of a larger study, this paper reports on whether the RICHER initiative is associated with increased: 1 access to health care for children and families with multiple forms of disadvantage and 2 patient-reported empowerment. This study provides the first examination of a model of delivering PHC, using a Social Paediatrics approach. Methods This was a mixed-methods study, using quantitative and qualitative approaches; it was undertaken in partnership with the community, both organizations and individual providers. Descriptive statistics, including logistic regression of patient survey data (n=86 and thematic analyses of patient interview data (n=7 were analyzed to examine the association between patient experiences with the RICHER initiative and parent-reported empowerment. Results Respondents found communication with the provider clear, that the provider explained any test results in a way they could understand, and that the provider was compassionate and respectful. Analysis of the survey and in-depth interview data provide evidence that interpersonal communication, particularly the provider’s interpersonal style (e.g., being treated as an equal, was very important. Even after controlling for parents’ education and ethnicity, the provider’s interpersonal style remained positively associated with parent-reported empowerment (p Conclusions This model of PHC delivery is unique in its purposeful and required partnerships between health care providers and community members. This study provides beginning evidence that RICHER can

  20. Increased Utilization of Primary Health Care Centers for Birthing Care in Tamil Nadu, India: A Visible Impact of Policies, Initiatives, and Innovations

    Science.gov (United States)

    Pandian, Jayanthi; Suresh, Saradha; Desikachari, B. R.; Padmanaban, P.

    2013-01-01

    Background: Tamil Nadu has been showing an increasing trend in institutional deliveries since early 1990's and has now achieved near 100%. Among the institutional deliveries, a change was observed since 2006, wherein primary health centers (PHCs) showed a four-fold increase in deliveries, while other public and private health facilities showed a decline, despite equal access to all categories of health facilities. What led to this increased utilization of PHCs for birthing care? Material and Methods: Policies, documents, and published reports of the Government of Tamil Nadu (GoTN) were reviewed and interviews were conducted with the various stakeholders involved in providing birthing care in the PHCs. This study analyzes the impact of the policies and supply side initiatives and innovations which led to increase utilization of the PHCs for birthing care. Results: Scaling up of 24 × 7 services in all PHCs, upgrading PHCs with good infrastructure, human resources, and women friendly services have helped to boost the image of the PHCs. Pro-women policies like maternity benefit schemes, birth companionship, providing food, and compulsory stay for 48 h following delivery have attracted women towards PHC. Innovative strategies like maternity picnics and use of expected date of delivery (EDD) chart for follow-up have made women choose PHCs, while periodic reviews and support to staff has improved service delivery. Conclusion: Women centered policies, efficient managerial systems, quality care, and innovative marketing of services have together contributed to increased utilization of PHCs for birthing. Other states could explore the possibility of replicating this model to make optimal use the PHC facilities. PMID:26664836

  1. Effects of increased nurses’ workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province

    Directory of Open Access Journals (Sweden)

    Rhulani C. Shihundla

    2016-05-01

    Full Text Available Background: Recording of information on multiple documents increases professional nurses’ responsibilities and workload during working hours. There are multiple registers and books at Primary Health Care (PHC facilities in which a patient’s information is to be recorded for different services during a visit to a health professional. Antenatal patients coming for the first visit must be recorded in the following documents: tick register; Prevention of Mother-ToChild Transmission (PMTCT register; consent form for HIV and AIDS testing; HIV Counselling and Testing (HCT register (if tested positive for HIV and AIDS then this must be recorded in the Antiretroviral Therapy (ART wellness register; ART file with an accompanying single file, completion of which is time-consuming; tuberculosis (TB suspects register; blood specimen register; maternity case record book and Basic Antenatal Care (BANC checklist. Nurses forget to record information in some documents which leads to the omission of important data. Omitting information might lead to mismanagement of patients. Some of the documents have incomplete and inaccurate information. As PHC facilities in Vhembe District render twenty four hour services through a call system, the same nurses are expected to resume duty at 07:00 the following morning. They are expected to work effectively and when tired a nurse may record illegible information which may cause problems when the document is retrieved by the next person for continuity of care. Objectives: The objective of this study was to investigate and describe the effects of increased nurses’ workload on quality documentation of patient information at PHC facilities in Vhembe District, Limpopo Province. Methods: The study was conducted in Vhembe District, Limpopo Province, where the effects of increased nurses’ workload on quality documentation of information is currently experienced. The research design was explorative, descriptive and contextual in

  2. Validating the accuracy of GIS-based accessibility analysis in determining public primary health care demand in Metropolitan areas

    CSIR Research Space (South Africa)

    Mokgalaka, H

    2014-07-01

    Full Text Available dual system made up of private and public health care facilities. Private PHC is expensive and only affordable to affluent citizens or people with medical insurance, and does not form a part of this study. Two challenges regarding GIS...

  3. Challenges and Opportunities of Implementing District-based Health Information System in Ethiopia

    DEFF Research Database (Denmark)

    Mengiste, Shegaw Anagaw

    2005-01-01

    This paper has analyzed the challenges of sustainability and scalability of HIS. The empirical analysis was conducted in a backward and disadvantaged region of Ethiopia. An ongoing process of HISP (Health Information System Program) was addressed and the main challenges in the implementation...... of sustainable and scalable district-based health information system in the context of Primary Health Care (PHC) sector in Ethiopia were identified. Human resource, infrastructure, and HIS related problems are the main challenges hindering the implementation of sustainable and scalable district-based health...... information systems in the region....

  4. Performance needs assessment of maternal and newborn health service delivery in urban and rural areas of Osun State, South-West, Nigeria.

    Science.gov (United States)

    Esan, Oluwaseun T; Fatusi, Adesegun O

    2014-06-01

    The study aimed to determine performance and compare gaps in maternal and newborn health (MNH) services in urban and rural areas of Osun State, Nigeria, to inform decisions for improved services. This study involved 14 urban and 10 rural-based randomly selected PHC facilities. Using a Performance Needs Assessment framework, desired performances were determined by key stakeholders and actual performances measured by conducting facility survey. Questionnaire interview of 143 health workers and 153 antenatal clients were done. Performance gaps were determined for the urban and rural areas and compared using Chi-square tests with SPSS version 17. PHC facilities and health workers in Osun State, Nigeria, were found to have significant gaps in MNH service performance and this was worse in the rural areas. Root cause of most of the performance gaps was poor political will of local government authorities. Improved government commitment to MNH is needful to address most of the gaps.

  5. Malaria among antenatal clients attending primary health care ...

    African Journals Online (AJOL)

    This study assessed the prevalence of fever, malarial parasitemia and anemia among pregnant women attending PHC facilities in Kano, northern Nigeria. Methods: A cross-sectional descriptive study was conducted among 360 ANCs attending PHC facilities in two Local Government Areas (LGAs) in Kano state. Data were ...

  6. [Governance of primary health-care-based health-care organization].

    Science.gov (United States)

    Báscolo, Ernesto

    2010-01-01

    An analytical framework was developed for explaining the conditions for the effectiveness of different strategies promoting integrated primary health-care (PHC) service-based systems in Latin-America. Different modes of governance (clan, incentives and hierarchy) were characterised from a political economics viewpoint for representing alternative forms of regulation promoting innovation in health-service-providing organisations. The necessary conditions for guaranteeing the modes of governance's effectiveness are presented, as are their implications in terms of posts in play. The institutional construction of an integrated health system is interpreted as being a product of a social process in which different modes of governance are combined, operating with different ways of resolving normative aspects for regulating service provision (with the hierarchical mode), resource distribution (with the incentives mode) and on the social values legitimising such process (with the clan mode).

  7. Experiences of homosexual patients' access to primary health care services in Umlazi, KwaZulu-Natal.

    Science.gov (United States)

    Cele, Nokulunga H; Sibiya, Maureen N; Sokhela, Dudu G

    2015-09-28

    Homosexual patients are affected by social factors in their environment, and as a result may not have easy access to existing health care services. Prejudice against homosexuality and homosexual patients remains a barrier to them seeking appropriate healthcare. The concern is that lesbians and gays might delay or avoid seeking health care when they need it because of past discrimination or perceived homophobia within the health care thereby putting their health at risk. The aim of the study was to explore and describe the experiences of homosexual patients utilising primary health care (PHC) services in Umlazi in the province ofKwaZulu-Natal (KZN). A qualitative, exploratory, descriptive study was conducted which was contextual innature. Semi-structured interviews were conducted with 12 participants. The findings of this study were analysed using content analysis. Two major themes emerged from the data analysis, namely, prejudice against homosexual patients by health care providers and other patients at the primary health care facilities, and, homophobic behaviour from primary health care personnel. Participants experienced prejudice and homophobic behaviour in the course of utilising PHC clinics in Umlazi, which created a barrier to their utilisation of health services located there. Nursing education institutions, in collaboration with the National Department of Health, should introduce homosexuality and anti-homophobia education programmes during the pre-service and in-service education period. Such programmes will help to familiarise health care providers with the health care needs of homosexual patients and may decrease homophobic attitudes.

  8. Panoramic view of challenges and opportunities for primary healthcare systems in Pakistan

    International Nuclear Information System (INIS)

    Sharif, H.; Sughra, U.; Butt, Z.

    2016-01-01

    Pakistan has a broad system of primary health care facilities to achieve mission of Health for all. Over the last seven years health expenditure by government of Pakistan has been increased to attain this goal. This study was conducted with the aim to assess all blocks of service readiness (basic equipment, basic amenities, laboratory capacity, standard precautions and essential medicines) in public-primary health care facilities of tehsil Rawalpindi, Pakistan. Methods: A cross-sectional survey was carried out utilizing two separate structured questionnaires for basic health units and rural health centres. Information was collected from administrative heads along with other staff where required, of all public-primary health care facilities of Tehsil Rawalpindi. Data were analysed by using SPSS version17. Results: A total of 26 health facilities were assessed; only 56% BHUs had a sign board that was available in readable form. BHUs with women medical officer as administrative head constituted 52%. Backup for electricity and toilet were the most neglected areas. Basic amenities, standard precautions and laboratory capacity of Basic Health Units (BHUs) showed a clear deviation from standards and is thus a challenge for Pakistan's Primary Health care (PHC). On the other hand for Rural Health Centres (RHCs), most were on the way to meet expectations. Conclusion: Pakistan's government is undoubtedly putting efforts in order to achieve targets of primary healthcare but it needs better mainstreaming of political, institutional and social commitments with modified standards for PHC. (author)

  9. Effect of Education of Primary Health Care Workers on HIV-related Oral Lesions in Nairobi East District.

    Science.gov (United States)

    Koyio, Lucina N; van der Sanden, Wil J M; van der Ven, Andre; Creugers, Nico; Merkx, Matthias A W; Frencken, Jo E

    2012-06-15

    An estimated 90% of HIV-infected people are likely to develop oral lesions in the course of HIV infection. Oro-pharyngeal candidiasis (OPC), an early marker for HIV-infection, can be diagnosed during an oral examination (OE). Primary healthcare (PHC) providers in Kenya are neither trained nor sufficiently equipped to perform this simple, cheap and non-invasive examination. The PHC system in Kenya offers an opportunity to integrate early recognition and management of oral lesions into general health care. This study aims to estimate the effect of a multifaceted intervention for PHC providers in training them to perform an OE. Specifically, our primary objective is to establish whether the intervention is effective in increasing: i) the frequency of early detection of HIV-related oral lesions; and ii) referral rates for HIV-testing. THE STUDY HAS BEEN DESIGNED IN TWO PARTS: a retrospective clinical data record study and a prospective cohort study with pre-post control group design, carried out in 2 administrative divisions in Nairobi East district. The intervention group will receive one day of training on recognition of HIV-related oral lesions and other common oral conditions. Reminder sessions will be held at individual health facilities. Routine tally sheets will be used to record all patients with HIV-related oral lesions, dental caries and periodontal disease. A convenience sample of all the PHC in a division will be used. It will not be possible to blind investigators or assessors. Expected impact of the study for Public Health. Early recognition and treatment of HIV infection influences long-term survival rates and will reduce healthcare expenditure. The project is funded by the Netherlands organisation for international cooperation in higher education (NUFFIC). We would like to thank all participating health facilities and health care workers for their willingness to take part in this study. LNK also thanks the Kenya Ministry of Public Health and Sanitation

  10. Patient satisfaction with quality of primary health care in Benghazi, Libya

    Directory of Open Access Journals (Sweden)

    Asharaf Abdul Salam

    2010-10-01

    Full Text Available Introduction: The Libyan National Health System (LNHS is debated for the paradox of its performance versus impact. It has poor performance, but the national health statistics are good and competitive. There are concerted efforts to manage health care services and to regain the lost trust. A primary health care (PHC system that focuses on preventive and promotive care is the core focus of LNHS efforts. Objectives: To assess patient satisfaction with quality of PHC assessed in terms of (a customer profile, (b patient satisfaction, and (c health care-seeking behavior. Methodology: A sample of nine health centers and seven polyclinics from various locations in Benghazi, Libya were selected for gathering information by structured face-to-face interviews. A total of 310 beneficiaries were interviewed by using an Arabic translation of the Charleston Psychiatric Outpatient Satisfaction Scale. Results: The beneficiaries appear to be quite satisfied with the quality of services. Geographical zone, marital status of beneficiary, and type of facility are satisfaction-related factors. There are preferences for facilities located within the City Centre over those located elsewhere. There is also an interaction effect of the geographical zone and the type of facility in creating differences in satisfaction. Conclusions: A customer-friendly facility concept that emphasizes reception, physician interaction, and cordiality shall add value. Polyclinics require more attention as does the Al Slawy area. A few utility services might also be considered.

  11. Row can the impact of PRe be evaluated?

    African Journals Online (AJOL)

    bidity, disability, infant mortality (IMR), under 5 mortality (U5MR) and ... health personnel. Progress in these areas can be linked to person orientated PHC factors to give a total PHC evaluation. The worldwide "Child Survival" programme is a selective PHC ... Growth Monitoring; Oral Rehydration Therapy;. Breast Feeding ...

  12. Patient-focused quality improvement in primary health care ...

    African Journals Online (AJOL)

    Method: Secondary analyses of data obtained from a cross-sectional national representative exit survey of patients' experiences of PHC which was conducted with the PES. The PES QUALISTAT is an array of analytic procedures and approaches for presenting data on PHC performance. Colour coding of performance (red ...

  13. Quantitative Guidance for Stove Usage and Performance to Achieve Health and Environmental Targets.

    Science.gov (United States)

    Johnson, Michael A; Chiang, Ranyee A

    2015-08-01

    Displacing the use of polluting and inefficient cookstoves in developing countries is necessary to achieve the potential health and environmental benefits sought through clean cooking solutions. Yet little quantitative context has been provided on how much displacement of traditional technologies is needed to achieve targets for household air pollutant concentrations or fuel savings. This paper provides instructive guidance on the usage of cooking technologies required to achieve health and environmental improvements. We evaluated different scenarios of displacement of traditional stoves with use of higher performing technologies. The air quality and fuel consumption impacts were estimated for these scenarios using a single-zone box model of indoor air quality and ratios of thermal efficiency. Stove performance and usage should be considered together, as lower performing stoves can result in similar or greater benefits than a higher performing stove if the lower performing stove has considerably higher displacement of the baseline stove. Based on the indoor air quality model, there are multiple performance-usage scenarios for achieving modest indoor air quality improvements. To meet World Health Organization guidance levels, however, three-stone fire and basic charcoal stove usage must be nearly eliminated to achieve the particulate matter target (< 1-3 hr/week), and substantially limited to meet the carbon monoxide guideline (< 7-9 hr/week). Moderate health gains may be achieved with various performance-usage scenarios. The greatest benefits are estimated to be achieved by near-complete displacement of traditional stoves with clean technologies, emphasizing the need to shift in the long term to near exclusive use of clean fuels and stoves. The performance-usage scenarios are also provided as a tool to guide technology selection and prioritize behavior change opportunities to maximize impact.

  14. Synthesis, P-31 NMR data and X-ray analysis of a ruthenium(II) dimethylphenylphosphine complex with dimerized phenylacetylene: The structure of [(PhMe(2)P)(4)Ru(eta(3)-PhC(3)CHPh)](PF6)

    CSIR Research Space (South Africa)

    Liles, DC

    1996-09-06

    Full Text Available Treatment of [RuHL (5)] (+) (L = PMe (2) Ph) with phenylacetylene in ethanol yielded the dimerization of HC=CPh to (Z)-1, 4-diphenylbut-3-en-1-yne. The molecular structure of [Ru(eta(3)-PhC(3)CHPh)L(4)](PF6) (L = PMe(2)Ph) (2) shows a seven...

  15. How Academic Health Systems Can Achieve Population Health in Vulnerable Populations Through Value-Based Care: The Critical Importance of Establishing Trusted Agency.

    Science.gov (United States)

    Wesson, Donald E; Kitzman, Heather E

    2018-01-16

    Improving population health may require health systems to proactively engage patient populations as partners in the implementation of healthy behaviors as a shared value using strategies that incentivize healthy outcomes for the population as a whole. The current reactive health care model, which focuses on restoring the health of individuals after it has been lost, will not achieve the goal of improved population health. To achieve this goal, health systems must proactively engage in partnerships with the populations they serve. Health systems will need the help of community entities and individuals who have the trust of the population being served to act on behalf of the health system if they are to achieve this effective working partnership. The need for these trusted agents is particularly pertinent for vulnerable and historically underserved segments of the population. In this Invited Commentary, the authors discuss ways by which health systems might identify, engage, and leverage trusted agents to improve the health of the population through value-based care.

  16. Understanding and benchmarking health service achievement of policy goals for chronic disease

    Science.gov (United States)

    2012-01-01

    Background Key challenges in benchmarking health service achievement of policy goals in areas such as chronic disease are: 1) developing indicators and understanding how policy goals might work as indicators of service performance; 2) developing methods for economically collecting and reporting stakeholder perceptions; 3) combining and sharing data about the performance of organizations; 4) interpreting outcome measures; 5) obtaining actionable benchmarking information. This study aimed to explore how a new Boolean-based small-N method from the social sciences—Qualitative Comparative Analysis or QCA—could contribute to meeting these internationally shared challenges. Methods A ‘multi-value QCA’ (MVQCA) analysis was conducted of data from 24 senior staff at 17 randomly selected services for chronic disease, who provided perceptions of 1) whether government health services were improving their achievement of a set of statewide policy goals for chronic disease and 2) the efficacy of state health office actions in influencing this improvement. The analysis produced summaries of configurations of perceived service improvements. Results Most respondents observed improvements in most areas but uniformly good improvements across services were not perceived as happening (regardless of whether respondents identified a state health office contribution to that improvement). The sentinel policy goal of using evidence to develop service practice was not achieved at all in four services and appears to be reliant on other kinds of service improvements happening. Conclusions The QCA method suggested theoretically plausible findings and an approach that with further development could help meet the five benchmarking challenges. In particular, it suggests that achievement of one policy goal may be reliant on achievement of another goal in complex ways that the literature has not yet fully accommodated but which could help prioritize policy goals. The weaknesses of QCA can be

  17. Health-Related Behaviors and Academic Achievement Among High School Students - United States, 2015.

    Science.gov (United States)

    Rasberry, Catherine N; Tiu, Georgianne F; Kann, Laura; McManus, Tim; Michael, Shannon L; Merlo, Caitlin L; Lee, Sarah M; Bohm, Michele K; Annor, Francis; Ethier, Kathleen A

    2017-09-08

    Studies have shown links between educational outcomes such as letter grades, test scores, or other measures of academic achievement, and health-related behaviors (1-4). However, as reported in a 2013 systematic review, many of these studies have used samples that are not nationally representative, and quite a few studies are now at least 2 decades old (1). To update the relevant data, CDC analyzed results from the 2015 national Youth Risk Behavior Survey (YRBS), a biennial, cross-sectional, school-based survey measuring health-related behaviors among U.S. students in grades 9-12. Analyses assessed relationships between academic achievement (i.e., self-reported letter grades in school) and 30 health-related behaviors (categorized as dietary behaviors, physical activity, sedentary behaviors, substance use, sexual risk behaviors, violence-related behaviors, and suicide-related behaviors) that contribute to leading causes of morbidity and mortality among adolescents in the United States (5). Logistic regression models controlling for sex, race/ethnicity, and grade in school found that students who earned mostly A's, mostly B's, or mostly C's had statistically significantly higher prevalence estimates for most protective health-related behaviors and significantly lower prevalence estimates for most health-related risk behaviors than did students with mostly D's/F's. These findings highlight the link between health-related behaviors and education outcomes, suggesting that education and public health professionals can find their respective education and health improvement goals to be mutually beneficial. Education and public health professionals might benefit from collaborating to achieve both improved education and health outcomes for youths.

  18. Impact of Different Normality Thresholds for 24-hour ABPM at the Primary Health Care Level

    Directory of Open Access Journals (Sweden)

    Guilherme Brasil Grezzana

    Full Text Available Abstract Background: Hypertension is an important risk factor for cardiovascular outcomes. Primary health care (PHC physicians should be prepared to act appropriately in the prevention of cardiovascular risk factors. However, the rates of patients with control of blood pressure (BP remain low. The impact of the reclassification of high BP by 24-hour ambulatory BP monitoring (ABPM can lead to different medical decisions in PHC. Objective: To evaluate the agreement between the BP measured by a conventional method by PHC physicians and by 24-hour ABPM, considering different BP normal thresholds for the 24-hour ABPM according to the V Brazilian ABPM Guidelines and the European Society of Hypertension Guidelines. Methods: A cross-sectional study including 569 hypertensive patients. The BP was initially measured by the PHC physicians and, later, by 24-hour ABPM. The BP measurements were obtained independently between the two methods. The therapeutic targets for the conventional BP followed the guidelines by the Eighth Joint National Committee (JNC 8, the V ABPM Brazilian Guidelines, and the 2013 European Hypertension Guidelines. Results: There was an accuracy of 54.8% (95% confidence interval [95%CI] 0.51 - 0.58% for the BP measured with the conventional method when compared with the 24-hour ABPM, with a sensitivity of 85% (95%CI 80.8 - 88.6%, specificity of 31.9% (95%CI 28.7 - 34.7%, and kappa value of 0.155, when considering the European Hypertension Guidelines. When using more stringent thresholds to characterize the BP as "normal" by ABPM, the accuracy was 45% (95%CI 0.41 - 0.47% for conventional measurement when compared with 24-hour ABPM, with a sensitivity of 86.7% (95%CI 0.81 - 0.91%, specificity of 29% (95%CI 0.26 - 0.30%, and kappa value of 0.103. Conclusion: The BP measurements obtained by PHC physicians showed low accuracy when compared with those obtained by 24-hour ABPM, regardless of the threshold set by the different guidelines.

  19. Assessment of medical waste management at a primary health-care center in Sao Paulo, Brazil

    Energy Technology Data Exchange (ETDEWEB)

    Moreira, A.M.M., E-mail: anamariainforme@hotmail.com [Department of Environmental Health, School of Public Health, University of Sao Paulo, Avenida Doutor Arnaldo 715, Sao Paulo 01246-904 (Brazil); Guenther, W.M.R. [Department of Environmental Health, School of Public Health, University of Sao Paulo, Avenida Doutor Arnaldo 715, Sao Paulo 01246-904 (Brazil)

    2013-01-15

    Highlights: Black-Right-Pointing-Pointer Assessment of medical waste management at health-care center before/after intervention. Black-Right-Pointing-Pointer Qualitative and quantitative results of medical waste management plan are presented. Black-Right-Pointing-Pointer Adjustments to comply with regulation were adopted and reduction of waste was observed. Black-Right-Pointing-Pointer The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of Sao Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized

  20. Attitudes, subjective norms, and intention to perform routine oral examination for oropharyngeal candidiasis as perceived by primary health-care providers in Nairobi Province

    NARCIS (Netherlands)

    Koyio, L.N.; Kikwilu, E.N.; Mulder, J.; Frencken, J.E.F.M.

    2013-01-01

    Objectives: To assess attitudes, subjective norms, and intentions of primary health-care (PHC) providers in performing routine oral examination for oropharyngeal candidiasis (OPC) during outpatient consultations. Methods: A 47-item Theory of Planned Behaviour-based questionnaire was developed and

  1. Health-financing reforms in southeast Asia: challenges in achieving universal coverage.

    Science.gov (United States)

    Tangcharoensathien, Viroj; Patcharanarumol, Walaiporn; Ir, Por; Aljunid, Syed Mohamed; Mukti, Ali Ghufron; Akkhavong, Kongsap; Banzon, Eduardo; Huong, Dang Boi; Thabrany, Hasbullah; Mills, Anne

    2011-03-05

    In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide expansion. For Thailand, the Philippines, Indonesia, and Vietnam, social health insurance financed by payroll tax is commonly used for formal sector employees (excluding Malaysia), with varying outcomes in terms of financial protection. Alternative payment methods have different implications for provider behaviour and financial protection. Two alternative approaches for financial protection of the non-poor outside the formal sector have emerged-contributory arrangements and tax-financed schemes-with different abilities to achieve high population coverage rapidly. Fiscal space and mobilisation of payroll contributions are both important in accelerating financial protection. Expanding coverage of good-quality services and ensuring adequate human resources are also important to achieve universal coverage. As health-financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. Barriers and enablers for the development and implementation of allied health clinical practice guidelines in South African primary healthcare settings: a qualitative study.

    Science.gov (United States)

    Dizon, J M; Grimmer, K; Louw, Q; Machingaidze, S; Parker, H; Pillen, H

    2017-09-15

    The South African allied health (AH) primary healthcare (PHC) workforce is challenged with the complex rehabilitation needs of escalating patient numbers. The application of evidence-based care using clinical practice guidelines (CPGs) is one way to make efficient and effective use of resources. Although CPGs are common for AH in high-income countries, there is limited understanding of how to do this in low- to middle-income countries. This paper describes barriers and enablers for AH CPG uptake in South African PHC. Semi-structured individual interviews were undertaken with 25 South African AH managers, policymakers, clinicians and academics to explore perspectives on CPGs. Interviews were conducted by researcher dyads, one being familiar with South African AH PHC practice and the other with CPG expertise. Rigour and transparency of data collection was ensured. Interview transcripts were analysed by structuring content into codes, categories and themes. Exemplar quotations were extracted to support themes. CPGs were generally perceived to be relevant to assist AH providers to address the challenges of consistently providing evidence-based care in South African PHC settings. CPGs were considered to be tools for managing clinical, social and economic complexities of AH PHC practice, particularly if CPG recommendations were contextusalised. CPG uptake was one way to deal with increasing pressures to make efficient use of scarce financial resources, and to demonstrate professional legitimacy. Themes comprised organisational infrastructures and capacities for CPG uptake, interactions between AH actors and interaction with broader political structures, the nature of AH evidence in CPGs, and effectively implementing CPGs into practice. CPGs contextualised to local circumstances offer South African PHC AH services with an efficient vehicle for putting evidence into practice. There are challenges to doing this, related to local barriers such as geography, AH training

  3. Experiences of homosexual patients’ access to primary health care services in Umlazi, KwaZulu-Natal

    Directory of Open Access Journals (Sweden)

    Nokulunga H. Cele

    2015-09-01

    Full Text Available Background: Homosexual patients are affected by social factors in their environment, and as a result may not have easy access to existing health care services. Prejudice against homosexuality and homosexual patients remains a barrier to them seeking appropriate healthcare. The concern is that lesbians and gays might delay or avoid seeking health care when they need it because of past discrimination or perceived homophobia within the health care thereby putting their health at risk. Aim of the study: The aim of the study was to explore and describe the experiences of homosexual patients utilising primary health care (PHC services in Umlazi in the province ofKwaZulu-Natal (KZN. Method: A qualitative, exploratory, descriptive study was conducted which was contextual innature. Semi-structured interviews were conducted with 12 participants. The findings of this study were analysed using content analysis. Results: Two major themes emerged from the data analysis, namely, prejudice against homosexual patients by health care providers and other patients at the primary health care facilities, and, homophobic behaviour from primary health care personnel. Conclusion: Participants experienced prejudice and homophobic behaviour in the course of utilising PHC clinics in Umlazi, which created a barrier to their utilisation of health services located there. Nursing education institutions, in collaboration with the National Department of Health, should introduce homosexuality and anti-homophobia education programmes during the pre-service and in-service education period. Such programmes will help to familiarise health care providers with the health care needs of homosexual patients and may decrease homophobic attitudes.

  4. Assessment of medical waste management at a primary health-care center in São Paulo, Brazil

    International Nuclear Information System (INIS)

    Moreira, A.M.M.; Günther, W.M.R.

    2013-01-01

    Highlights: ► Assessment of medical waste management at health-care center before/after intervention. ► Qualitative and quantitative results of medical waste management plan are presented. ► Adjustments to comply with regulation were adopted and reduction of waste was observed. ► The method applied could be useful for similar establishments. - Abstract: According to the Brazilian law, implementation of a Medical Waste Management Plan (MWMP) in health-care units is mandatory, but as far as we know evaluation of such implementation has not taken place yet. The purpose of the present study is to evaluate the improvements deriving from the implementation of a MWMP in a Primary Health-care Center (PHC) located in the city of São Paulo, Brazil. The method proposed for evaluation compares the first situation prevailing at this PHC with the situation 1 year after implementation of the MWMP, thus allowing verification of the evolution of the PHC performance. For prior and post-diagnosis, the method was based on: (1) application of a tool (check list) which considered all legal requirements in force; (2) quantification of solid waste subdivided into three categories: infectious waste and sharp devices, recyclable materials and non-recyclable waste; and (3) identification of non-conformity practices. Lack of knowledge on the pertinent legislation by health workers has contributed to non-conformity instances. The legal requirements in force in Brazil today gave origin to a tool (check list) which was utilized in the management of medical waste at the health-care unit studied. This tool resulted into an adequate and simple instrument, required a low investment, allowed collecting data to feed indicators and also conquered the participation of the unit whole staff. Several non-conformities identified in the first diagnosis could be corrected by the instrument utilized. Total waste generation increased 9.8%, but it was possible to reduce the volume of non

  5. Perception of health care providers toward geriatric oral health in Belgaum district: A cross-sectional study.

    Science.gov (United States)

    Mehta, Nishant; Rajpurohit, Ladusingh; Ankola, Anil; Hebbal, Mamata; Setia, Priyanka

    2015-05-01

    To access knowledge and practices related to the oral health of geriatrics among the health care providers practicing in urban and rural areas. Older adults have identified a number of barriers that contribute to lack of dental service use. However, barriers that clinicians encounter in providing dental treatment to older adults are not as clear-cut. 236 health professionals (of allopathy, ayurveda, and homeopathy) from urban and rural areas were assessed by means of structured questionnaire related to oral health practices and beliefs. Doctors practicing in urban areas assessed dental care needs more frequently (P = 0.038) and performed greater practices related to oral health of geriatrics (P = 0.043) than the doctors practicing in primary health care (PHC) centers (rural) (P = 0.038). Owing to the relative lack of knowledge among rural practitioners, there is a need to integrate primary health care with oral care in rural areas.

  6. Leaving the street and reconstructing lives: impact of DOTS in empowering homeless people in Tokyo, Japan.

    Science.gov (United States)

    Kawatsu, L; Sato, N; Ngamvithayapong-Yanai, J; Ishikawa, N

    2013-07-01

    Since 2000, the Public Health Centre (PHC) in Shinjuku, an area of Tokyo with one of the largest homeless populations in Japan, has been implementing PHC-based DOTS treatment for homeless tuberculosis (TB) patients, with much epidemiological success. Anecdotal evidence indicates that homeless patients treated under DOTS have experienced various positive changes. However, this experience has not yet been systematically analysed. To explore the changes experienced by homeless TB patients, and to discuss the possible role of PHC-based DOTS treatment in effecting these changes. A qualitative study via in-depth interviews with 18 ex-homeless patients who completed DOTS-based treatment at Shinjuku City PHC. The data were analysed using the interpretive content analysis method. The various changes experienced by the participants were categorised into five sub-categories of empowerment, including improved mental health and interpersonal relationships. Some of these changes were attributable to the participants undergoing PHC-based DOTS, which, by addressing their various emotional needs, helped to trigger patient empowerment. Based on our findings, a model of empowerment using PHC-based DOTS was constructed. PHC-based DOTS not only successfully controlled TB, it also empowered homeless patients by addressing their emotional needs. The interpersonal skills of the nurses played a critical role in this process.

  7. Western Cape Primary Care Assessment Tool (PCAT) study: Measuring primary care organisation and performance in the Western Cape Province, South Africa (2013)

    Science.gov (United States)

    Sayed, Abdul-Rauf; le Grange, Cynthia; Bhagwan, Susheela; Manga, Nayna; Hellenberg, Derek

    2016-01-01

    Background Major health sector reform and the need for baseline measures of performance to determine impact. Aim Baseline audit of primary healthcare (PHC) performance. Setting Cape Town and Cape Winelands (rural) PHC facilities (PCFs) in Western Cape Province, South Africa. Method The South African cross-culturally validated ZA PCAT to audit PHC performance on 11 subdomains associated with improved health and reduced costs. Adult PCF users systematically sampled. All full-time doctors and nurse practitioners in PCFs sampled and all PCF managers in sub-districts sampled invited into the study. Results Data from 1432 users, 100 clinicians and 64 managers from 13 PCFs in 10 sub-districts analysed (figures show stakeholder percentages scoring subdomain performance ‘acceptable to good’). 11.5% users scored access ‘acceptable to good’; community orientation and comprehensive services provided 20.8% and 39.9%, respectively. Total PHC score for users 50.2%; for managers and practitioners 82.8% and 88.0%, respectively. Among practitioners access was lowest (33.3%); PHC team (98.0%) and comprehensive services available (100.0%) highest. Among managers, access (13.5%) and family centredness (45.6%) are lowest; PHC team (85.9%) and comprehensive services available (90.6%) highest. Managers scored access, family centredness and cultural competence significantly lower than practitioners. Users scored comprehensive services available, comprehensive services provided and community orientation significantly lower than practitioners and managers. Conclusion Gaps between users’ experience and providers’ assessments of PHC performance are identified. Features that need strengthening and alignment with best practice, provincial and national, and health policies are highlighted with implications for practitioner and manager training, health policy, and research. PMID:27247157

  8. The Effect of Antiretroviral Treatment on Health Care Utilization in Rural South Africa: A Population-Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Jan A C Hontelez

    Full Text Available The effect of the rapid scale-up of vertical antiretroviral treatment (ART programs for HIV in sub-Saharan Africa on the overall health system is under intense debate. Some have argued that these programs have reduced access for people suffering from diseases unrelated to HIV because ART programs have drained human and physical resources from other parts of the health system; others have claimed that the investments through ART programs have strengthened the general health system and the population health impacts of ART have freed up health care capacity for the treatment of diseases that are not related to HIV. To establish the population-level impact of ART programs on health care utilization in the public-sector health system, we compared trends in health care utilization among HIV-infected people receiving and not receiving ART with HIV-uninfected people during a period of rapid ART scale-up.We used data from the Wellcome Trust Africa Centre for Population Health, which annually elicited information on health care utilization from all surveillance participants over the period 2009-2012 (N = 32,319. We determined trends in hospitalization, and public-sector and private-sector primary health care (PHC clinic visits for HIV-infected and -uninfected people over a time period of rapid ART scale-up (2009-2012 in this community. We regressed health care utilization on HIV status and ART status in different calendar years, controlling for sex, age, and area of residence. The proportion of people who reported to have visited a public-sector primary health care (PHC clinic in the last 6 months increased significantly over the period 2009-2012, for both HIV-infected people (from 59% to 67%; p<0.001, and HIV-uninfected people (from 41% to 47%; p<0.001. In contrast, the proportion of HIV-infected people visiting a private-sector PHC clinic declined from 22% to 12% (p<0.001 and hospitalization rates declined from 128 to 82 per 1000 PY (p<0.001. For HIV

  9. The Effect of Antiretroviral Treatment on Health Care Utilization in Rural South Africa: A Population-Based Cohort Study.

    Science.gov (United States)

    Hontelez, Jan A C; Tanser, Frank C; Naidu, Kevindra K; Pillay, Deenan; Bärnighausen, Till

    2016-01-01

    The effect of the rapid scale-up of vertical antiretroviral treatment (ART) programs for HIV in sub-Saharan Africa on the overall health system is under intense debate. Some have argued that these programs have reduced access for people suffering from diseases unrelated to HIV because ART programs have drained human and physical resources from other parts of the health system; others have claimed that the investments through ART programs have strengthened the general health system and the population health impacts of ART have freed up health care capacity for the treatment of diseases that are not related to HIV. To establish the population-level impact of ART programs on health care utilization in the public-sector health system, we compared trends in health care utilization among HIV-infected people receiving and not receiving ART with HIV-uninfected people during a period of rapid ART scale-up. We used data from the Wellcome Trust Africa Centre for Population Health, which annually elicited information on health care utilization from all surveillance participants over the period 2009-2012 (N = 32,319). We determined trends in hospitalization, and public-sector and private-sector primary health care (PHC) clinic visits for HIV-infected and -uninfected people over a time period of rapid ART scale-up (2009-2012) in this community. We regressed health care utilization on HIV status and ART status in different calendar years, controlling for sex, age, and area of residence. The proportion of people who reported to have visited a public-sector primary health care (PHC) clinic in the last 6 months increased significantly over the period 2009-2012, for both HIV-infected people (from 59% to 67%; p<0.001), and HIV-uninfected people (from 41% to 47%; p<0.001). In contrast, the proportion of HIV-infected people visiting a private-sector PHC clinic declined from 22% to 12% (p<0.001) and hospitalization rates declined from 128 to 82 per 1000 PY (p<0.001). For HIV

  10. Strategic planning as a tool for achieving alignment in academic health centers.

    Science.gov (United States)

    Higginbotham, Eve J; Church, Kathryn C

    2012-01-01

    After the passage of the Patient Protection and Affordable Care Act in March 2010, there is an urgent need for medical schools, teaching hospitals, and practice plans to work together seamlessly across a common mission. Although there is agreement that there should be greater coordination of initiatives and resources, there is little guidance in the literature to address the method to achieve the necessary transformation. Traditional approaches to strategic planning often engage a few leaders and produce a set of immeasurable initiatives. A nontraditional approach, consisting of a Whole-Scale (Dannemiller Tyson Associates, Ann Arbor, MI) engagement, appreciative inquiry, and a balanced scorecard can, more rapidly transform an academic health center. Using this nontraditional approach to strategic planning, increased organizational awareness was achieved in a single academic health center. Strategic planning can be an effective tool to achieve alignment, enhance accountability, and a first step in meeting the demands of the new landscape of healthcare.

  11. Strategic Planning as a Tool for Achieving Alignment in Academic Health Centers

    Science.gov (United States)

    Higginbotham, Eve J.; Church, Kathryn C.

    2012-01-01

    After the passage of the Patient Protection and Affordable Care Act in March 2010, there is an urgent need for medical schools, teaching hospitals, and practice plans to work together seamlessly across a common mission. Although there is agreement that there should be greater coordination of initiatives and resources, there is little guidance in the literature to address the method to achieve the necessary transformation. Traditional approaches to strategic planning often engage a few leaders and produce a set of immeasurable initiatives. A nontraditional approach, consisting of a Whole-Scale (Dannemiller Tyson Associates, Ann Arbor, MI) engagement, appreciative inquiry, and a balanced scorecard can, more rapidly transform an academic health center. Using this nontraditional approach to strategic planning, increased organizational awareness was achieved in a single academic health center. Strategic planning can be an effective tool to achieve alignment, enhance accountability, and a first step in meeting the demands of the new landscape of healthcare. PMID:23303997

  12. Comparative Evaluation of Cash Benefit Scheme of Janani Suraksha Yojana for Beneficiary Mothers from Different Health Care Settings of Rewa District, Madhya Pradesh, India.

    Directory of Open Access Journals (Sweden)

    Trivedi R

    2014-05-01

    Full Text Available Introduction: For better outcomes in mother and child health, Government of India launched the National Rural Health Mission (NRHM in 2005 with a major objective of providing accessible, affordable and quality health care to the rural population; especially the vulnerable. Reduction in MMR to 100/100,000 is one of its goals and the Janani Suraksha Yojana (JSY is the key strategy of NRHM to achieve this reduction. The JSY, as a safe motherhood intervention and modified alternative of the National Maternity Benefit Scheme (NMBS, has been implemented in all states and Union territories with special focus on low performing states. The main objective and vision of JSY is to reduce maternal, neo-natal mortality and promote institutional delivery among the poor pregnant women of rural and urban areas. This scheme is 100% centrally sponsored and has an integrated delivery and post delivery care with the help of a key person i.e. ASHA (Accredited Social Health Activist, followed by cash monetary help to the women. Objectives: 1To evaluate cash benefit service provided under JSY at different health care settings. 2 To know the perception and elicit suggestions of beneficiaries on quality of cash benefit scheme of JSY. Methodology: This is a health care institute based observational cross sectional study including randomly selected 200 JSY beneficiary mothers from the different health care settings i.e., Primary Health Centres, Community Health Centres, District Hospital and Medical College Hospital of Rewa District of Madhya Pradesh state. Data was collected with the help of set pro forma and then analysed with Epi Info 2000. Chi square test was applied appropriately. Results: 60% and 80% beneficiaries from PHC and CHC received cash within 1 week after discharge whereas 100% beneficiaries of District Hospital and Medical College Hospital received cash at the time of discharge; the overall distribution of time of cash disbursement among beneficiaries of

  13. Human rights and the right to health in Latin America: the Two Faces of One Powerful Idea

    Directory of Open Access Journals (Sweden)

    Alicia Ines Stolkiner

    2010-04-01

    Full Text Available During the past decade the discussion of human rights has reappeared in the field of health, replacing the technocratic approaches of the previous period which had centered on cost-effectiveness. The focus on rights in public policies, with its emphasis on international norms for social rights, has influenced primary health care (PHC strategy and fostered the return of PHC to its original role as guarantor of the right to health.3 As human rights became increasingly global, they once again occupied a central place in World Health Organization (WHO documents and in government attitudes. The revival of human rights discourse occurred at a time when neoliberalism was being discredited intellectually. It coincided with the appearance of governments critical of the hegemonic model of the 1990s, the restructuring of geopolitical alliances, and a crisis of world capitalism affecting its central core. Various trends have co-existed within this process; the attempt to establish more just societies runs parallel to the search for a new way to legitimize power, given the loss of consensus over the neoliberal model. This dual aspect of the inclusion of human rights in the political arena demands a careful analysis of the various discourses and the proposals with which they are associated.

  14. Predictors of women's utilization of primary health care for skilled pregnancy care in rural Nigeria.

    Science.gov (United States)

    Okonofua, Friday; Ntoimo, Lorretta; Ogungbangbe, Julius; Anjorin, Seun; Imongan, Wilson; Yaya, Sanni

    2018-04-18

    Although Primary Health Care (PHC) was designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths, very little is known of the factors that predict the use of PHC for skilled maternity care in rural parts of Nigeria - where its use is likely to have a greater positive impact on maternal health care. The objective of this study was to identify the factors that lead pregnant women to use or not use existing primary health care facilities for antenatal and delivery care. The study was a cross-sectional community-based study conducted in Esan South East and Etsako East LGAs of Edo State, Nigeria. A total of 1408 randomly selected women of reproductive age were interviewed in their households using a pre-tested structured questionnaire. The data were analyzed with descriptive and multivariate statistical methods. The results showed antenatal care attendance rate by currently pregnant women of 62.1%, and a skilled delivery of 46.6% by recently delivered women at PHCs, while 25% of women delivered at home or with traditional birth attendants. Reasons for use and non-use of PHCs for antenatal and delivery care given by women were related to perceptions about long distances to PHCs, high costs of services and poor quality of PHC service delivery. Chi-square test of association revealed that level of education and marital status were significantly related to use of PHCs for antenatal care. The results of logistic regression for delivery care showed that women with primary (OR 3.10, CI 1.16-8.28) and secondary (OR 2.37, CI 1.19-4.71) levels education were more likely to receive delivery care in PHCs than the highly educated. Being a Muslim (OR 1.56, CI 1.00-2.42), having a partner who is employed in Estako East (OR 2.78, CI 1.04-7.44) and having more than five children in Esan South East (OR 2.00, CI 1.19-3.35) significantly increased the odds of delivery in PHCs. The likelihood of using a PHC facility was less for women who had more

  15. Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India.

    Science.gov (United States)

    Prinja, Shankar; Gupta, Aditi; Verma, Ramesh; Bahuguna, Pankaj; Kumar, Dinesh; Kaur, Manmeet; Kumar, Rajesh

    2016-01-01

    With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology. The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630-10,294,065) and INR 26.9 million (95% CI: 22,225,159.3-32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6-208.3) and INR162.1 (95% CI: 112-219.1), respectively. The study estimates can be used

  16. Primary health care in rural Malawi - a qualitative assessment exploring the relevance of the community-directed interventions approach

    DEFF Research Database (Denmark)

    Makaula, Peter; Bloch, Paul; Banda, Hastings T.

    2012-01-01

    Primary Health Care (PHC) is a strategy endorsed for attaining equitable access to basic health care including treatment and prevention of endemic diseases. Thirty four years later, its implementation remains sub-optimal in most Sub-Saharan African countries that access to health interventions...... is still a major challenge for a large proportion of the rural population. Community-directed treatment with ivermectin (CDTi) and community-directed interventions (CDI) are participatory approaches to strengthen health care at community level. Both approaches are based on values and principles associated...

  17. The relationship of school performance and mental health: Educational achievement as indicator of psychopathology

    NARCIS (Netherlands)

    Tempelaar, W.M.

    2017-01-01

    In this thesis we explored the relationship between poor educational achievement and psychopathology. Examining the association between educational achievement and mental health problems and development of psychiatric disorders is important to investigate the potential value of educational

  18. Why Is Bigger Not Always Better in Primary Health Care Practices? The Role of Mediating Organizational Factors

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    Raynald Pineault MD, PhD

    2016-01-01

    Full Text Available Size of primary health care (PHC practices is often used as a proxy for various organizational characteristics related to provision of care. The objective of this article is to identify some of these organizational characteristics and to determine the extent to which they mediate the relationship between size of PHC practice and patients’ experience of care, preventive services, and unmet needs. In 2010, we conducted population and organization surveys in 2 regions of the province of Quebec. We carried out multilevel linear and logistic regression analyses, adjusting for respondents’ individual characteristics. Size of PHC practice was associated with organizational characteristics and resources, patients’ experience of care, unmet needs, and preventive services. Overall, the larger the size of a practice, the higher the accessibility, but the lower the continuity. However, these associations faded away when organizational variables were introduced in the analysis model. This result supports the hypothesized mediating effect of organizational characteristics on relationships between practice size and patients’ experience of care, preventive services, and unmet needs. Our results indicate that size does not add much information to organizational characteristics. Using size as a proxy for organizational characteristics can even be misleading because its relationships with different outcomes are highly variable.

  19. Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service

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    O'Dea Kerin

    2011-01-01

    Full Text Available Abstract Background Cardiovascular disease (CVD is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC, results in better identification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community. Methods Interrupted time series study over six years in a remote primary health care (PHC service involving Aboriginal adults identified with elevated CVD risk (N = 64. Several process and outcome measures were audited at 6 monthly intervals for three years prior to the AHC (the intervention and three years following: (i the proportion of guideline scheduled CVD preventive care services delivered, (ii mean CVD medications prescribed and dispensed, (iii mean PHC consultations, (iv changes in participants' CVD risk factors and estimated absolute CVD risk and (v mean number of CVD events and iatrogenic events. Results Twenty-five percent of AHC participants were identified as having elevated CVD risk. Of these, 84% had not been previously identified during routine care. Following the intervention, there were significant improvements in the recorded delivery of preventive care services for CVD (30% to 53%, and prescription of CVD related medications (28% to 89% (P P = 0.004 following the intervention. However, there were no significant changes in the mean number of PHC consultations or mean number of CVD events or iatrogenic events. Conclusions Holistic CVD risk assessment during an AHC can lead to better and earlier identification of elevated CVD risk, improvement in the recorded delivery of preventive care services for CVD, intensification of treatment for CVD, and improvements in participants' CVD risk profile. Further research is required on

  20. The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care.

    Science.gov (United States)

    Carlfjord, S; Andersson, A; Nilsen, P; Bendtsen, P; Lindberg, M

    2010-12-01

    The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers' theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC. © 2010 Blackwell Publishing Ltd.

  1. Millennium Development Goals: how public health professionals perceive the achievement of MDGs

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    Marta Lomazzi

    2014-09-01

    Full Text Available Background: There have been various consultations on the Millennium Development Goals (MDGs by different groups. However, even if it is clear that the health sector has led the development success of the MDGs, only a few MDG reports consider public health experts’ points of view and these are mainly government driven. Designs: The World Federation of Public Health Associations (WFPHA has executed a global survey to consult public health professionals worldwide concerning the implementation and achievements of the MDGs.The survey was conceived by WFPHA health professionals and promulgated online. Public health professionals and organisations dealing with MDGs responded to the survey. Content analysis was conducted to analyse the data. Results: Survey participants attributed the highest importance worldwide to MDGs dealing with women, poverty and hunger reduction, and disease prevention and management. Moreover, they underlined the role of education, referring both to school children and professionals. In high and upper-middle income countries, environmental challenges also received considerable attention.Notably, respondents underlined that weak governance and unstable political situations, as well as the gap between professionals and politicians, were among the main causes that detracted from MDG achievements. Conclusion: The public health workforce felt it would be imperative to be included from the outset in the design and implementation of further goals. This implies that those professionals have to take an active part in the political process leading to a new and accountable framework.

  2. Influence of organizational culture on provider adherence to the diabetic clinical practice guideline: using the competing values framework in Palestinian Primary Healthcare Centers

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    Radwan M

    2017-08-01

    Full Text Available Mahmoud Radwan,1 Ali Akbari Sari,1 Arash Rashidian,1 Amirhossein Takian,1 Sanaa Abou-Dagga,2 Aymen Elsous1 1Department of Health Management and Economics, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran; 2Department of Research Affairs and Graduates Studies, Islamic University of Gaza, Gaza Strip, Palestine Background: Diabetes mellitus (DM is a serious chronic disease and an important public health issue. This study aimed to identify the predominant culture within the Palestinian Primary Healthcare Centers of the Ministry of Health (PHC-MoH and the Primary Healthcare Centers of the United Nations Relief and Works Agency for Palestine Refugees (PHC-UNRWA by using the competing values framework (CVF and examining its influence on the adherence to the Clinical Practice Guideline (CPG for DM.Methods: A cross-sectional design was employed with a census sample of all the Palestinian family doctors and nurses (n=323 who work within 71 PHC clinic. A cross-cultural adaptation framework was followed to develop the Arabic version of the CVF questionnaire. Results: The overall adherence level to the diabetic guideline was disappointingly suboptimal (51.5%, p<0.001; 47.3% in the PHC-MoH and 55.5% in the PHC-UNRWA. In the PHC-MoH, the clan/group culture was the most predominant (mean =41.13; standard deviation [SD] =8.92, followed by hierarchical (mean =33.14; SD=5.96, while in the PHC-UNRWA, hierarchical was the prevailing culture (mean =48.43; SD =12.51, followed by clan/group (mean =29.73; SD =8.37. Although a positively significant association between the adherence to CPG and the rational culture and a negatively significant association with the developmental archetype were detected in the PHC-MoH, no significant associations were found in the PHC-UNRWA. Conclusion: Our study demonstrates that the organizational culture has a marginal influence on the adherence to the diabetic guideline. Future research

  3. The Relationships and Risk Factors Associated with Hypertension, Diabetes, and Proteinuria among Adults from Bheramara Upazila, Bangladesh: Findings from Portable Health Clinic Data, 2013-2016

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    Fumihiko Yokota

    2018-02-01

    Full Text Available Objective: The aim of this study was to investigate the relationships among hypertension, diabetes, and proteinuria and their risk factors in adults who participated in a community-based mobile health check-up service called portable health clinic (PHC in rural Bangladesh. Methods: Data were collected from 2890 individuals who agreed to participate in the PHC at Bheramara sub-district between 2013 and 2016. Data included basic demographic and health check-up information. Multivariate logistic regression models were used with three outcome variables (proteinuria, diabetes, and hypertension and four independent and control variables (age, sex, pulse rate, and body mass index. Results: Among participants who had both hypertension and diabetes, 77% had proteinuria. Among those who had diabetes, 55% had proteinuria and 45% had hypertension. Age and sex-adjusted logistic regression models found that diabetes was significantly associated with proteinuria (odds ratio OR=3.0, P=0.005, while the association between hypertension and proteinuria showed borderline significance (P<0.057. Hypertension was significantly associated with diabetes after controlling for age and sex (OR=1.5, P<0.001. Participants aged older than 40 years had higher odds of having diabetes or having hypertension comparing with the odds for participants aged between 15 and 39 years. Conclusions: Prevention of complications in Non-Communicable Diseases (NCD in Bheramara needs to focus on sub-populations aged older than 40 years and those with hypertension, diabetes, and/or proteinuria. PHC services in rural Bangladesh is important for screening a large number of unaware and undiagnosed diabetic, hypertensive, and proteinuria patients.

  4. Family socioeconomic status, family health, and changes in students' math achievement across high school: A mediational model.

    Science.gov (United States)

    Barr, Ashley Brooke

    2015-09-01

    In response to recent calls to integrate understandings of socioeconomic disparities in health with understandings of socioeconomic disparities in academic achievement, this study tested a mediational model whereby family socioeconomic status predicted gains in academic achievement across high school through its impact on both student and parent health. Data on over 8000 high school students in the U.S. were obtained from wave 1 (2009-2010) and wave 2 (2012) of the High School Longitudinal Study of 2009 (HSLS:09), and structural equation modeling with latent difference scores was used to determine the role of family health problems in mediating the well-established link between family SES and gains in academic achievement. Using both static and dynamic indicators of family SES, support was found for this mediational model. Higher family SES in 9th grade reduced the probability of students and their parents experiencing a serious health problem in high school, thereby promoting growth in academic achievement. In addition, parent and student health problems mediated the effect of changes in family SES across high school on math achievement gains. Results emphasize the importance of considering the dynamic nature of SES and that both student and parent health should be considered in understanding SES-related disparities in academic achievement. This relational process provides new mechanisms for understanding the intergenerational transmission of socioeconomic status and the status attainment process more broadly. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.

    Science.gov (United States)

    Luitel, Nagendra P; Jordans, Mark Jd; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H

    2015-01-01

    Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry

  6. Comparing the performance of the public, social security and private health subsystems in Argentina by core dimensions of primary health care.

    Science.gov (United States)

    Yavich, Natalia; Báscolo, Ernesto Pablo; Haggerty, Jeannie

    2016-06-01

    Most Latin American health systems are comprised of public (PubS), social security (SSS) and private (PrS) subsystems. These subsystems coexist, causing health care fragmentation and population segmentation. To estimate the extent of subsystem cross-coverage in a geographically bounded population (Rosario city) and to compare the subsystems' performance on primary health care (PHC) dimensions. Through a cross-sectional, interviewer-administered survey to a representative sample (n = 822) of the Rosario population, we measured the percentage of cross-coverage (people with usual source of care in one subsystem but also covered by another subsystem) and the health services' performance by core PHC dimensions, as reported by each subsystem's usual users. We compared the subsystems' performance using chi-square analysis and one-way analysis of variance testing. We analyzed whether the observed differences were coherent with the predominant institutional and organizational features of each subsystem. Overall, 39.3% of the population was affiliated with the PubS, 44.8% with the SSS and 15.9% with the PrS. Cross-coverage was reported by 40.6% of respondents. The performance of the PubS was weak on accessibility but strong on person-and-community-oriented care, the opposite of the PrS. The SSS combined the strengths of the other two subsystems. Rosario's health system has a high percentage of cross-coverage, contributing to issues of fragmentation, segmentation, financial inequity and inefficiency. The overall performance of the SSS was better than that of the PrS and PubS, though each subsystem had a particular performance pattern with areas of strength and weakness that were consistent with their institutional and organizational profiles. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  7. HEALTH-RISK BEHAVIOUR IN REGARD OF FAMILY STRUCTURE AND ITS EFFECT ON ACADEMIC ACHIEVEMENT

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    Kovács, Karolina Eszter

    2018-01-01

    Full Text Available The frequency of health-risk behaviours like smoking, alcohol consumption and substance use is usually higher in adolescence. In addition, its appearance is higher among students coming from non-intact families. These factors also have a strong influence on academic achievement as students from fragile families and students having these health-damaging habits tend to be less effective. According to our results, four different student clusters can be detected regarding health behaviour (traditional risk-takers, hard risk-takers, ambivalent students and risk-avoiders. Ambivalent students reached the best achievement while hard risk-takers showed the poorest efficacy. Finally, students from intact families showed better results compared to their peers from single-parent or patchwork families.

  8. Smoking cessation advice: the self-reported attitudes and practice of primary health care physicians in a military community, central Saudi Arabia.

    Science.gov (United States)

    AlAteeq, Mohammed; Alrashoud, Abdulaziz M; Khair, Mohammed; Salam, Mahmoud

    2016-01-01

    Brief advice on smoking cessation from primary health care (PHC) physicians reduces smoking prevalence. However, few studies have investigated the provision of such advice by PHC physicians providing services to military communities. The aim of this study was to evaluate PHC physicians' attitudes toward and practice of delivering smoking cessation advice to smokers in a military community in central Saudi Arabia. A self-reported survey of PHC physicians was conducted in 2015 using a previously validated tool. The age, sex, educational level, job title, experience and previous smoking cessation training of each physician was recorded. Attitude (ten statements) and practice (six statements) were evaluated on a five-point Likert scale. Scoring system was applied and percentage mean scores (PMS) were calculated. Descriptive/statistical analyses were applied to identify factors that were significantly associated with a positive attitude and favorable practice (PMS >65 each). P-values smoking cessation educational program in the previous year. Approximately 75% of physicians had a positive attitude (PMS =72.4±11.2), while 64.4% reported favorable practice (PMS =65.3±27.7). Higher education levels were significantly more associated with positive attitude than lower education levels (adj. odds ratio [OR] 95% confidence interval [CI] =17.9 [1.3-242.3]; adj. P=0.03). More experienced physicians (adj. OR [95% CI] =9.5 [1.6-54.6]) and those with positive attitude (adj. OR [95% CI] =6.1 [1.6-23.3]) were more likely to report a favorable practice, compared to the less experienced (adj. P=0.012) and physicians with a negative attitude (adj. P=0.008). Provision of smoking cessation advice by primary health care physicians serving a military community is significantly associated with their attitude and years of experience. Patients who are seeking smoking cessation advice should be referred to physicians with higher levels of education. Routinely scheduled training on proper

  9. Perceived challenges to achieving universal health coverage: a cross-sectional survey of social health insurance managers/administrators in China.

    Science.gov (United States)

    Shan, Linghan; Wu, Qunhong; Liu, Chaojie; Li, Ye; Cui, Yu; Liang, Zi; Hao, Yanhua; Liang, Libo; Ning, Ning; Ding, Ding; Pan, Qingxia; Han, Liyuan

    2017-06-02

    China has achieved over 96% health insurance coverage. However, universal health coverage (UHC) entails population coverage and the range of services covered and the extent to which health service costs are covered. This study aimed to determine the performance of the health insurance system in China in terms of its role in UHC and to identify challenges in the progress of UHC as perceived by health insurance managers/administrators. A cross-sectional questionnaire survey was conducted in Beijing, Ningbo, Harbin and Chongqing over the period of 2014 and 2015. A stratified cluster random sampling strategy was adopted to select study participants. A total of 1277 (64.8%) respondents who reported familiarity with the current health insurance system and the requirements of UHC provided valid data for analyses. They gave a rating on the role of the current health insurance system in achieving UHC. A multivariate logistic regression model was developed to determine the associations between the rating and the features of insurance arrangements. There was consensus among the respondents on the performance of the current health insurance system in terms of its role in UHC, regardless who they were and what responsibility they held in their organisation (ie, policy development, managing fund transactions, and so on). Overall, about 45% of the respondents believed that there is a long way to go to achieve UHC. The low rating was found to be associated with limited financial protection (OR=1.656, 95% CI 1.279 to 2.146), healthcare inequity (OR=1.607, 95% CI 1.268 to 2.037), poor portability (OR=1.347, 95% CI 1.065 to 1.703) and ineffective supervision and administration of funds (OR=1.339, 95% CI 1.061 to 1.692) as perceived by the respondents. Health insurance managers/administrators in China are pessimistic about the achievements of the current health insurance system. They are concerned about the overall lack of benefit that insurance programmes bring to members

  10. Leadership profile: HealthAchieve 2013 Nursing Leadership Award Winner, Tiziana Rivera.

    Science.gov (United States)

    Rivera, Tiziana

    2014-03-01

    Tiziana Rivera, the winner of the 2013 Nursing Leadership Award at the November HealthAchieve conference, is chief nursing executive and chief practice officer at Mackenzie Health. As such, she provides strategic leadership for the development and implementation of a shared vision for professional practice, nursing and all disciplines to promote innovative care and the development of care delivery models that will improve quality of care and population health.Prior to assuming her position at Mackenzie Health, Rivera provided strategic leadership for the Seniors' Health Program at Trillium Health Centre, where her role focused on the development of seniors' health services across the continuum of care. She has published numerous articles in refereed journals, conducted several research studies and presented her papers provincially, nationally and internationally. Rivera has a clinical appointment at the University of Toronto Faculty of Nursing, a faculty adviser position at Ryerson and an adjunct faculty position at the School of Health Sciences, York University and at the School of Health Sciences, Humber Institute of Technology and Advanced Learning.In the following Q and A, Rivera shares her thoughts on leadership in nursing and perspectives on several critical issues.

  11. Effect of distance learning on (health worker behvarz knowledge level in comparison with other health teams of Kashan, health care systems in the field of PHC (Primary Health Care 2014

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    Zohre Rajabi

    2018-01-01

    Full Text Available Background: Health education is the first and most important step in health care. Then, it is necessary to pay attention to personnel training. Methods: The research population is all employees of Kashan University of Medical Sciences who were selected through the census. Educational pamphlets were sent to the centers and the first test was held. After 2 months, the test was resumed. Data were analyzed using SPSS software and paired t-test. Results: The highest percentage of correct responses by groups of community health workers, technicians, and experts struggles with illness, family health expert technicians, and midwives-related topic drugs are estimated to be in the home health. The lowest percentage of correct answers was to issues related to physical activity pyramid, pyramid charts, and knowledge of physical activity. The findings of this study showed that there was no significant difference between the study groups with community health workers' knowledge of aging issues, depression, health, miracle foods, drugs, home health assessment, and cough natural asthma in children, bandages and dressings, child abuse, thalassemia research on home health care, quality improvement, empowerment, injection safety, physical activity, and oral health pyramid (in 80% of paired comparisons between groups of the worker. Conclusion: Due to the lack of significant differences between knowledge community health workers and other health team members in most comparisons of educational programs in primary health care for health professionals, it seems that university education should be done with higher qualifications for high academic degrees and if we learn more to community health workers, we can expect high performance from them.

  12. Achieving the American dream: facilitators and barriers to health and mental health for Latino immigrants.

    Science.gov (United States)

    Shobe, Marcia A; Coffman, Maren J; Dmochowski, Jacek

    2009-01-01

    Latinos are the largest minority group in the U.S. For Latino immigrants, a shift in migration from larger to smaller cities has recently occurred; the Latino immigrant population in Charlotte, North Carolina, has increased by 634% since 1990. The extent to which immigrants can achieve health and well-being is often related to employment, healthcare access, and social support. This study explored the human, social, and financial capital circumstances of Latino immigrants new to Charlotte and examined the effects of different aspects of capital on health outcomes. Findings indicate that capital is significantly associated with functional status and depression. Implications for social work are discussed.

  13. La prevención de la mortalidad por dengue: un espacio y un reto para la atención primaria de salud Preventing deaths from dengue: a space and challenge for primary health care

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    Eric Martínez Torres

    2006-07-01

    Full Text Available Dengue is an arthropod-borne viral disease whose frequency has increased steadily in the Americas over the past 25 years. The type of dengue that carries the highest mortality is the clinical variant known as dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS. Even though no vaccine or drug against the disease is available, successful management consists of preventing serious illness through patient follow-up and monitoring danger signals so as to be able to initiate aggressive intravenous rehydration and prevent shock or treat it early and successfully. These measures are also useful in preventing other complications, such as massive hemorrhage, disseminated intravascular coagulation, multiple organ failure, and respiratory failure due to non-cardiogenic pulmonary edema. Primary health care (PHC settings and the community are ideal spaces for this type of preventive management based on health education and active case detection. It involves training all medical and nursing staff, students, and community health workers, as well as reorganizing health care in PHC units and hospitals and redistributing available resources during a dengue epidemic.

  14. Is integration of healthy lifestyle promotion into primary care feasible? Discussion and consensus sessions between clinicians and researchers

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    Arrazola Arantza

    2008-10-01

    Full Text Available Abstract Background The adoption of a healthy lifestyle, including physical activity, a healthy diet, moderate alcohol consumption and abstinence from smoking, is associated with a major decrease in the incidence of chronic diseases and mortality. Primary health-care (PHC services therefore attempt, with rather limited success, to promote such lifestyles in their patients. The objective of the present study is to ascertain the perceptions of clinicians and researchers within the Basque Health System of the factors that hinder or facilitate the integration of healthy lifestyle promotion in routine PHC setting. Methods Formative research based on five consensus meetings held by an expert panel of 12 PHC professionals with clinical and research experience in health promotion, supplied with selected bibliographic material. These meetings were recorded, summarized and the provisional findings were returned to participants in order to improve their validity. Results The Health Belief Model, the Theory of Planned Action, the Social Learning Theory, "stages of change" models and integrative models were considered the most useful by the expert panel. Effective intervention strategies, such as the "5 A's" strategy (assess, advise, agree, assist and arrange are also available. However, none of these can be directly implemented or continuously maintained under current PHC conditions. These strategies should therefore be redesigned by adjusting the intervention objectives and contents to the operation of primary care centres and, in turn, altering the organisation of the centres where they are to be implemented. Conclusion It is recommended to address optimisation of health promotion in PHC from a research perspective in which PHC professionals, researchers and managers of these services cooperate in designing and evaluating innovative programs. Future strategies should adopt a socio-ecological approach in which the health system plays an essential role but

  15. Participatory health councils and good governance: healthy democracy in Brazil?

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    Kohler, Jillian Clare; Martinez, Martha Gabriela

    2015-02-19

    The Brazilian Government created Participatory Health Councils (PHCs) to allow citizen participation in the public health policy process. PHCs are advisory bodies that operate at all levels of government and that bring together different societal groups to monitor Brazil's health system. Today they are present in 98% of Brazilian cities, demonstrating their popularity and thus their potential to help ensure that health policies are in line with citizen preferences. Despite their expansive reach, their real impact on health policies and health outcomes for citizens is uncertain. We thus ask the following question: Do PHCs offer meaningful opportunities for open participation and influence in the public health policy process? Thirty-eight semi-structured interviews with health council members were conducted. Data from these interviews were analyzed using a qualitative interpretive content analysis approach. A quantitative analysis of PHC data from the Sistema de Acompanhamento dos Conselhos de Saude (SIACS) database was also conducted to corroborate findings from the interviews. We learned that PHCs fall short in many of the categories of good governance. Government manipulation of the agenda and leadership of the PHCs, delays in the implementation of PHC decision making, a lack of training of council members on relevant technical issues, the largely narrow interests of council members, the lack of transparency and monitoring guidelines, a lack of government support, and a lack of inclusiveness are a few examples that highlight why PHCs are not as effective as they could be. Although PHCs are intended to be inclusive and participatory, in practice they seem to have little impact on the health policymaking process in Brazil. PHCs will only be able to fulfil their mandate when we see good governance largely present. This will require a rethinking of their governance structures, processes, membership, and oversight. If change is resisted, the PHCs will remain largely

  16. Demand assessment and price-elasticity estimation of quality-improved primary health care in Palestine: a contribution from the contingent valuation method.

    Science.gov (United States)

    Mataria, Awad; Luchini, Stéphane; Daoud, Yousef; Moatti, Jean-Paul

    2007-10-01

    This paper proposes a new methodology to assess demand and price-elasticity for health care, based on patients' stated willingness to pay (WTP) values for certain aspects of health care quality improvements. A conceptual analysis of how respondents consider contingent valuation (CV) questions allowed us to specify a probability density function of stated WTP values, and consequently, to model a demand function for quality-improved health care, using a parametric survival approach. The model was empirically estimated using a CV study intended to assess patients' values for improving the quality of primary health care (PHC) services in Palestine. A random sample of 499 individuals was interviewed following medical consultation in four PHC centers. Quality was assessed using a multi-attribute approach; and respondents valued seven specific quality improvements using a decomposed valuation scenario and a payment card elicitation technique. Our results suggest an inelastic demand at low user fees levels, and when the price-increase is accompanied with substantial quality-improvements. Nevertheless, demand becomes more and more elastic if user fees continue to rise. On the other hand, patients' reactions to price-increase turn out to depend on their level of income. Our results can be used to design successful health care financing strategies that include a consideration of patients' preferences and financial capacities. John Wiley & Sons, Ltd.

  17. Exploration of priority actions for strengthening the role of nurses in achieving universal health coverage.

    Science.gov (United States)

    Maaitah, Rowaida Al; AbuAlRub, Raeda Fawzi

    2017-01-30

    to explore priority actions for strengthening the role of Advanced Practice Nurses (APNs) towards the achievement of Universal Health Converge (UHC) as perceived by health key informants in Jordan. an exploratory qualitative design, using a semi-structured survey, was utilized. A purposive sample of seventeen key informants from various nursing and health care sectors was recruited for the purpose of the study. Content analysis utilizing the five-stage framework approach was used for data analysis. the findings revealed that policy and regulation, nursing education, research, and workforce were identified as the main elements that influence the role of APNs in contributing to the achievement of UHC. Priority actions were identified by the participants for the main four elements. study findings confirm the need to strengthen the role of APNs to achieve UHC through a major transformation in nursing education, practice, research, leadership, and regulatory system. Nurses should unite to come up with solid nursing competencies related to APNs, PHC, UHC, leadership and policy making to strengthen their position as main actors in influencing the health care system and evidence creation. analisar as ações prioritárias para o fortalecimento do papel da enfermeira em prática avançada na Cobertura Universal de Saúde , segundo a percepção dos informantes-chave na Jordânia. foi utilizado desenho qualitativo exploratório, com um questionário semiestruturado. A amostra intencional de dezessete informantes-chave de vários setores de enfermagem e de saúde foi recrutado para o propósito do estudo. A análise de conteúdo utilizando a abordagem do quadro de cinco estágios foi utilizada para a análise de dados. os resultados revelaram que as políticas e regulações, educação em enfermagem, pesquisa e força de trabalho foram identificados como os principais elementos que influenciam o papel da enfermeira em prática avançada em contribuir para a realização da

  18. Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing.

    Science.gov (United States)

    Tangcharoensathien, Viroj; Limwattananon, Supon; Patcharanarumol, Walaiporn; Thammatacharee, Jadej; Jongudomsuk, Pongpisut; Sirilak, Supakit

    2015-11-01

    Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser-provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite

  19. The Barriers to Achieve Financial Protection in Iranian Health System: A Qualitative Study in a Developing Country.

    Science.gov (United States)

    Naghdi, Seyran; Moradi, Tayebeh; Tavangar, Fateh; Bahrami, Giti; Shahboulaghi, Mohammadi; Ghiasvand, Hesam

    2017-09-01

    The move to universal health coverage and consequently health promotion is influenced by political, socio-economic and other contextual factors in a country. Iran, as a developing country with an upper-middle national income, has developed policies to achieve universal health coverage through financial protection. This study aims to investigate barriers to develop financial protection as a requirement to achieve universal health coverage. This qualitative study was conducted using 20 in-depth interviews with experts in social welfare, health insurance and financing. The framework analysis method was used to analyze the data. The results have been categorized in three major themes that were extracted from ten sub-themes. The major themes included the political, social and economic context of the country, the context and structure of healthcare system and dimensions of UHC. Achieving financial protection as a long-term objective should be considered as a priority among Iranian policy makers that requires an inter-sectoral collaboration with a defined in-charge body. Health policy makers in Iran should develop a more comprehensive benefits package for diseases and health conditions with catastrophic consequences. They also should develop a plan to cover the poor people.

  20. Effects of increased nurses’ workload on quality documentation of patient information at selected Primary Health Care facilities in Vhembe District, Limpopo Province

    OpenAIRE

    Rhulani C. Shihundla; Rachel T. Lebese; Maria S. Maputle

    2016-01-01

    Background: Recording of information on multiple documents increases professional nurses’ responsibilities and workload during working hours. There are multiple registers and books at Primary Health Care (PHC) facilities in which a patient’s information is to be recorded for different services during a visit to a health professional. Antenatal patients coming for the first visit must be recorded in the following documents: tick register; Prevention of Mother-ToChild Transmission (PMTCT) regis...

  1. Assessing the role of appropriate primary health care on the use of dental services by Brazilian low-income preschool children

    OpenAIRE

    Baldani, Márcia Helena; Rocha, Juliana Schaia; Fadel, Cristina Berger; Nascimento, Antonio Carlos; Antunes, José Leopoldo Ferreira; Moysés, Samuel Jorge

    2017-01-01

    Abstract: This cross-sectional study aimed to assess the association between the quality of primary health care (PHC) and the use of dental services by preschoolers served by the Family Health Strategy (FHS), controlling for socio-demographic determinants and perceived need. The sample encompassed 438 children aged 3-5 years, enrolled in 19 FHS facilities in Ponta Grossa, Paraná State, Brazil. Individual level variables were collected by interviewing parents or caregivers at home. They answer...

  2. Responses of Aboriginal and Torres Strait Islander Primary Health-Care Services to Continuous Quality Improvement Initiatives.

    Science.gov (United States)

    Larkins, Sarah; Woods, Cindy E; Matthews, Veronica; Thompson, Sandra C; Schierhout, Gill; Mitropoulos, Maxwell; Patrao, Tania; Panzera, Annette; Bailie, Ross Stewart

    2015-01-01

    Indigenous primary health-care (PHC) services participating in continuous quality improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining quality improvement initiatives. The aim of this study is to examine trends in quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time and examine health service characteristics associated with positive and negative trends in quality of care. PHC services providing care for Indigenous people in urban, rural, and remote northern Australia that had completed at least three annual audits of service delivery for at least one aspect of care (n = 73). Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analyzed. Health center performance was classified into six patterns of change over time: consistent high improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in quality of care. Trends in quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model, or accreditation status with positive or negative trends in quality of care. The variable trends in quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the

  3. Accelerators/decelerators of achieving universal access to sexual and reproductive health services: a case study of Iranian health system.

    Science.gov (United States)

    Akbari, Nahid; Ramezankhani, Ali; Pazargadi, Mehrnoosh

    2013-07-01

    At the 1994 International Conference on Population and Development (ICPD), held in Cairo, the global community agreed to the goal of achieving universal access to sexual and reproductive health (SRH) and rights by 2015. This research explores the accelerators and decelerators of achieving universal access to the sexual and reproductive health targets and accordingly makes some suggestions. We have critically reviewed the latest national reports and extracted the background data on each SRH indicator. The key stakeholders, both national and international, were visited and interviewed at two sites. A total of 55 in-depth interviews were conducted with religious leaders, policy-makers, senior managers, senior academics, and health care managers. Six focus-group discussions were also held among health care providers. The study was qualitative in nature. Obstacles on the road to achieving universal access to SRH can be viewed from two perspectives. One gap exists between current achievements and the targets. The other gap arises due to age, marital status, and residency status. The most recently observed trends in the indicators of the universal access to SRH shows that the achievements in the "unmet need for family planning" have been poor. Unmet need for family planning could directly be translated to unwanted pregnancies and unwanted childbirths; the former calls for sexual education to underserved people, including adolescents; and the latter calls for access to safe abortion. Local religious leaders have not actively attended international goal-setting programs. Therefore, they usually do not presume a positive attitude towards these goals. Such negative attitudes seem to be the most important factors hindering the progress towards universal access to SRH. Lack of international donors to fund for SRH programs is also another barrier. In national levels both state and the society are interactively playing their roles. We have used a cascade model for presenting the

  4. [Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

    Science.gov (United States)

    Bergholz, W

    2008-11-01

    In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

  5. The experience of community health workers training in Iran: a qualitative study

    Directory of Open Access Journals (Sweden)

    Javanparast Sara

    2012-08-01

    Full Text Available Abstract Background The role of Community Health Workers (CHWs in improving access to basic healthcare services, and mobilising community actions on health is broadly recognised. The Primary Health Care (PHC approach, identified in the Alma Ata conference in 1978, stressed the role of CHWs in addressing community health needs. Training of CHWs is one of the key aspects that generally seeks to develop new knowledge and skills related to specific tasks and to increase CHWs’ capacity to communicate with and serve local people. This study aimed to analyse the CHW training process in Iran and how different components of training have impacted on CHW performance and satisfaction. Methods Data were collected from both primary and secondary sources. Training policies were reviewed using available policy documents, training materials and other relevant documents at national and provincial levels. Documentary analysis was supplemented by individual interviews with ninety-one Iranian CHWs from 18 provinces representing a broad range of age, work experience and educational levels, both male and female. Results Recognition of the CHW program and their training in the national health planning and financing facilitates the implementation and sustainability of the program. The existence of specialised training centres managed by district health network provides an appropriate training environment that delivers comprehensive training and increases CHWs’ knowledge, skills and motivation to serve local communities. Changes in training content over time reflect an increasing number of programs integrated into PHC, complicating the work expected of CHWs. In-service training courses need to address better local needs. Conclusion Although CHW programs vary by country and context, the CHW training program in Iran offers transferable lessons for countries intending to improve training as one of the key elements in their CHW program.

  6. Achieving value for money in health: a comparative analysis of OECD countries and regional countries.

    Science.gov (United States)

    Çelik, Yusuf; Khan, Mahmud; Hikmet, Neşet

    2017-10-01

    To measure efficiency gains in health sector over the years 1995 to 2013 in OECD, EU, non-member European countries. An output-oriented DEA model with variable return to scale, and residuals estimated by regression equations were used to estimate efficiencies of health systems. Slacks for health care outputs and inputs were calculated by using DEA multistage method of estimating country efficiency scores. Better health outcomes of countries were related with higher efficiency. Japan, France, or Sweden were found to be peer-efficient countries when compared to other developed countries like Germany and United States. Increasing life expectancy beyond a certain high level becomes very difficult to achieve. Despite declining marginal productivity of inputs on health outcomes, some developed countries and developing countries were found to have lowered their inefficiencies in the use of health inputs. Although there was no systematic relationship between political system of countries and health system efficiency, the objectives of countries on social and health policy and the way of achieving these objectives might be a factor increasing the efficiency of health systems. Economic and political stability might be as important as health expenditure in improving health system goals. A better understanding of the value created by health expenditures, especially in developed countries, will require analysis of specific health interventions that can increase value for money in health. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  7. Behavioural contracting as a tool to help patients achieve better health.

    Science.gov (United States)

    Neale, A V

    1991-12-01

    Behavioural contracting is an intervention technique in which a client signs an agreement to make certain behaviour changes within a specified time, usually with explicitly defined rewards for adherence or success. Contracting is being increasingly used by health professionals to assist patients in making beneficial life style changes. This paper presents data on the outcome of behavioural contracting interventions to lower serum cholesterol and to increase exercise activity. Of 223 primary care patients enrolled in a health promotion programme, 179 met with the project health educator to improve their cardiovascular risk profile; 144 of these were classified as having 'high cholesterol' and 51 signed contracts to adopt the American Heart Association guidelines diet within a 3-month period. Everyone was encouraged to sign a contract to engage in aerobic exercise three times per week; 96 did so. The results indicate that contractors achieved greater beneficial health changes than non-contractors, and that the group which fully met their contract obligations experienced the greatest health benefit of all (either a lowering of cholesterol or a decreased exercising heart rate).

  8. Evaluation of immunization coverage by lot quality assurance sampling compared with 30-cluster sampling in a primary health centre in India.

    OpenAIRE

    Singh, J.; Jain, D. C.; Sharma, R. S.; Verghese, T.

    1996-01-01

    The immunization coverage of infants, children and women residing in a primary health centre (PHC) area in Rajasthan was evaluated both by lot quality assurance sampling (LQAS) and by the 30-cluster sampling method recommended by WHO's Expanded Programme on Immunization (EPI). The LQAS survey was used to classify 27 mutually exclusive subunits of the population, defined as residents in health subcentre areas, on the basis of acceptable or unacceptable levels of immunization coverage among inf...

  9. The association between academic engagement and achievement in health sciences students

    Science.gov (United States)

    2013-01-01

    Background Educational institutions play an important role in encouraging student engagement, being necessary to know how engaged are students at university and if this factor is involved in student success point and followed. To explore the association between academic engagement and achievement. Methods Cross-sectional study. The sample consisted of 304 students of Health Sciences. They were asked to fill out an on-line questionnaire. Academic achievements were calculated using three types of measurement. Results Positive correlations were found in all cases. Grade point average was the academic rate most strongly associated with engagement dimensions and this association is different for male and female students. The independent variables could explain between 18.9 and 23.9% of the variance (p < 0.05) in the population of university students being analyzed. Conclusions Engagement has been shown to be one of the many factors, which are positively involved, in the academic achievements of college students. PMID:23446005

  10. The Role of Public Health Nutrition in Achieving the Sustainable Development Goals in the Asia Pacific Region.

    Science.gov (United States)

    Binns, Colin; Lee, Mi Kyung; Low, Wah Yun; Zerfas, Alfred

    2017-10-01

    The Sustainable Development Goals (SDGs) replaced the Millennium Development Goals (MDCs) in 2015, which included several goals and targets primarily related to nutrition: to eradicate extreme poverty and hunger and to reduce child mortality and improve maternal health. In the Asia-Pacific Academic Consortium for Public Health (APACPH) member countries as a group, infant and child mortality were reduced by more than 65% between 1990 and 2015, achieving the MDG target of two-thirds reduction, although these goals were not achieved by several smaller countries. The SDGs are broader in focus than the MDGs, but include several goals that relate directly to nutrition: 2 (zero hunger-food), 3 (good health and well-being-healthy life), and 12 (responsible consumption and production-sustainability). Other SDGs that are closely related to nutrition are 4 and 5 (quality education and equality in gender-education and health for girls and mothers, which is very important for infant health) and 13 (climate action). Goal 3 is "good health and well-being," which includes targets for child mortality, maternal mortality, and reducing chronic disease. The Global Burden of Disease Project has confirmed that the majority of risk for these targets can be attributed to nutrition-related targets. Dietary Guidelines were developed to address public health nutrition risk in the Asia Pacific region at the 48th APACPH 2016 conference and they are relevant to the achievement of the SDGs. Iron deficiency increases the risk of maternal death from haemorrhage, a cause of 300000 deaths world-wide each year. Improving diets and iron supplementation are important public health interventions in the APACPH region. Chronic disease and obesity rates in the APACPH region are now a major challenge and healthy life course nutrition is a major public health priority in answering this challenge. This article discusses the role of public health nutrition in achieving the SDGs. It also examines the role of

  11. Community-based participatory action research: transforming multidisciplinary practice in primary health care Investigación-acción participativa basada en la comunidad: transformación de la práctica multidisciplinaria en atención primaria de salud

    Directory of Open Access Journals (Sweden)

    Marcia Hills

    2007-03-01

    Full Text Available OBJECTIVES: Health care systems throughout the world are in the process of restructuring and reforming their health service delivery systems, reorienting themselves to a primary health care (PHC model that uses multidisciplinary practice (MDP teams to provide a range of coordinated, integrated services. This study explores the challenges of putting the MDP approach into practice in one community in a city in Canada. METHODS: The data we analyzed were derived from a community-based participatory action research (CBPAR project, conducted in 2004, that was used to enhance collaborative MDP in a PHC center serving a residential and small-business community of 11 000 within a medium-sized city of approximately 300 000 people in Canada. CBPAR is a planned, systematic approach to issues relevant to the community of interest, requires community involvement, has a problem-solving focus, is directed at societal change, and makes a lasting contribution to the community. We drew from one aspect of this complex, multiyear project aimed at transforming the rhetoric advocating PHC reform into actual sustainable practices. The community studied was diverse with respect to age, socioeconomics, and lifestyle. Its interdisciplinary team serves approximately 3 000 patients annually, 30% of whom are 65 years or older. This PHC center's multidisciplinary, integrated approach to care makes it a member of a very distinct minority within the larger primary care system in Canada. RESULTS: Analysis of practice in PHC revealed entrenched and unconscious ideas of the limitations and boundaries of practice. In the rhetoric of PHC, MDP was lauded by many. In practice, however, collaborative, multidisciplinary team approaches to care were difficult to achieve. CONCLUSIONS: The successful implementation of an MDP approach to PHC requires moving away from physician-driven care. This can only be achieved once there is a change in the underlying structures, values, power relations

  12. Financing of health systems to achieve the health Millennium Development Goals in low-income countries.

    Science.gov (United States)

    Fryatt, Robert; Mills, Anne; Nordstrom, Anders

    2010-01-30

    Concern that underfunded and weak health systems are impeding the achievement of the health Millennium Development Goals in low-income countries led to the creation of a High Level Taskforce on Innovative International Financing for Health Systems in September, 2008. This report summarises the key challenges faced by the Taskforce and its Working Groups. Working Group 1 examined the constraints to scaling up and costs. Challenges included: difficulty in generalisation because of scarce and context-specific health-systems knowledge; no consensus for optimum service-delivery approaches, leading to wide cost differences; no consensus for health benefits; difficulty in quantification of likely efficiency gains; and challenges in quantification of the financing gap owing to uncertainties about financial commitments for health. Working Group 2 reviewed the different innovative mechanisms for raising and channelling funds. Challenges included: variable definitions of innovative finance; small evidence base for many innovative finance mechanisms; insufficient experience in harmonisation of global health initiatives; and inadequate experience in use of international investments to improve maternal, newborn, and child health. The various mechanisms reviewed and finally recommended all had different characteristics, some focusing on specific problems and some on raising resources generally. Contentious issues included the potential role of the private sector, the rights-based approach to health, and the move to results-based aid. The challenges and disagreements that arose during the work of the Taskforce draw attention to the many issues facing decision makers in low-income countries. International donors and recipient governments should work together to improve the evidence base for strengthening health systems, increase long-term commitments, and improve accountability through transparent and inclusive national approaches. Copyright 2010 Elsevier Ltd. All rights reserved.

  13. Primary health care teams put to the test a cross-sectional study from Austria within the QUALICOPC project.

    Science.gov (United States)

    Hoffmann, Kathryn; George, Aaron; Dorner, Thomas E; Süß, Katharina; Schäfer, Willemijn L A; Maier, Manfred

    2015-11-16

    Multidisciplinary Primary Health Care Teams (PHCT) provide a comprehensive approach to address the social and health needs of communities. It was the aim of this analysis to assess the number of PHCT in Austria, a country with a weak PHC system, and to compare preventive activities, psychosocial care, and work satisfaction between GPs who work and those who do not work in PHCT. Within the QUALICOPC study, data collection was performed between November 2011 and May 2012, utilizing a standardized questionnaire for GPs. A stratified sample of GPs from across Austria was invited. Statistical analyses included descriptive statistics and tests. Data from 171 GPs questionnaires were used for this analysis. Of these, 61.1 % (n = 113) had a mono-disciplinary office, 26.3 % (n = 45) worked in an office consisting of GP, receptionist and one additional primary care profession, and 7.6 % (n = 13) worked in a larger PHCT. GPs that worked in larger PHCT were younger and more involved in psychosocial and preventive care. No differences were found with regard to work satisfaction or workload. This study gives insight into the structures of PHC in Austria. The results indicate a low number of PHCT; however, the overall return rate in our sample was low with more male GPs, more GPs from urban areas and more GPs working in offices together with other physicians than the national average. Younger GPs demonstrate a greater tendency to implement this primary care practice model in their practices, which seems to be associated with an emphasis in psychosocial and preventive care. If Austria is to increase the number of PHC teams, the country should embrace the work of young GPs and should offer relevant support for PHCT. Future developments could be guided by considering effective models of good practice and governmental support as in other countries.

  14. Impatience versus achievement strivings in the Type A pattern: Differential effects on students' health and academic achievement

    Science.gov (United States)

    Spence, Janet T.; Helmreich, Robert L.; Pred, Robert S.

    1987-01-01

    Psychometric analyses of college students' responses to the Jenkins Activity Survey, a self-report measure of the Type A behavior pattern, revealed the presence of two relatively independent factors. Based on these analyses, two scales, labeled Achievement Strivings (AS) and Impatience and Irritability (II), were developed. In two samples of male and female college students, scores on AS but not on II were found to be significantly correlated with grade point average. Responses to a health survey, on the other hand, indicated that frequency of physical complaints was significantly correlated with II but not with AS. These results suggest that there are two relatively independent factors in the Type A pattern that have differential effects on performance and health. Future research on the personality factors related to coronary heart disease and other disorders might more profitably focus on the syndrome reflected in the II scale than on the Type A pattern.

  15. Is the Role of Physicians Really Evolving Due to Non-physician Clinicians Predominance in Staff Makeup in Sub-Saharan African Health Systems?; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”

    Directory of Open Access Journals (Sweden)

    Mohsin M. Sidat

    2016-12-01

    Full Text Available Health workforce shortages in Sub-Saharan Africa are widely recognized, particularly of physicians, leading the training and deployment of Non-physician clinicians (NPCs. The paper by Eyal et al provides interesting and legitimate viewpoints on evolving role of physicians in context of decisive increase of NPCss in Sub-Saharan Africa. Certainly, in short or mid-term, NPCs will continue to be a proxy solution and a valuable alternative to overcome physicians’ shortages in sub-Saharan Africa. Indeed, NPCs have an important role at primary healthcare (PHC level. Physicians at PHC level can certainly have all different roles that were suggested by Eyal et al, including those not directly related to healthcare provision. However, at secondary and higher levels of healthcare, physicians would assume other roles that are mainly related to patient clinical care. Thus, attempting to generalize the role of physicians without taking into account the context where they will work would be not entirely appropriate. It is true that often physicians start the professional carriers at PHC level and progress to other levels of healthcare particularly after clinical post-graduation training. Nevertheless, the training programs offered by medical institutions in sub-Saharan Africa need to be periodically reviewed and take into account professional and occupational roles physicians would take in context of evolving health systems in sub-Saharan Africa.

  16. Influence of Health Education and Healthy Lifestyle on Students' Academic Achievement in Biology in Nigeria

    Science.gov (United States)

    Babatunde, Ezekiel Olusegun

    2017-01-01

    The positive effects of health education and healthy lifestyle on adolescent academic achievement cannot be over emphasized as learning experiences to help students accurately assess the level of risk-taking behaviour among their peers, emphasis on the value of good health that reinforces health-enhancing attitudes and beliefs are paramount.…

  17. [Use of ineffective practices in Primary Health Care: professional opinions].

    Science.gov (United States)

    Domínguez Bustillo, L; Barrasa Villar, J I; Castán Ruíz, S; Moliner Lahoz, F J; Aibar Remón, C

    2014-01-01

    To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD]=1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

  18. The Impact of Polio Eradication on Routine Immunization and Primary Health Care: A Mixed-Methods Study

    Science.gov (United States)

    Closser, Svea; Cox, Kelly; Parris, Thomas M.; Landis, R. Matthew; Justice, Judith; Gopinath, Ranjani; Maes, Kenneth; Banteyerga Amaha, Hailom; Mohammed, Ismaila Zango; Dukku, Aminu Mohammed; Omidian, Patricia A.; Varley, Emma; Tedoff, Pauley; Koon, Adam D.; Nyirazinyoye, Laetitia; Luck, Matthew A.; Pont, W. Frank; Neergheen, Vanessa; Rosenthal, Anat; Nsubuga, Peter; Thacker, Naveen; Jooma, Rashid; Nuttall, Elizabeth

    2014-01-01

    Background. After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC). Methods. Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review. Results. Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year. Conclusions. Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts. PMID:24690667

  19. Association between organizational climate and perceptions and use of an innovation in Swedish primary health care: a prospective study of an implementation.

    Science.gov (United States)

    Carlfjord, Siw; Festin, Karin

    2015-09-10

    There is a need for new knowledge regarding determinants of a successful implementation of new methods in health care. The role of a receptive context for change to support effective diffusion has been underlined, and could be studied by assessing the organizational climate. The aim of this study was to assess the association between organizational climate when a computer-based lifestyle intervention tool (CLT) was introduced in primary health care (PHC) and the implementation outcome in terms of how the tool was perceived and used after 2 years. The CLT was offered to 32 PHC units in Sweden, of which 22 units agreed to participate in the study. Before the introduction of the CLT, the creative climate at each participating unit was assessed. After 24 months, a follow-up questionnaire was distributed to the staff to assess how the CLT was perceived and how it was used. A question on the perceived need for the CLT was also included. The units were divided into three groups according to the creative climate: high, medium and low. The main finding was that the units identified as having a positive creative climate demonstrated more frequent use and more positive perceptions regarding the new tool than those with the least positive creative climate. More positive perceptions were seen at both individual and unit levels. According to the results from this study there is an association between organizational climate at baseline and implementation outcome after 2 years when a tool for lifestyle intervention is introduced in PHC in Sweden. Further studies are needed before measurement of organizational climate at baseline can be recommended in order to predict implementation outcome.

  20. Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: A national longitudinal analysis.

    Directory of Open Access Journals (Sweden)

    Thomas Hone

    2017-05-01

    Full Text Available Universal health coverage (UHC can play an important role in achieving Sustainable Development Goal (SDG 10, which addresses reducing inequalities, but little supporting evidence is available from low- and middle-income countries. Brazil's Estratégia de Saúde da Família (ESF (family health strategy is a community-based primary healthcare (PHC programme that has been expanding since the 1990s and is the main platform for delivering UHC in the country. We evaluated whether expansion of the ESF was associated with differential reductions in mortality amenable to PHC between racial groups.Municipality-level longitudinal fixed-effects panel regressions were used to examine associations between ESF coverage and mortality from ambulatory-care-sensitive conditions (ACSCs in black/pardo (mixed race and white individuals over the period 2000-2013. Models were adjusted for socio-economic development and wider health system variables. Over the period 2000-2013, there were 281,877 and 318,030 ACSC deaths (after age standardisation in the black/pardo and white groups, respectively, in the 1,622 municipalities studied. Age-standardised ACSC mortality fell from 93.3 to 57.9 per 100,000 population in the black/pardo group and from 75.7 to 49.2 per 100,000 population in the white group. ESF expansion (from 0% to 100% was associated with a 15.4% (rate ratio [RR]: 0.846; 95% CI: 0.796-0.899 reduction in ACSC mortality in the black/pardo group compared with a 6.8% (RR: 0.932; 95% CI: 0.892-0.974 reduction in the white group (coefficients significantly different, p = 0.012. These differential benefits were driven by greater reductions in mortality from infectious diseases, nutritional deficiencies and anaemia, diabetes, and cardiovascular disease in the black/pardo group. Although the analysis is ecological, sensitivity analyses suggest that over 30% of black/pardo deaths would have to be incorrectly coded for the results to be invalid. This study is limited by

  1. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries.

    Science.gov (United States)

    Harris, Mark F; Advocat, Jenny; Crabtree, Benjamin F; Levesque, Jean-Frederic; Miller, William L; Gunn, Jane M; Hogg, William; Scott, Cathie M; Chase, Sabrina M; Halma, Lisa; Russell, Grant M

    2016-01-01

    A key aim of reforms to primary health care (PHC) in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood. To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices. Collaborative synthesis of 12 mixed methods studies. Primary care practices undergoing transformational change in three countries: Australia, Canada, and the USA, including three Canadian provinces (Alberta, Ontario, and Quebec). We conducted a synthesis and secondary analysis of 12 qualitative and quantitative studies conducted by the authors in order to understand the impacts and how they were influenced by local context. There was a diverse range of complex reforms seeking to foster interprofessional teamwork in the care of patients with chronic disease. The impact on communication and relationships between different professional groups, the roles of nursing and allied health services, and the expressed satisfaction of PHC providers with their work varied more within than between jurisdictions. These variations were associated with local contextual factors such as the size, power dynamics, leadership, and physical environment of the practice. Unintended consequences included deterioration of the work satisfaction of some team members and conflict between medical and nonmedical professional groups. The variation in impacts can be understood to have arisen from the complexity of interprofessional dynamics at the practice level. The same characteristic could have both positive and negative influence on different aspects (eg, larger practice may have less capacity for adoption but more capacity to support interprofessional practice). Thus, the impacts are not entirely predictable and need to be monitored, and so that interventions can be adapted at the local level.

  2. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries

    Science.gov (United States)

    Harris, Mark F; Advocat, Jenny; Crabtree, Benjamin F; Levesque, Jean-Frederic; Miller, William L; Gunn, Jane M; Hogg, William; Scott, Cathie M; Chase, Sabrina M; Halma, Lisa; Russell, Grant M

    2016-01-01

    Context A key aim of reforms to primary health care (PHC) in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood. Objective To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices. Design Collaborative synthesis of 12 mixed methods studies. Setting Primary care practices undergoing transformational change in three countries: Australia, Canada, and the USA, including three Canadian provinces (Alberta, Ontario, and Quebec). Methods We conducted a synthesis and secondary analysis of 12 qualitative and quantitative studies conducted by the authors in order to understand the impacts and how they were influenced by local context. Results There was a diverse range of complex reforms seeking to foster interprofessional teamwork in the care of patients with chronic disease. The impact on communication and relationships between different professional groups, the roles of nursing and allied health services, and the expressed satisfaction of PHC providers with their work varied more within than between jurisdictions. These variations were associated with local contextual factors such as the size, power dynamics, leadership, and physical environment of the practice. Unintended consequences included deterioration of the work satisfaction of some team members and conflict between medical and nonmedical professional groups. Conclusion The variation in impacts can be understood to have arisen from the complexity of interprofessional dynamics at the practice level. The same characteristic could have both positive and negative influence on different aspects (eg, larger practice may have less capacity for adoption but more capacity to support interprofessional practice). Thus, the impacts are not entirely predictable and need to be monitored, and so that

  3. Guidelines and mHealth to Improve Quality of Hypertension and Type 2 Diabetes Care for Vulnerable Populations in Lebanon: Longitudinal Cohort Study

    Science.gov (United States)

    Paik, Kenneth E; Hei Tam, Hok; Fahed, Zeina; Winkler, Eric; Kontunen, Kaisa; Mkanna, Abdalla; Burnham, Gilbert

    2017-01-01

    Background Given the protracted nature of the crisis in Syria, the large noncommunicable disease (NCD) caseload of Syrian refugees and host Lebanese, and the high costs of providing NCD care, the implications for Lebanon’s health system are vast. Objective The aim of this study was to evaluate the effectiveness of treatment guidelines and a mobile health (mHealth) app on quality of care and health outcomes in primary care settings in Lebanon. Methods A longitudinal cohort study was implemented from January 2015 to August 2016 to evaluate the effectiveness of treatment guidelines and an mHealth app on quality of care and health outcomes for Syrian and Lebanese patients in Lebanese primary health care (PHC) facilities. Results Compared with baseline record extraction, recording of blood pressure (BP) readings (−11.4%, PmHealth phase as compared with baseline (−8.4%, P=.001); however, recording of body mass index (BMI) reporting increased at the end of the mHealth phase from baseline (8.1%, PmHealth app showed that a higher proportion of providers offered lifestyle counseling compared with the counseling reported in patients’ paper records (health diet counseling; 77.3% in app data vs 8.8% in paper records, PmHealth implementation (PmHealth phases by 12.9% and 59.6%, respectively, (PmHealth implementation by 66.3% (PmHealth phase by 39.8% (PmHealth app in 10 PHC facilities in Lebanon indicate that the app has potential to improve adherence to guidelines and quality of care. Further studies are necessary to determine the effects of patient-controlled health record apps on provider adherence to treatment guidelines, as well as patients’ long-term medication and treatment adherence and disease control. PMID:29046266

  4. Assessment of quality of prescribing in patients of hypertension at primary and secondary health care facilities using the Prescription Quality Index (PQI) tool.

    Science.gov (United States)

    Suthar, Jalpa Vashishth; Patel, Varsha J

    2014-01-01

    To determine the quality of prescribing in hypertension in primary and secondary health care settings using the Prescription Quality Index (PQI) tool and to assess the reliability of this tool. An observational cross-sectional study was carried out for 6 months in order to assess quality of prescribing of antihypertensive drugs using Prescription Quality Index (PQI) at four primary (PHC) and two secondary (SHC) health care facilities. Patients attending these facilities for at least 3 months were included. Complete medical history and prescriptions received were noted. Total and criteria wise PQI scores were derived for each prescription. Prescriptions were categorized as poor (score of ≤31), medium (score 32-33) and high quality (score 34-43) based on PQI total score. Psychometric analysis using factor analysis was carried out to assess reliability and validity. Total 73 hypertensive patients were included. Mean age was 61.2 ± 11 years with 35 (48%) patients above 65 years of age. Total PQI score was 26 ± 11. There was a significant difference in PQI score between PHC and SHC (P hypertensive patients was poor, somewhat better in primary as compared to secondary health care facility. PQI is reliable for measuring prescribing quality in hypertension in Indian set up.

  5. The neglected role of adolescent emotional well-being in national educational achievement: bridging the gap between education and mental health policies.

    Science.gov (United States)

    Sznitman, Sharon R; Reisel, Liza; Romer, Daniel

    2011-02-01

    Although child poverty is recognized as a critical determinant of poor educational achievement in the United States, policy discussions on raising academic achievement rarely include the importance of the effects of poverty on the mental health of adolescents. This article examines the role of adolescent emotional well-being (indicators of depression) as a mediator of the effects of poverty on differences in educational achievement at the national and U.S. state levels. Differences in standardized adolescent academic achievement across 23 developed countries and 39 U.S. states were analyzed using path analytic techniques to test the hypothesis that indicators of adolescent emotional well-being mediate relations between child poverty rates and academic achievement. Child poverty rates were related to both adolescent emotional well-being and educational achievement across both U.S. states and developed countries. Path analyses showed that the status of a country's or state's adolescent emotional well-being is a strong predictor of its educational achievement and that emotional well-being mediates the relationship between poverty and educational achievement. Policies designed to ameliorate the adverse effects of poverty on mental health are critical as they are likely to improve both average educational achievement and student emotional well-being. Attention to improving mental health care not only has the potential to reduce societal and individual costs directly related to health but also to reduce the indirect costs of poor educational achievement. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  6. Tracking the Market Performance of Companies That Integrate a Culture of Health and Safety: An Assessment of Corporate Health Achievement Award Applicants.

    Science.gov (United States)

    Fabius, Raymond; Loeppke, Ronald R; Hohn, Todd; Fabius, Dan; Eisenberg, Barry; Konicki, Doris L; Larson, Paul

    2016-01-01

    The aim of this study was to assess the hypothesis that stock market performance of companies achieving high scores on either health or safety in the Corporate Health Achievement Award (CHAA) process will be superior to average index performance. The stock market performance of portfolios of CHAA winners was examined under six different scenarios using simulation and past market performance in tests of association framed to inform the investor community. CHAA portfolios out-performed the S&P average on all tests. This study adds to the growing evidence that a healthy and safe workforce correlates with a company's performance and its ability to provide positive returns to shareholders. It advances the idea that a proven set of health and safety metrics based on the CHAA evaluation process merits inclusion with existing measures for market valuation.

  7. A global response to elder abuse and neglect: building primary health care capacity to deal with the problem worldwide : main report

    National Research Council Canada - National Science Library

    Kaindl, Karina

    2008-01-01

    ....Elder.abuse.and.neglect.and.the.role.of.PHC.professionals. . ... 3 1.4.Detecting.elder.abuse.in.a.PHC.setting... 5 2 The project ...7 2.1.Aims.and.objectives... 7 2.2.The.Elder.Abuse.Suspicion.Index. . ... 8 2.3...

  8. Un marco de evaluación de la atención primaria de salud en América Latina A framework for evaluating primary health care in Latin America

    Directory of Open Access Journals (Sweden)

    Jeannie L. Haggerty

    2009-11-01

    Full Text Available OBJETIVOS: Determinar la pertinencia de aplicar la estrategia canadiense de evaluación de la atención primaria de salud (APS en América Latina y proponer las modificaciones necesarias para llegar a un consenso latinoamericano. MÉTODOS: Se utilizó el método Delphi para llegar a un consenso entre 29 expertos comprometidos con el desarrollo o la evaluación de la APS en América Latina. Se realizaron cuatro rondas virtuales y un encuentro presencial para discutir el modelo lógico de evaluación de la APS, los siete objetivos y los seis factores condicionantes que forman parte de la estrategia canadiense, con sus interrogantes de evaluación e indicadores. Se calificaron la relevancia y la pertinencia de cada concepto desde el punto de vista de los países de América Latina. RESULTADOS: Los expertos consideraron los objetivos y los factores condicionantes de la estrategia canadiense altamente pertinentes para evaluar la APS en América Latina, aunque reconocieron la necesidad de modificarlos para aumentar su pertinencia. Los principales cambios fueron la formulación de una visión y una misión de la APS, la inclusión de nuevos objetivos y factores condicionantes y la reformulación de los originales. Los objetivos de coordinación y atención integral e integrada no lograron un alto nivel de consenso debido a ambigüedades en los enunciados originales y la coexistencia de distintas interpretaciones sobre el significado de ciertas dimensiones de evaluación referidas en los enunciados. CONCLUSIONES: Se lograron avances significativos en el camino hacia la construcción de un marco de evaluación para la APS en la Región de las Américas. Es necesario desarrollar indicadores e instrumentos de recolección de información adecuados y factibles de ser aplicados en distintos contextos.OBJECTIVES: To determine the relevancy of applying the Canadian primary health care (PHC assessment strategy to Latin America and to propose any modifications

  9. Colombian public policies contributing to the achievement of Millennium Development Goals in the health sector, 2006

    Directory of Open Access Journals (Sweden)

    Lina M. Grisales

    2008-02-01

    Full Text Available During the General Assembly of the United Nations, in September 2000,189 countries (including Colombia committed to eight objectives leading to a more human and fairer world. Such objectives are called the Millennium Development Goals (mdg and to achieve them it is crucial to incorporate them in the action agendas of each country. The purpose of this monograph is to recognize current public policies in Colombia and Antioquia leading the achievement of the Millennium Development Goals, specifically those related to the reduction of mortality among children less than 5 years of age, improvement of maternal health and fighting against hiv/aids, malaria and dengue.In Colombia, Conpes 91 of 2005 is the only guideline given by the Government establishing goals and strategies to achieve the Millennium Development Goals in 2015. Nevertheless, other policies, programs and projects before and even after the Millennium Statement (but without explicit purpose contribute to achieving such goals. Revision of those policies is an effort for the research project “Degree of contribution of public policies to the achievement of the Millennium Development Goals related to the health sector, Antioquia, 2006”, which will evaluate the impact these guidelines have had in the achievement of the development goals in that particular sector.

  10. Atenção Primária à Saúde - a "menina dos olhos" do SUS: sobre as representações sociais dos protagonistas do Sistema Único de Saúde Primary health care - the "apple of the eye" of SUS: about social representations of the protagonists of the Unified Health System

    Directory of Open Access Journals (Sweden)

    Karine de Oliveira Gomes

    2011-01-01

    Full Text Available A Atenção Primária à Saúde (APS constitui o primeiro nível de contato com o sistema de saúde. No Brasil, o Programa Saúde da Família (PSF é a principal estratégia de implementação e organização da APS. O objetivo deste estudo foi avaliar o serviço realizado pelo PSF, a partir das representações sociais dos entrevistados sobre as dimensões exclusivas da APS - atenção ao primeiro contato, longitudinalidade, integralidade e coordenação. Trata-se de uma pesquisa qualiquantitativa, realizada em Cajuri (MG. Foram entrevistados os gestores municipais, os profissionais do PSF e as gestantes atendidas pelo PSF. Em relação às representações sociais sobre o SUS, observou-se um inadequado nível de apreensão e conhecimento dos seus princípios e diretrizes. Quanto ao PSF, foram expressas várias conotações positivas e o conjunto de percepções dos protagonistas identificaram-no como uma estratégia de reestruturação da APS no município. Não obstante, foram percebidas fortes influências do modelo biomédico e o desafio da integração com os demais níveis de atenção, indicando a necessidade de investimentos na capacitação dos profissionais e na estruturação dos demais níveis de atenção à saúde .The Primary Health Care (PHC is the first contact level with the health system. In Brazil, the Family Health Program (PSF is the main implementation and organization strategy of the PHC. The objective of this study is to evaluate the actions and services of health offered by the PSF, starting from the social representations of the interviewee on the exclusive dimensions of PHC - attention to the first contact, longitudinality, integrality and coordination. It is a quali-quantitative research, accomplished in Cajuri, Minas Gerais State. Municipal managers, PSF professionals and pregnant women assisted by PSF were interviewed. Regarding social representations on SUS, it was observed an inadequate level of apprehension and

  11. Constructing Taxonomies to Identify Distinctive Forms of Primary Healthcare Organizations

    Science.gov (United States)

    Borgès Da Silva, Roxane; Pineault, Raynald; Hamel, Marjolaine; Levesque, Jean-Frédéric; Roberge, Danièle; Lamarche, Paul

    2013-01-01

    Background. Primary healthcare (PHC) renewal gives rise to important challenges for policy makers, managers, and researchers in most countries. Evaluating new emerging forms of organizations is therefore of prime importance in assessing the impact of these policies. This paper presents a set of methods related to the configurational approach and an organizational taxonomy derived from our analysis. Methods. In 2005, we carried out a study on PHC in two health and social services regions of Quebec that included urban, suburban, and rural areas. An organizational survey was conducted in 473 PHC practices. We used multidimensional nonparametric statistical methods, namely, multiple correspondence and principal component analyses, and an ascending hierarchical classification method to construct a taxonomy of organizations. Results. PHC organizations were classified into five distinct models: four professional and one community. Study findings indicate that the professional integrated coordination and the community model have great potential for organizational development since they are closest to the ideal type promoted by current reforms. Conclusion. Results showed that the configurational approach is useful to assess complex phenomena such as the organization of PHC. The analysis highlights the most promising organizational models. Our study enhances our understanding of organizational change in health services organizations. PMID:24959575

  12. Dental Procedures in Primary Health Care of the Brazilian National Health System

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    Suellen R. Mendes

    2017-12-01

    Full Text Available The aim of this study was to examine the procedures of primary dental health care performed by oral health teams (OHTs adhering to the second cycle of the ‘National Programme for Improving Access and Quality of Primary Care’ (PMAQ-AB in Brazil. A cross-sectional descriptive analysis was performed, across 23 dental procedures comprising preventive, restorative/prosthetic, surgical, endodontic and oral cancer monitoring. Descriptive analysis shows that most of the oral health teams carry out basic dental procedures. However, most of the time, they do not keep adequate records of suspected cases of oral cancer, diagnosis tests or follow-ups, and do not perform dental prosthetic procedures. Data also showed disparities in the average number of procedures performed in each Brazilian geographical region in 2013–2014, ranging from 13.9 in the northern to 16.5 in the southern and south-eastern regions, reinforcing the great social disparities between them. Brazilian regions with the highest volume of dental need deliver the lowest number of dental procedures. The need to tackle inequalities and further shape the supply of appropriate primary health care (PHC is evident.

  13. Mandated Local Health Networks across the province of Québec: a better collaboration with primary care working in the communities?

    Science.gov (United States)

    Breton, Mylaine; Maillet, Lara; Haggerty, Jeannie; Vedel, Isabelle

    2014-01-01

    Background In 2004, the Québec government implemented an important reform of the healthcare system. The reform was based on the creation of new organisations called Health Services and Social Centres (HSSC), which were formed by merging several healthcare organisations. Upon their creation, each HSSC received the legal mandate to establish and lead a Local Health Network (LHN) with different partners within their territory. This mandate promotes a 'population-based approach' based to the responsibility for the population of a local territory. Objective The aim of this paper is to illustrate and discuss how primary healthcare organisations (PHC) are involved in mandated LHNs in Québec. For illustration, we describe four examples that facilitate a better understanding of these integrated relationships. Results The development of the LHNs and the different collaboration relationships are described through four examples: (1) improving PHC services within the LHN - an example of new PHC models; (2) improving access to specialists and diagnostic tests for family physicians working in the community - an example of centralised access to specialists services; (3) improving chronic-disease-related services for the population of the LHN - an example of a Diabetes Centre; and (4) improving access to family physicians for the population of the LHN - an example of the centralised waiting list for unattached patients. Conclusion From these examples, we can see that the implementation of large-scale reform involves incorporating actors at all levels in the system, and facilitates collaboration between healthcare organisations, family physicians and the community. These examples suggest that the reform provided room for multiple innovations. The planning and organisation of health services became more focused on the population of a local territory. The LHN allows a territorial vision of these planning and organisational processes to develop. LHN also seems a valuable lever when

  14. Characteristics of Indigenous primary health care service delivery models: a systematic scoping review.

    Science.gov (United States)

    Harfield, Stephen G; Davy, Carol; McArthur, Alexa; Munn, Zachary; Brown, Alex; Brown, Ngiare

    2018-01-25

    Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The evolution of Indigenous primary health care services arose from mainstream health services being unable to adequately meet the needs of Indigenous communities and Indigenous peoples often being excluded and marginalised from mainstream health services. Part of the solution has been to establish Indigenous specific primary health care services, for and managed by Indigenous peoples. There are a number of reasons why Indigenous primary health care services are more likely than mainstream services to improve the health of Indigenous communities. Their success is partly due to the fact that they often provide comprehensive programs that incorporate treatment and management, prevention and health promotion, as well as addressing the social determinants of health. However, there are gaps in the evidence base including the characteristics that contribute to the success of Indigenous primary health care services in providing comprehensive primary health care. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. This systematic scoping review was led by an Aboriginal researcher, using the Joanna Briggs Institute Scoping Review Methodology. All published peer-reviewed and grey literature indexed in PubMed, EBSCO CINAHL, Embase, Informit, Mednar, and Trove databases from September 1978 to May 2015 were reviewed for inclusion. Studies were included if they describe the characteristics of service delivery models implemented within an Indigenous primary health care service. Sixty-two studies met the inclusion criteria. Data were extracted and then thematically analysed to identify the characteristics of Indigenous PHC service delivery models. Culture was the most prominent characteristic underpinning all of the other seven characteristics which were identified - accessible health services, community

  15. Older women in an aging world: achieving health across the life course.

    Science.gov (United States)

    Bonita, R; Howe, A L

    1996-01-01

    This article, based on a report (Women, aging and health: achieving health across the life span) prepared for the WHO Global Commission on Women's Health under the guidance of WHO's Aging and Health Programme, presents demographic data that clearly demonstrate the need for recognition of the health of aging women as a global issue of major public health concern. The authors show that, while female life expectancy at birth is significantly different in developed and developing countries (because of high infant and maternal mortality in the latter), these differences tend to decrease for women in developing countries who reach middle age. The authors review the various facets of the "gender transition" brought about by demographic and epidemiological transitions, drawing attention to contrasts between the situation in developing countries in Asia and Latin America and that in Eastern Europe, for example. The role of older women as care-givers is discussed, as is the likelihood of a future increase in the proportion of older women living alone in the developing world (a factor which renders them particularly vulnerable in many socioeconomic and health respects). Suggestions are made on methodologies for monitoring health trends in aging women, and on the role of WHO in this respect. A basic goal for global strategies relating to the health of older women is formulated: reduction of the inequities in life expectancy between developed and developing countries.

  16. System-Level Action Required for Wide-Scale Improvement in Quality of Primary Health Care: Synthesis of Feedback from an Interactive Process to Promote Dissemination and Use of Aggregated Quality of Care Data.

    Science.gov (United States)

    Bailie, Jodie; Laycock, Alison; Matthews, Veronica; Bailie, Ross

    2016-01-01

    There is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary health care (PHC) centers in delivery of care. Where aspects of care are not being done well across a range of PHC centers, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders' perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement. This paper draws on data collected as part of a large-scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analyzed to develop a "driver diagram," an improvement tool used to locate barriers and enablers within causal pathways (as primary and secondary drivers), enabling them to be targeted by tailored interventions. We identified 5 primary drivers and 11 secondary drivers of high-quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high-quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data-driven decision-making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilization for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service delivery, use of information systems and community health

  17. A public health achievement under adversity: the eradication of poliomyelitis from Peru, 1991.

    Science.gov (United States)

    Sobti, Deepak; Cueto, Marcos; He, Yuan

    2014-12-01

    The fight to achieve global eradication of poliomyelitis continues. Although native transmission of poliovirus was halted in the Western Hemisphere by the early 1990s, and only a few cases have been imported in the past few years, much of Latin America's story remains to be told. Peru conducted a successful flexible, or flattened, vertical campaign in 1991. The initial disease-oriented programs began to collaborate with community-oriented primary health care systems, thus strengthening public-private partnerships and enabling the common goal of poliomyelitis eradication to prevail despite rampant terrorism, economic instability, and political turmoil. Committed leaders in Peru's Ministry of Health, the Pan American Health Organization, and Rotary International, as well as dedicated health workers who acted with missionary zeal, facilitated acquisition of adequate technologies, coordinated work at the local level, and increased community engagement, despite sometimes being unable to institutionalize public health improvements.

  18. PREVALENCE OF ANAEMIA IN PREGNANT WOMEN ATTENDING A PRIMARY HEALTH CENTRE IN BARPETA DISTRICT, ASSAM

    Directory of Open Access Journals (Sweden)

    Dhritishna

    2016-05-01

    Full Text Available BACKGROUND Anaemia in pregnancy has serious adverse effects on the health of the mother and the developing foetus. OBJECTIVES The study aims to estimate the prevalence of anaemia in pregnant woman attending the Nagaon Primary Health Centre (PHC in Barpeta district, Assam. METHODS A cross-sectional study was carried out from 1 April, 2014 to 1 May, 2014. 100 pregnant women attending Nagaon PHC were interviewed using a predesigned and pretested interview schedule followed by a short clinical examination for pallor and laboratory estimation of haemoglobin. Sahli’s (Acid Haematin method was used for haemoglobin estimation. Haemoglobin level below the cut-off 11 g/dL was used to label a pregnant woman as anaemic and further classified as mild (10-10.9 g/dL, moderate anaemia (7-9.9 g/dL and severe anaemia (<7 g/dL. RESULTS 77% women were suffering from anaemia. Out of these, 57 %were mildly anaemic and 20% were moderately anaemic. Women of younger age groups, greater parity, a gap less than 3 years between subsequent pregnancies, less education and practising Hinduism had a greater prevalence of anaemia. CONCLUSION Awareness about the serious consequences that anaemia can lead to and advocacy of a proper iron-rich diet, regular intake of IFA tablets and purification of water to prevent infestation by parasites can help in reduction of anaemia.

  19. Screening for cardiovascular risk in asymptomatic users of the primary health care network in Lebanon, 2012-2013.

    Science.gov (United States)

    Yamout, Rouham; Adib, Salim M; Hamadeh, Randa; Freidi, Alia; Ammar, Walid

    2014-07-17

    In 2012, the Ministry of Public Health in Lebanon piloted a service of multifactorial cardiovascular screening in the publicly subsidized Primary Health Care (PHC) Network. We present an epidemiological analysis of data produced during this pilot to justify the inclusion of this service in the package of essential services offered through PHC and to present a preliminary cardiovascular risk profile in an asymptomatic population. A total of 4,205 participants (two-thirds of which were women) aged at least 40 years and reportedly free from diabetes, hypertension, dyslipidemia, and cardiovascular disease (CVD) were screened. The screening protocol used a questionnaire and direct measurements to assess 5 modifiable cardiovascular risk factors; total cardiovascular risk score was calculated according to a paper-based algorithm developed by the World Health Organization and the International Society of Hypertension. Approximately 25% of the sample displayed metabolic impairments (11% for impaired blood glucose metabolism and 17% for impaired systolic blood pressure), and 6.6% were classified at total cardiovascular risk of 10% or more. Just over one-quarter of the sample was obese, almost half had a substantially elevated waist circumference, and 41% were smokers. Men were significantly more likely to screen positive for metabolic impairment than women, and women were more likely to be obese. The implementation of a multifactorial screening for CVD among asymptomatic subjects detected a substantial proportion of previously undiagnosed cases of high metabolic risk, people who could now be referred to optimal medical follow-up.

  20. Diabetes Self-Management: A Key for Better Health-related Quality of Life in Patients with Diabetes.

    Science.gov (United States)

    Badr, Hanan E; Al-Khaledi, Maha; Al-Dousari, Hussah; Al-Dhufairi, Shaikhah; Al-Mousawi, Taiba; Al-Azemi, Rehab; Al-Azimi, Farah

    2018-04-17

    This study was aimed at assessing health-related quality of life (HRQOL) among adult patients with diabetes attending primary health care diabetes clinics in Kuwait and to examine the factors associated with patients with the HRQOL of patients with diabetes. This cross-sectional study was conducted among 503 patients with diabetes attending 26 primary healthcare diabetes clinics in Kuwait. A self-administered questionnaire on participants' socio-demographic and clinical characteristics, in addition to the Diabetes Self-Management Questionnaire (DSMQ) to assess patients' DSM was used. SF12 was employed to assess the HRQOL, producing two outcomes: Physical health composite and Mental health composite. The mean age of participants was 52. ± 0.8 years, 53.1% were males, and 49.0% were Kuwaitis. The median DSM sum score was 6.5. Male patients with diabetes showed significantly better median DSM sum score than female patients with diabetes. The overall median score of HRQOL was 61.7/100 with a better median score of PHC than MHC of quality of life (66.7/100 and 56.7/100, respectively). Multivariate analysis revealed a significant direct association between DSM and better primary health composite and mental health composite. It also showed that female gender, and reporting two or more diabetic complications were significantly associated with poor PHC. Kuwaiti patients with diabetes showed a modest level of HRQOL. Patients' DSM, gender, and diabetes complications were significant independent correlates to HRQOL. Appraisal of patients with diabetes' HRQOL as an essential component of diabetes management in clinical settings is suggested. Further studies to examine the impact of good diabetes self-management on HRQOL improvement are needed. . ©2018The Author(s). Published by S. Karger AG, Basel.

  1. An Alternative Approach for Supportive Supervision and Skill Measurements of Health Workers for Integrated Management of Neonatal and Childhood Illnesses Program in 10 Districts of Haryana.

    Science.gov (United States)

    Aggarwal, Arun K; Gupta, Rakesh; Das, Dhritiman; Dhakar, Anar S; Sharma, Gourav; Anand, Himani; Kaur, Kamalpreet; Sheoran, Kiran; Dalpath, Suresh; Khatri, Jaidev; Gupta, Madhu

    2018-01-01

    "Integrated Management of Neonatal and Childhood Illnesses" (IMNCI) needs regular supportive supervision (SS). The aim of this study was to find suitable SS model for implementing IMNCI. This was a prospective interventional study in 10 high-focus districts of Haryana. Two methods of SS were used: (a) visit to subcenters and home visits (model 1) and (b) organization of IMNCI clinics/camps at primary health center (PHC) and community health center (CHC) (model 2). Skill scores were measured at different time points. Routine IMNCI data from study block and randomly selected control block of each district were retrieved for 4 months before and after the training and supervision. Change in percentage mean skill score difference and percentage difference in median number of children were assessed in two areas. Mean skill scores increased significantly from 2.1 (pretest) to 7.0 (posttest 1). Supportive supervisory visits sustained and improved skill scores. While model 2 of SS could positively involve health system officials, model 1 was not well received. Outcome indicator in terms of number of children assessed showed a significant improvement in intervention areas. SS in IMNCI clinics/camps at PHC/CHC level and innovative skill scoring method is a promising approach.

  2. Integrating HIV care and treatment into primary healthcare: Are clinics equipped?

    Directory of Open Access Journals (Sweden)

    Talitha Crowley

    2014-01-01

    Full Text Available Background: The demand for HIV care and treatment services is increasing rapidly and strategies to sustain long-term care should be employed. The decentralisation and integration of HIV care and treatment services into primary healthcare (PHC is vitally important in order to ensure optimal access to life-saving antiretroviral therapy and ongoing chronic care. Conversely, the PHC system is fraught with the current burden of disease. Setting: The study was conducted in PHC clinics in the uMgungundlovu district, Kwa-Zulu Natal.Aim: The objectives of the study were to assess whether PHC clinics were equipped to deliver integrated HIV services and to evaluate the availability of resources as well as support systems for HIV care and treatment in PHC clinics.Methods: A quantitative, cross-sectional descriptive study was undertaken in 20 randomly-selected, eligible clinics in the uMgungundlovu district, KwaZulu-Natal, South Africa. An evaluation instrument was completed through observations and review of the clinic data records. Criteria were based on the World Health Organization’s guide to indicators for antiretroviral programmes as well as South African HIV standards for PHC facilities.Results: None of the clinics were equipped adequately. Clinics with a higher patient load had poorer scores, whilst clinics providing antiretroviral therapy were better equipped in terms of human resources and infrastructure.Conclusion: HIV services are an essential part of primary healthcare and clinics need to be equipped adequately in order to render this service. It is unlikely that the over-burdened health system would be able to cope with an increased number of patients on antiretroviral therapy in the long term, whilst maintaining quality of services, without support being given to PHC clinics.

  3. Integrating HIV care and treatment into primary healthcare: Are clinics equipped?

    Directory of Open Access Journals (Sweden)

    Talitha Crowley

    2014-08-01

    Full Text Available Background: The demand for HIV care and treatment services is increasing rapidly and strategies to sustain long-term care should be employed. The decentralisation and integration of HIV care and treatment services into primary healthcare (PHC is vitally important in order to ensure optimal access to life-saving antiretroviral therapy and ongoing chronic care. Conversely, the PHC system is fraught with the current burden of disease. Setting: The study was conducted in PHC clinics in the uMgungundlovu district, Kwa-Zulu Natal. Aim: The objectives of the study were to assess whether PHC clinics were equipped to deliver integrated HIV services and to evaluate the availability of resources as well as support systems for HIV care and treatment in PHC clinics. Methods: A quantitative, cross-sectional descriptive study was undertaken in 20 randomly-selected, eligible clinics in the uMgungundlovu district, KwaZulu-Natal, South Africa. An evaluation instrument was completed through observations and review of the clinic data records. Criteria were based on the World Health Organization’s guide to indicators for antiretroviral programmes as well as South African HIV standards for PHC facilities. Results: None of the clinics were equipped adequately. Clinics with a higher patient load had poorer scores, whilst clinics providing antiretroviral therapy were better equipped in terms of human resources and infrastructure. Conclusion: HIV services are an essential part of primary healthcare and clinics need to be equipped adequately in order to render this service. It is unlikely that the over-burdened health system would be able to cope with an increased number of patients on antiretroviral therapy in the long term, whilst maintaining quality of services, without support being given to PHC clinics.

  4. Citizen's Charter in a primary health-care setting of Nepal: An accountability tool or a "mere wall poster"?

    Science.gov (United States)

    Gurung, Gagan; Gauld, Robin; Hill, Philip C; Derrett, Sarah

    2018-02-01

    Despite some empirical findings on the usefulness of citizen's charters on awareness of rights and services, there is a dearth of literature about charter implementation and impact on health service delivery in low-income settings. To gauge the level of awareness of the Charter within Nepal's primary health-care (PHC) system, perceived impact and factors affecting Charter implementation. Using a case study design, a quantitative survey was administered to 400 participants from 22 of 39 PHC facilities in the Dang District to gauge awareness of the Charter. Additionally, qualitative interviews with 39 key informants were conducted to explore the perceived impact of the Charter and factors affecting its implementation. Few service users (15%) were aware of the existence of the Charter. Among these, a greater proportion were literate, and there were also differences according to ethnicity and occupational group. The Charter was usually not properly displayed and had been implemented with no prior public consultation. It contained information that provided awareness of health facility services, particularly the more educated public, but had limited potential for increasing transparency and holding service providers accountable to citizens. Proper display, consultation with stakeholders, orientation or training and educational factors, follow-up and monitoring, and provision of sanctions were all lacking, negatively influencing the implementation of the Charter. Poor implementation and low public awareness of the Charter limit its usefulness. Provision of sanctions and consultation with citizens in Charter development are needed to expand the scope of Charters from information brochures to tools for accountability. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

  5. Health physics experiences in achieving ALARA exposures to plant personnel at NAPS

    International Nuclear Information System (INIS)

    Ramakrishna, V.; Lal Chand

    2000-01-01

    Unit 1 of NAPS achieved first criticality on 12.3.1989 and Unit 2 achieved on 24.10.1991. Till the end of Feb-2000 these units have completed 1890 and 1811 full power days respectively. The performance of NAPS was expected to be better than the earlier Indian reactors in respect of safe production as well as cumulative radiation exposures. This is because of the major design improvements like: fully double containment system, elimination of 41 Ar by introducing light water in calandria vault, reduction of core based fuel failure rate, separation of high radiation equipment to no occupancy areas during normal operation, a separate purification building for the purification of both moderator and PHT systems, a better layout of equipment and plant areas, elimination of unnecessary equipment in various systems besides ensuring the reliability of equipment for safe operation, selection of materials with low corrosion and activation characteristics etc. In this paper, the operational health physics experiences at NAPS to achieve ALARA exposures to plant personnel are described briefly. (author)

  6. Latin America and the Caribbean: assessment of the advances in public health for the achievement of the Millennium Development Goals.

    Science.gov (United States)

    Mitra, Amal K; Rodriguez-Fernandez, Gisela

    2010-05-01

    To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs), that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1) eradicating extreme poverty and hunger; (2) achieving universal primary education; (3) promoting gender equality; (4) reducing child mortality; (5) improving maternal health; (6) combating HIV/AIDS, malaria and other diseases; (7) ensuring environmental sustainability; and (8) developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC). The paper also identifies areas of deficits for the achievement of MDGs in LAC.

  7. Design and implementation of pay-for-quality in primary healthcare: A case study from Iran

    Directory of Open Access Journals (Sweden)

    Jafar Sadegh Tabrizi

    2017-06-01

    Full Text Available Background The common methods of payment to healthcare providers such as capitation and salary are not designed to be stimulation for high quality healthcare. The pay-for -quality (P4Q programs are designed to provide the financial incentives to the service providers in order to improve quality of services based on specified criteria. Aims This study describes the design and implementation of a P4Q program in the primary healthcare (PHc in East Azerbaijan Province, Iran. Methods The present study is a case study that describes the process of designing and implementing the P4Q program in PHC in East-Azerbaijan province in 2015. To design the P4Q program, after identifying core components of the program through literature review and Focus Group Discussion (FGD, final decision about each component was made by achieving consensus from a panel of recognised experts in the area of PHc. Altogether two FGD and seven expert panel sessions were hold in EAPHC in order to design the P4Q program. Results Key components of P4Q program were selected by qualitative studies and the results were categorized in five headings including P4Q formula, quality measures, payment strategy, data reporting and performance evaluation. The formula consists of five elements including fixed payment, individual, team and organization performance and managerial appraisal. A total of 37 measures, which covers the domains of quality of PHc, human resource development and responsibility were selected. ‘Improvement’ and ‘absolute level of measures’ were selected as the payment strategy. The methods of data reporting included valid questionnaire, organization’s documents and medical records. The final P4Q program was used for paying incentives to all primary health care providers in public health centres affiliated to Tabriz University of Medical Sciences. Conclusion Designing and implementing the P4Q program led to a shift in paying the incentives to healthcare providers

  8. Modelling the implications of reducing smoking prevalence: the public health and economic benefits of achieving a 'tobacco-free' UK.

    Science.gov (United States)

    Hunt, Daniel; Knuchel-Takano, André; Jaccard, Abbygail; Bhimjiyani, Arti; Retat, Lise; Selvarajah, Chit; Brown, Katrina; Webber, Laura L; Brown, Martin

    2018-03-01

    Smoking is still the most preventable cause of cancer, and a leading cause of premature mortality and health inequalities in the UK. This study modelled the health and economic impacts of achieving a 'tobacco-free' ambition (TFA) where, by 2035, less than 5% of the population smoke tobacco across all socioeconomic groups. A non-linear multivariate regression model was fitted to cross-sectional smoking data to create projections to 2035. These projections were used to predict the future incidence and costs of 17 smoking-related diseases using a microsimulation approach. The health and economic impacts of achieving a TFA were evaluated against a predicted baseline scenario, where current smoking trends continue. If trends continue, the prevalence of smoking in the UK was projected to be 10% by 2035-well above a TFA. If this ambition were achieved by 2035, it could mean 97 300 +/- 5 300 new cases of smoking-related diseases are avoided by 2035 (tobacco-related cancers: 35 900+/- 4 100; chronic obstructive pulmonary disease: 29 000 +/- 2 700; stroke: 24 900 +/- 2 700; coronary heart disease: 7600 +/- 2 700), including around 12 350 diseases avoided in 2035 alone. The consequence of this health improvement is predicted to avoid £67 +/- 8 million in direct National Health Service and social care costs, and £548 million in non-health costs, in 2035 alone. These findings strengthen the case to set bold targets on long-term declines in smoking prevalence to achieve a tobacco 'endgame'. Results demonstrate the health and economic benefits that meeting a TFA can achieve over just 20 years. Effective ambitions and policy interventions are needed to reduce the disease and economic burden of smoking. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Is it just religious practice? Exploring patients' reasons for choosing a faith-based primary health clinic over their local public sector primary health clinic.

    Science.gov (United States)

    Porter, James D; Bresick, Graham

    2017-06-29

    Person-centred, re-engineered primary health care (PHC) is a national and global priority. Faith-based health care is a significant provider of PHC in sub-Saharan Africa, but there is limited published data on the reasons for patient choice of faith-based health care, particularly in South Africa. The primary objective was to determine and explore the reasons for patient choice of a faith-based primary care clinic over their local public sector primary care clinic, and secondarily to determine to what extent these reasons were influenced by demography. The study was conducted at Jubilee Health Centre (JHC), a faith-based primary care clinic attached to Jubilee Community Church in Cape Town, South Africa. Focus groups, using the nominal group technique, were conducted with JHC patients and used to generate ranked reasons for attending the clinic. These were collated into the top 15 reasons and incorporated into a quantitative questionnaire which was administered to adult patients attending JHC. A total of 164 patients were surveyed (a response rate of 92.4%) of which 68.3% were female and 57.9% from the Democratic Republic of the Congo (DRC). Of patients surveyed, 98.2% chose to attend JHC because 'the staff treat me with respect', 96.3% because 'the staff are friendly' and 96.3% because 'the staff take time to listen to me'. The reason 'it is a Christian clinic' was chosen by 70.1% of patients. 'The staff speak my home language' was given as a reason by 61.1% of DRC patients and 37.1% of South African patients. 'The clinic is close to me' was chosen by 66.6% of Muslims and 40.8% of Christians. Patients chose to attend JHC (a faith-based primary care clinic) because of the quality of care received. They emphasised the staff-patient relationship and patient-centredness rather than the clinic's religious practices (prayer with patients). These findings may be important in informing efforts to improve public sector primary care.

  10. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement.

    Science.gov (United States)

    Langford, Rebecca; Bonell, Christopher P; Jones, Hayley E; Pouliou, Theodora; Murphy, Simon M; Waters, Elizabeth; Komro, Kelli A; Gibbs, Lisa F; Magnus, Daniel; Campbell, Rona

    2014-04-16

    The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of

  11. Achieving the health Millennium Development Goals for South Africa: challenges and priorities.

    Science.gov (United States)

    Chopra, Mickey; Lawn, Joy E; Sanders, David; Barron, Peter; Abdool Karim, Salim S; Bradshaw, Debbie; Jewkes, Rachel; Abdool Karim, Quarraisha; Flisher, Alan J; Mayosi, Bongani M; Tollman, Stephen M; Churchyard, Gavin J; Coovadia, Hoosen

    2009-09-19

    15 years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The effect of the unprecedented HIV/AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potential of South Africa to attain the Millennium Development Goals (MDGs). However The Lancet's Series on South Africa has identified several examples of leadership and innovation that point towards a different future scenario. We discuss the type of vision, leadership, and priority actions needed to achieve such a change. We still have time to change the health trajectory of the country, and even meet the MDGs. The South African Government, installed in April, 2009, has the mandate and potential to address the public health emergencies facing the country--will they do so or will another opportunity and many more lives be lost?

  12. Latin America and the Caribbean: Assessment of the Advances in Public Health for the Achievement of the Millennium Development Goals

    Directory of Open Access Journals (Sweden)

    Amal K. Mitra

    2010-05-01

    Full Text Available To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs, that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1 eradicating extreme poverty and hunger; (2 achieving universal primary education; (3 promoting gender equality; (4 reducing child mortality; (5 improving maternal health; (6 combating HIV/AIDS, malaria and other diseases; (7 ensuring environmental sustainability; and (8 developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC. The paper also identifies areas of deficits for the achievement of MDGs in LAC.

  13. Influence of organizational culture on provider adherence to the diabetic clinical practice guideline: using the competing values framework in Palestinian Primary Healthcare Centers.

    Science.gov (United States)

    Radwan, Mahmoud; Akbari Sari, Ali; Rashidian, Arash; Takian, Amirhossein; Abou-Dagga, Sanaa; Elsous, Aymen

    2017-01-01

    Diabetes mellitus (DM) is a serious chronic disease and an important public health issue. This study aimed to identify the predominant culture within the Palestinian Primary Healthcare Centers of the Ministry of Health (PHC-MoH) and the Primary Healthcare Centers of the United Nations Relief and Works Agency for Palestine Refugees (PHC-UNRWA) by using the competing values framework (CVF) and examining its influence on the adherence to the Clinical Practice Guideline (CPG) for DM. A cross-sectional design was employed with a census sample of all the Palestinian family doctors and nurses (n=323) who work within 71 PHC clinic. A cross-cultural adaptation framework was followed to develop the Arabic version of the CVF questionnaire. The overall adherence level to the diabetic guideline was disappointingly suboptimal (51.5%, p culture was the most predominant (mean =41.13; standard deviation [SD] =8.92), followed by hierarchical (mean =33.14; SD=5.96), while in the PHC-UNRWA, hierarchical was the prevailing culture (mean =48.43; SD =12.51), followed by clan/group (mean =29.73; SD =8.37). Although a positively significant association between the adherence to CPG and the rational culture and a negatively significant association with the developmental archetype were detected in the PHC-MoH, no significant associations were found in the PHC-UNRWA. Our study demonstrates that the organizational culture has a marginal influence on the adherence to the diabetic guideline. Future research should preferably mix quantitative and qualitative approaches and explore the use of more sensitive instruments to measure such a complex construct and its effects on guideline adherence in small-sized clinics.

  14. Effectively engaging the private sector through vouchers and contracting - A case for analysing health governance and context.

    Science.gov (United States)

    Nachtnebel, Matthias; O'Mahony, Ashleigh; Pillai, Nandini; Hort, Kris

    2015-11-01

    Health systems of low and middle income countries in the Asia Pacific have been described as mixed, where public and private sector operate in parallel. Gaps in the provision of primary health care (PHC) services have been picked up by the private sector and led to its growth; as can an enabling regulatory environment. The question whether governments should purchase services from the private sector to address gaps in service provision has been fiercely debated. This purposive review draws evidence from systematic reviews, and additional published and grey literature, for input into a policy brief on purchasing PHC-services from the private sector for underserved areas in the Asia Pacific region. Additional published and grey literature on vouchers and contracting as mechanisms to engage the private sector was used to supplement the conclusions from systematic reviews. We analysed the literature through a policy lens, or alternatively, a 'bottom-up' approach which incorporates components of a realist review. Evidence indicates that both vouchers and contracting can improve health service outcomes in underserved areas. These outcomes however are strongly influenced by (1) contextual factors, such as roles and functions attributable to a shared set of key actors (2) the type of delivered services and community demand (3) design of the intervention, notably provider autonomy and trust (4) governance capacity and provision of stewardship. Examining the experience of vouchers and contracting to expand health services through engagement with private sector providers in the Asia Pacific found positive effects with regards to access and utilisation of health services, but more importantly, highlighted the significance of contextual factors, appropriate selection of mechanism for services provided, and governance arrangements and stewardship capacity. In fact, for governments seeking to engage the private sector, analysis of context and capacities are potentially a more

  15. Strategies for the Prevention and Control of Cervical Cancer in Rural ...

    African Journals Online (AJOL)

    adedamla

    Result & Conclusion: Increasing the knowledge base and competences (skills) of PHC operators and ..... organization (NGOs) and qualified health ... equipment, training of health care professionals for ..... organizations and health structures.

  16. Association between scores in high school, aptitude and achievement exams and early performance in health science college

    Directory of Open Access Journals (Sweden)

    Al-Alwan Ibrahim

    2009-01-01

    Full Text Available This retrospective study was carried out to assess the correlation between admi-ssion criteria to health science colleges, namely, final high school grade and Saudi National Apti-tude and Achievement exams, and early academic performance in these colleges. The study inclu-ded 91 male students studying in the two-year pre-professional program at the King Saud bin Abdulaziz University for Health Sciences (KSAU-HS, Riyadh, Saudi Arabia. Records of these students were used to extract relevant information and their academic performance (based on the grade point average achieved at the end of the first semester of the pre-professional program, which were analytically studied. Pearson correlation coefficient was used to assess the associa-tions between the different scores. SPSS statistical program (version 12.0 was used for data ana-lyses. We found a strong correlation between the academic performance and the Achievement Exam, Aptitude Exam and high school final grade, with Pearson Correlation Coefficients of 0.96, 0.93, 0.87, respectively. The Saudi National Achievement Exam showed the most significant correla-tion. Our results indicate that academic performance showed good correlation with the admission criteria used, namely final high school grade, Saudi National Aptitude and Achievement Exams.

  17. The views of key stakeholders in Zimbabwe on the introduction of postgraduate family medicine training: A qualitative study.

    Science.gov (United States)

    Sururu, Cherifa; Mash, Robert

    2017-09-12

    Strengthening primary health care (PHC) is a priority for all effective health systems, and family physicians are seen as a key member of the PHC team. Zimbabwe has joined a number of African countries that are seriously considering the introduction of postgraduate family medicine training. Implementation of training, however, has not yet happened. To explore the views of key stakeholders on the introduction of postgraduate family medicine training. Key academic, governmental and professional stakeholders in Zimbabwean health and higher education systems. Twelve semi-structured interviews were conducted with purposively selected key stakeholders. Data were recorded, transcribed and analysed using the framework method. Anticipated benefits: More effective functioning of PHC and district health services with reduced referrals, improved access to more comprehensive services and improved clinical outcomes. Opportunities: International trend towards family medicine training, government support, availability of a small group of local trainers, need to revise PHC policy. Anticipated barriers: Family medicine is unattractive as a career choice because it is largely unknown to newly qualified doctors and may not be recognised in private sector. There is concern that advocacy is mainly coming from the private sector. Threats: Economic conditions, poor remuneration, lack of funding for resources and new initiatives, resistance from other specialists in private sector. Stakeholders anticipated significant benefits from the introduction of family medicine training and identified a number of opportunities that support this, but also recognised the existence of major barriers and threats to successful implementation.

  18. Results of a workplace health campaign: what can be achieved?

    Science.gov (United States)

    Leyk, Dieter; Rohde, Ulrich; Hartmann, Nadine D; Preuß, Philipp A; Sievert, Alexander; Witzki, Alexander

    2014-05-02

    Effective health promotion in the workplace is now essential because of the rising health-related costs for businesses, the increasing pressure arising from international competition, prolonged working lives, and the aging of the work force. The basic problem of prevention campaigns is that the target groups are too rarely reached and sustainable benefits too rarely achieved. In 2011, we carried out a broad-based health and fitness campaign to assess how many personnel could be motivated to participate in a model study under nearly ideal conditions. 1010 personnel were given the opportunity to participate in various kinds of sports, undergo sports-medicine examinations, attend monthly expert lectures, and benefit from nutritional offerings and Intranet information during work hours. Pseudonymized questionnaires were used to classify the participants according to their exercise behavior as non-active, not very active, and very active. The participants' subjective responses (regarding, e.g., health, exercise, nutrition, and the factors that motivated them to participate in sports or discouraged them from doing so) were recorded, as were their objective data (measures of body size and strength). The duration of the study was one year. 490 of the 1010 personnel (48.5%, among whom 27.2% were nonactive, 44.1% not very active, and 28.7% very active) participated in the initial questionnaire and testing. By the end of the study, this figure had dropped to 17.8%; diminished participation affected all three groups to a comparable extent. A comparison of dropouts and non-dropouts revealed that older age was a stable predictor for drop-out (bivariate odds ratio [OR] 1.028, p = 0.006; multivariate OR 1.049, p = 0.009). The study participants reported beneficial effects on their health and health awareness, performance ability, psychological balance, stress perception, exercise and dietary behavior. Even under optimal conditions and with high use of staff resources, this model

  19. Team composition and chronic disease management within primary healthcare practices in eastern Ontario: an application of the Measuring Organizational Attributes of Primary Health Care Survey.

    Science.gov (United States)

    Lukewich, Julia; Edge, Dana S; VanDenKerkhof, Elizabeth; Williamson, Tyler; Tranmer, Joan

    2018-04-15

    Various organizational-level attributes are being implemented in primary healthcare to improve healthcare delivery. There is a need to describe the distribution and nature of these attributes and explore differences across practices.AimThe aim of this study was to better understand organizational attributes of primary care teams, focusing specifically on team composition, nursing roles, and strategies that support chronic disease management. We employed a cross-sectional survey design. Team composition, nursing roles, availability of health services, and chronic disease management activities were described using the 'Measuring Organizational Attributes of Primary Health Care Survey.'FindingsA total of 76% (n=26 out of 34) of practice locations completed the survey, including family health teams (FHT; n=21) and community health centers (CHC; n=4). Nurse practitioners (NPs) and registered nurses (RNs) were the most common non-physician providers, and CHCs had a greater proportion of non-physician providers than FHTs. There was overlap in roles performed by NPs and RNs, and registered practical nurses engaged in fewer roles compared with NPs and RNs. A greater proportion of FHTs had systematic chronic disease management services for hypertension, depression and Alzheimer's disease compared with CHC practices. The 'Measuring Organizational Attributes of Primary Health Care Survey' was a useful tool to highlight variability in organizational attributes across PHC practices. Nurses are prominent within PHC practices, engaging in a wide range of roles related to chronic disease management, suggesting a need to better understand their contributions to patient care to optimize their roles.

  20. Primary ethynamines (HC similarly ordered CNH2, PhC similarly ordere CNH2), aminopropadienone (H2NCH=C=C=O), and imidoylketene (NH=CHCH=C=O). Preparation and identification of molecules of cosmochemical interest

    International Nuclear Information System (INIS)

    Wentrup, C.; Briehl, H.; Lorencak, P.; Vogelbacher, U.J.; Winter, H.W.; Maquestiau, A.; Flammang, R.

    1988-01-01

    Ethynamine (HC similarly ordered CNH 2 ) has been prepared from three different precursors by flash vacuum pyrolysis (FVP) and observed by low-temperature infrared spectroscopy for the first time. The collision activation mass spectra (CAMS) strongly support the assignments. The Meldrum's acid derivative also gives rise to equilibrating imidoylketene and aminopropadienone observable by both IR and CAMS. Ethynamine isomerizes in part to acetonitrile in the gas phase but polymerizes in the solid state between -70 and -50 0 C. Both ketene imine (H 2 C=C=NH) and acrylonitrile are formed on FVP of 3-hydroxypropionitrile. 2-Phenylethynamine (PhC similarly ordered CNH 2 ) is readily produced by FVP of the isoxazolone

  1. Screening for Cardiovascular Risk in Asymptomatic Users of the Primary Health Care Network in Lebanon, 2012–2013

    Science.gov (United States)

    Adib, Salim M.; Hamadeh, Randa; Freidi, Alia; Ammar, Walid

    2014-01-01

    Introduction In 2012, the Ministry of Public Health in Lebanon piloted a service of multifactorial cardiovascular screening in the publicly subsidized Primary Health Care (PHC) Network. We present an epidemiological analysis of data produced during this pilot to justify the inclusion of this service in the package of essential services offered through PHC and to present a preliminary cardiovascular risk profile in an asymptomatic population. Methods A total of 4,205 participants (two-thirds of which were women) aged at least 40 years and reportedly free from diabetes, hypertension, dyslipidemia, and cardiovascular disease (CVD) were screened. The screening protocol used a questionnaire and direct measurements to assess 5 modifiable cardiovascular risk factors; total cardiovascular risk score was calculated according to a paper-based algorithm developed by the World Health Organization and the International Society of Hypertension. Results Approximately 25% of the sample displayed metabolic impairments (11% for impaired blood glucose metabolism and 17% for impaired systolic blood pressure), and 6.6% were classified at total cardiovascular risk of 10% or more. Just over one-quarter of the sample was obese, almost half had a substantially elevated waist circumference, and 41% were smokers. Men were significantly more likely to screen positive for metabolic impairment than women, and women were more likely to be obese. Conclusion The implementation of a multifactorial screening for CVD among asymptomatic subjects detected a substantial proportion of previously undiagnosed cases of high metabolic risk, people who could now be referred to optimal medical follow-up. PMID:25032835

  2. How do small rural primary health care services sustain themselves in a constantly changing health system environment?

    Directory of Open Access Journals (Sweden)

    Buykx Penny

    2012-03-01

    Full Text Available Abstract Background The ability to sustain comprehensive primary health care (PHC services in the face of change is crucial to the health of rural communities. This paper illustrates how one service has proactively managed change to remain sustainable. Methods A 6-year longitudinal evaluation of the Elmore Primary Health Service (EPHS located in rural Victoria, Australia, is currently underway, examining the performance, quality and sustainability of the service. Threats to, and enablers of, sustainability have been identified from evaluation data (audit of service indicators, community surveys, key stakeholder interviews and focus groups and our own observations. These are mapped against an overarching framework of service sustainability requirements: workforce organisation and supply; funding; governance, management and leadership; service linkages; and infrastructure. Results Four years into the evaluation, the evidence indicates EPHS has responded effectively to external and internal changes to ensure viability. The specific steps taken by the service to address risks and capitalise on opportunities are identified. Conclusions This evaluation highlights lessons for health service providers, policymakers, consumers and researchers about the importance of ongoing monitoring of sentinel service indicators; being attentive to changes that have an impact on sustainability; maintaining community involvement; and succession planning.

  3. A training intervention on child feeding among primary healthcare workers in Ibadan Municipality

    Directory of Open Access Journals (Sweden)

    Folake O. Samuel

    2016-09-01

    Full Text Available Introduction: Health workers at the primary level are well positioned to provide health information and counselling on child feeding to mothers on antenatal visits. The study was designed to evaluate the effect of training on the knowledge, attitudes and provision of infant and young child feeding (IYCF information and counselling among primary healthcare (PHC workers. Methods: A two-stage cluster sample was used to select health workers for training on IYCF in Ibadan, Nigeria. Baseline, immediate and 4-week post-training surveys were conducted to assess knowledge, attitudes and practices of health workers regarding IYCF. Paired t-tests were used to measure differences (p < 0.05 before and after the training. Results: A total of 124 health workers were trained on current global IYCF recommendations. Participants included community health extension workers (59.7%, nurses (27.4%, community health officers (11.3%, and pharmacy technicians (1.6%. Mean age was 41.8 ± 8.2 years and 95.2% were women. Knowledge of health workers regarding IYCF, particularly complementary feeding, was low at baseline but improved significantly following the training intervention. Attitudes and practices regarding provision of IYCF were suboptimal among health workers at the PHC facilities, but this improved with training. Conclusion: Health workers at the PHC level need regular retraining exercises to ensure effective counselling on IYCF.

  4. Scale-up of HIV treatment through PEPFAR: a historic public health achievement.

    Science.gov (United States)

    El-Sadr, Wafaa M; Holmes, Charles B; Mugyenyi, Peter; Thirumurthy, Harsha; Ellerbrock, Tedd; Ferris, Robert; Sanne, Ian; Asiimwe, Anita; Hirnschall, Gottfried; Nkambule, Rejoice N; Stabinski, Lara; Affrunti, Megan; Teasdale, Chloe; Zulu, Isaac; Whiteside, Alan

    2012-08-15

    Since its inception in 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has been an important driving force behind the global scale-up of HIV care and treatment services, particularly in expansion of access to antiretroviral therapy. Despite initial concerns about cost and feasibility, PEPFAR overcame challenges by leveraging and coordinating with other funders, by working in partnership with the most affected countries, by supporting local ownership, by using a public health approach, by supporting task-shifting strategies, and by paying attention to health systems strengthening. As of September 2011, PEPFAR directly supported initiation of antiretroviral therapy for 3.9 million people and provided care and support for nearly 13 million people. Benefits in terms of prevention of morbidity and mortality have been reaped by those receiving the services, with evidence of societal benefits beyond the anticipated clinical benefits. However, much remains to be accomplished to achieve universal access, to enhance the quality of programs, to ensure retention of patients in care, and to continue to strengthen health systems.

  5. Prevalence, diagnostics and management of musculoskeletal disorders in primary health care in Sweden : an investigation of 2000 randomly selected patient records

    OpenAIRE

    Wiitavaara, Birgitta; Fahlström, Martin; Djupsjöbacka, Mats

    2017-01-01

    Abstract Rationale, aims and objectives The aims of this study is to investigate the prevalence of patients seeking care due to different musculoskeletal disorders (MSDs) at primary health care centres (PHCs), to chart different factors such as symptoms, diagnosis and actions prescribed for patients that visited the PHCs due to MSD and to make comparisons regarding differences due to gender, age and rural or urban PHC. Methods Patient records (2000) for patients in working age were randomly s...

  6. The Role of a Provider-Sponsored Health Plan in Achieving Scale and Integration.

    Science.gov (United States)

    Johnson, Steven P

    2016-01-01

    In pursuit of two primary strategies-to become an integrated delivery network (IDN) on the local level and to achieve additional overall organizational scale to sustain operations-Health First, based in Rockledge, Florida, relies on the success of its provider-sponsored health plan (PSHP) as a critical asset. For Health First, the PSHP serves as an agent for holding and administering financial risk for the health of populations. In addition, we are learning that our PSHP is a critical asset in support of integrating the components of our care delivery system to manage that financial risk effectively, efficiently, and in a manner that creates a unified experience for the customer.Health First is challenged by continuing pressure on reimbursement, as well as by a substantial regulatory burden, as we work to optimize the environments and tools of care and population health management. Even with strong margins and a healthy balance sheet, we simply do not have the resources needed to bring an IDN robustly to life. However, we have discovered that our PSHP can be the vehicle that carries us to additional scale. Many health systems do not own or otherwise have access to a PSHP to hold and manage financial risk. Health First sought and found a not-for-profit health system with complementary goals and a strong brand to partner with, and we now provide private-label health plan products for that system using its strong name while operating the insurance functions under our license and with our capabilities.

  7. Interprofessional teamwork innovations for primary health care practices and practitioners: evidence from a comparison of reform in three countries

    Directory of Open Access Journals (Sweden)

    Harris MF

    2016-01-01

    Full Text Available Mark F Harris,1 Jenny Advocat,2 Benjamin F Crabtree,3 Jean-Frederic Levesque,1,4 William L Miller,5 Jane M Gunn,6 William Hogg,7 Cathie M Scott,8 Sabrina M Chase,9 Lisa Halma,10 Grant M Russell11 1Center for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, 2Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Notting Hill, VIC, Australia; 3Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA; 4Bureau of Health Information, NSW Government, Sydney, NSW, Australia; 5Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA, USA; 6Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia; 7The CT Lamont Primary Care Research Center, The University of Ottawa, Ottawa, ON, 8Alberta Centre for Child, Family, and Community Research, University of Calgary, AB, Canada; 9Rutgers University, Rutgers School of Nursing, Rutgers, NJ, USA; 10Alberta Health Services, Lethbridge, AB, Canada; 11School of Primary Health Care, Monash University, Notting Hill, VIC, Australia Context: A key aim of reforms to primary health care (PHC in many countries has been to enhance interprofessional teamwork. However, the impact of these changes on practitioners has not been well understood.Objective: To assess the impact of reform policies and interventions that have aimed to create or enhance teamwork on professional communication relationships, roles, and work satisfaction in PHC practices.Design: Collaborative synthesis of 12 mixed methods studies.Setting: Primary care practices undergoing transformational change in three countries: Australia, Canada, and the USA, including three Canadian provinces (Alberta, Ontario, and Quebec.Methods: We conducted a synthesis and secondary analysis of 12 qualitative and quantitative studies conducted by the authors in order to understand the impacts and how they

  8. Vaccination ecosystem health check: achieving impact today and sustainability for tomorrow.

    Science.gov (United States)

    Saadatian-Elahi, Mitra; Bloom, David; Plotkin, Stanley; Picot, Valentina; Louis, Jacques; Watson, Michael

    2017-01-01

    Vaccination is a complex ecosystem with several components that interact with one another and with the environment. Today's vaccine ecosystem is defined by the pursuit of polio eradication, the drive to get as many of the new vaccines to as many people as possible and the research and development against immunologically challenging diseases. Despite these successes, vaccine ecosystem is facing keys issues with regard to supply/distribution and cost/profitability asymmetry that risk slowing its global growth. The conference "Vaccination ecosystem health check: achieving impact today and sustainability for tomorrow" held in Annecy-France (January 19-21, 2015) took stock of the health of today's vaccination ecosystem and its ability to reliably and sustainably supply high-quality vaccines while investing in tomorrow's needed innovation. Small and decreasing numbers of suppliers/manufacturing facilities; paucity of research-driven companies; regulatory pressures; market uncertainties; political prioritization; anti-vaccine movements/complacency; and technological and programmatic issues were acknowledged as the major challenges that could weaken today's vaccination ecosystem. The expert panel discussed also drivers and barriers to a sustainable vaccination ecosystem; the metrics of a vaccination ecosystem; and what should be added, removed, increased, or reduced to maintain the health of the vaccination ecosystem.

  9. Global commitments and China's endeavors to promote health and achieve sustainable development goals.

    Science.gov (United States)

    Tan, Xiaodong; Wu, Qian; Shao, Haiyan

    2018-04-12

    With its immense population and as the largest developing country in the world, China has made remarkable achievements in health promotion at a relatively low cost. However, China is still faced with challenges such as changes of disease spectrum, the coming era of an aging society, and the risk of environmental pollution. On October 25, 2016, China formally passed the blueprint of "Healthy China 2030," working towards the national goal of reaching a health standard on par with developed countries by 2030, which was also a response to realize the 2030 United Nations Sustainable Development Goals. "Healthy China 2030" is comprised of 29 chapters that cover five health areas. China is sparing no effort to transfer from being merely the most populous country, to becoming a leading nation in health education. In "Healthy China 2030," collaborated construction and resource sharing were clearly stated as the core strategy. A shift in concentration towards coordinated development of health-based economy from a previous pursuit of rapid economic growth was also underlined. There are also several major issues, such as severely aging population, the burden of chronic diseases, the insufficiency of health expenditure, and the great demand on health protection, waiting to be dealt with during the implementation process of "Healthy China 2030". "Healthy China 2030" is a momentous move to enhance public health, which is also a response to the global commitments. We also need to rethink our approach to reach the living standards and maintain a better environment.

  10. The quest for universal health coverage: achieving social protection for all in Mexico.

    Science.gov (United States)

    Knaul, Felicia Marie; González-Pier, Eduardo; Gómez-Dantés, Octavio; García-Junco, David; Arreola-Ornelas, Héctor; Barraza-Lloréns, Mariana; Sandoval, Rosa; Caballero, Francisco; Hernández-Avila, Mauricio; Juan, Mercedes; Kershenobich, David; Nigenda, Gustavo; Ruelas, Enrique; Sepúlveda, Jaime; Tapia, Roberto; Soberón, Guillermo; Chertorivski, Salomón; Frenk, Julio

    2012-10-06

    Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries. Copyright

  11. Indian public health standards in primary health centers and community health centers in Shimla District of Himachal Pradesh: A descriptive evaluation

    Directory of Open Access Journals (Sweden)

    Raman Chauhan

    2016-01-01

    Full Text Available Introduction: The health planners in India have visualized primary health centers (PHCs and community health centers (CHCs as the key healthcare delivery institutions in rural areas. These centers are supposed to have health manpower, infrastructure, and service delivery as per the Indian public health standards (IPHS guidelines (2010. Materials and Methods: A cross-sectional study was conducted in seven CHCs and 12 PHCs, randomly selected from eight blocks of Shimla District and evaluated in terms of health manpower, infrastructure, and services from September 2011 to August 2012. Data was collected from the selected units using structured data collection instruments designed by the IPHS. Results: The health centers were assessed according to IPHS guidelines. Outpatient department services and referral services were provided in all the centers studied. No specialist doctor was posted at any of CHCs against a sanctioned strength of at least four (surgeon, physician, obstetrician, and pediatrician per CHC. In 3 (42.8% CHCs and 8 (75% PHCs, no pharmacist was posted. Eight (75% PHCs did not have any staff nurse posted. Three (42.8% CHCs and 10 (83.3% PHCs did not have a laboratory technician. In CHCs, separate labor room was available in 6 (85.7% whereas a separate laboratory was available in all seven. Separate labor room and laboratory were available in four (25% PHCs. Conclusions: IPHS guidelines are not being followed at PHC and CHC levels of the district. Health manpower shortage is the key bottleneck in service delivery. Political advocacy is needed to ensure sufficient health manpower availability to deliver quality healthcare.

  12. Significance of mental health legislation for successful primary care for mental health and community mental health services: A review.

    Science.gov (United States)

    Ayano, Getinet

    2018-03-29

     Mental health legislation (MHL) is required to ensure a regulatory framework for mental health services and other providers of treatment and care, and to ensure that the public and people with a mental illness are afforded protection from the often-devastating consequences of mental illness.  To provide an overview of evidence on the significance of MHL for successful primary care for mental health and community mental health servicesMethod: A qualitative review of the literature on the significance of MHL for successful primary care for mental health and community mental health services was conducted.  In many countries, especially in those who have no MHL, people do not have access to basic mental health care and treatment they require. One of the major aims of MHL is that all people with mental disorders should be provided with treatment based on the integration of mental health care services into the primary healthcare (PHC). In addition, MHL plays a crucial role in community integration of persons with mental disorders, the provision of care of high quality, the improvement of access to care at community level. Community-based mental health care further improves access to mental healthcare within the city, to have better health and mental health outcomes, and better quality of life, increase acceptability, reduce associated social stigma and human rights abuse, prevent chronicity and physical health comorbidity will likely to be detected early and managed.  Mental health legislation plays a crucial role in community integration of persons with mental disorders, integration of mental health at primary health care, the provision of care of high quality and the improvement of access to care at community level. It is vital and essential to have MHL for every country.

  13. Is the Role of Physicians Really Evolving Due to Non-physician Clinicians Predominance in Staff Makeup in Sub-Saharan African Health Systems? Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians".

    Science.gov (United States)

    Sidat, Mohsin M

    2016-07-02

    Health workforce shortages in Sub-Saharan Africa are widely recognized, particularly of physicians, leading the training and deployment of Non-physician clinicians (NPCs). The paper by Eyal et al provides interesting and legitimate viewpoints on evolving role of physicians in context of decisive increase of NPCss in Sub-Saharan Africa. Certainly, in short or mid-term, NPCs will continue to be a proxy solution and a valuable alternative to overcome physicians' shortages in sub-Saharan Africa. Indeed, NPCs have an important role at primary healthcare (PHC) level. Physicians at PHC level can certainly have all different roles that were suggested by Eyal et al, including those not directly related to healthcare provision. However, at secondary and higher levels of healthcare, physicians would assume other roles that are mainly related to patient clinical care. Thus, attempting to generalize the role of physicians without taking into account the context where they will work would be not entirely appropriate. It is true that often physicians start the professional carriers at PHC level and progress to other levels of healthcare particularly after clinical post-graduation training. Nevertheless, the training programs offered by medical institutions in sub-Saharan Africa need to be periodically reviewed and take into account professional and occupational roles physicians would take in context of evolving health systems in sub-Saharan Africa. © 2016 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

  14. Equity of the premium of the Ghanaian National Health Insurance Scheme and the implications for achieving universal coverage.

    Science.gov (United States)

    Amporfu, Eugenia

    2013-01-07

    The Ghanaian National Health Insurance Scheme (NHIS) was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.

  15. Equity of the premium of the Ghanaian national health insurance scheme and the implications for achieving universal coverage

    Directory of Open Access Journals (Sweden)

    Amporfu Eugenia

    2013-01-01

    Full Text Available Abstract The Ghanaian National Health Insurance Scheme (NHIS was introduced to provide access to adequate health care regardless of ability to pay. By law the NHIS is mandatory but because the informal sector has to make premium payment before they are enrolled, the authorities are unable to enforce mandatory nature of the scheme. The ultimate goal of the Scheme then is to provide all residents with access to adequate health care at affordable cost. In other words, the Scheme intends to achieve universal coverage. An important factor for the achievement of universal coverage is that revenue collection be equitable. The purpose of this study is to examine the vertical and horizontal equity of the premium collection of the Scheme. The Kakwani index method as well as graphical analysis was used to study the vertical equity. Horizontal inequity was measured through the effect of the premium on redistribution of ability to pay of members. The extent to which the premium could cause catastrophic expenditure was also examined. The results showed that revenue collection was both vertically and horizontally inequitable. The horizontal inequity had a greater effect on redistribution of ability to pay than vertical inequity. The computation of catastrophic expenditure showed that a small minority of the poor were likely to incur catastrophic expenditure from paying the premium a situation that could impede the achievement of universal coverage. The study provides recommendations to improve the inequitable system of premium payment to help achieve universal coverage.

  16. Positive and negative affect in the future teacher: relationships with their academic achievement, mental health and satisfaction with life

    Directory of Open Access Journals (Sweden)

    Ruth Pinedo González

    2017-02-01

    Full Text Available Affects are composed of two key dimensions: the positive affect (PA and negative affect (NA. Both dimensions are related to psychological adjustment of the person and life satisfaction. This study is exploratory in nature and aims to make a first correlational analysis between different constructs: emotional disposition, academic achievement, mental health and life satisfaction in a sample of 143 student teachers. We have used the following scales adapted to the culture: The Positive and Negative Affect Schedule (PANAS, the Mental Health Inventory (MHI-5 and the Satisfaction With Life Scale (SWLS. Among the most interesting results it was found that positive affect was associated with academic achievement, mental health and life satisfaction. Positive and negative affects and satisfaction with life were formed as predictors of future teachers’ mental health. Extensive analysis and discussion of the results is included in the document.

  17. Compressed air production with waste heat utilization in industry

    Science.gov (United States)

    Nolting, E.

    1984-06-01

    The centralized power-heat coupling (PHC) technique using block heating power stations, is presented. Compressed air production in PHC technique with internal combustion engine drive achieves a high degree of primary energy utilization. Cost savings of 50% are reached compared to conventional production. The simultaneous utilization of compressed air and heat is especially interesting. A speed regulated drive via an internal combustion motor gives a further saving of 10% to 20% compared to intermittent operation. The high fuel utilization efficiency ( 80%) leads to a pay off after two years for operation times of 3000 hr.

  18. 42 CFR 3.304 - Principles for achieving compliance.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Principles for achieving compliance. 3.304 Section 3.304 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL... Principles for achieving compliance. (a) Cooperation. The Secretary will, to the extent practicable, seek the...

  19. Following on from the Life Esidimeni incident – access to care for ...

    African Journals Online (AJOL)

    2017-12-01

    Dec 1, 2017 ... mental-health policy, in particular the National Mental Health Policy .... and management of child and adolescent mental disorders in PHC clinics and at ... (i) Providing mental-health promotion and prevention interventions, ...

  20. The challenges of reshaping disease specific and care oriented community based services towards comprehensive goals: a situation appraisal in the Western Cape Province, South Africa.

    Science.gov (United States)

    Schneider, Helen; Schaay, Nikki; Dudley, Lilian; Goliath, Charlyn; Qukula, Tobeka

    2015-09-30

    Similar to other countries in the region, South Africa is currently reorienting a loosely structured and highly diverse community care system that evolved around HIV and TB, into a formalized, comprehensive and integrated primary health care outreach programme, based on community health workers (CHWs). While the difficulties of establishing national CHW programmes are well described, the reshaping of disease specific and care oriented community services, based outside the formal health system, poses particular challenges. This paper is an in-depth case study of the challenges of implementing reforms to community based services (CBS) in one province of South Africa. A multi-method situation appraisal of CBS in the Western Cape Province was conducted over eight months in close collaboration with provincial stakeholders. The appraisal mapped the roles and service delivery, human resource, financing and governance arrangements of an extensive non-governmental organisation (NGO) contracted and CHW based service delivery infrastructure that emerged over 15-20 years in this province. It also gathered the perspectives of a wide range of actors - including communities, users, NGOs, PHC providers and managers - on the current state and future visions of CBS. While there was wide support for new approaches to CBS, there are a number of challenges to achieving this. Although largely government funded, the community based delivery platform remains marginal to the formal public primary health care (PHC) and district health systems. CHW roles evolved from a system of home based care and are limited in scope. There is a high turnover of cadres, and support systems (supervision, monitoring, financing, training), coordination between CHWs, NGOs and PHC facilities, and sub-district capacity for planning and management of CBS are all poorly developed. Reorienting community based services that have their origins in care responses to HIV and TB presents an inter-related set of resource

  1. Clinical undergraduate training and assessment in primary health care: Experiences gained from Crete, Greece

    Directory of Open Access Journals (Sweden)

    Fioretos Michael

    2005-05-01

    Full Text Available Abstract Background Primary Health Care (PHC is increasingly being introduced into undergraduate medical education. In Greece, the Faculty of Medicine of the University of Crete was the first to introduce a 4-week long training in primary health care. This paper presents the experiences gained from the initial implementation of the teaching of practice-based primary care in rural Crete and reports on the assessment scale that was developed. Methods 284 students' case write-ups from the 6 primary care units (PCUs where they were allocated for the period 1990 to 1994 were analysed. The demographic data of the students and patients and the number of home visits were studied. Content analysis of the students' write-ups was carried out, using an assessment scale consisting of 10 dichotomous variables, in order to quantify eight (8 primary qualitative criteria. Results Internal reliability was estimated by the index KR20 = 0.67. Face and content validity was found to conform to the standards set for the course, while logistic linear regression analysis showed that the quality criteria could be used as an assessment scale. The number of home visits carried out varied between the various different PCUs (p Conclusion The primary health care course achieved the objectives of introducing students to comprehensive, community oriented care, although there was variation between the PCUs. The assessment scale that was developed to analyse the case-write ups of the students provided data that can be used to evaluate the course.

  2. Ghana's community-based primary health care: Why women and children are 'disadvantaged' by its implementation.

    Science.gov (United States)

    Atinga, Roger A; Agyepong, Irene Akua; Esena, Reuben K

    2018-03-01

    Policy analysis on why women and children in low- and middle-income settings are still disadvantaged by access to appropriate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street-level bureaucracy theory, we explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana's community-based PHC implementation to the disadvantage of women and children accessing and using health services. This was a qualitative study conducted in 4 communities drawn from rural and urban districts of the Upper West region. Data were collected from 8 focus group discussions with community informants, 73 in-depth interviews with clients, 13 in-depth interviews with district health managers and FLP, and observations. Data were recorded, transcribed and coded deductively and inductively for themes with the aid of Nvivo 11 software. Findings showed that apart from FLP frequent lateness to, and absenteeism from work, that affected care seeking for children, their exercise of discretionary power in determining children who deserve care over others had ripple effects: families experienced financial hardships in seeking alternative care for children, and avoided that by managing symptoms with care provided in non-traditional spaces. FLP adverse behaviours were driven by weak implementation structures embedded in the district health systems. Basic obstetric facilities such as labour room, infusion stand, and beds for deliveries, detention and palpation were lacking prompting FLP to cope by conducting deliveries using a patchwork of improvised delivery methods which worked out to encourage unassisted home deliveries. Perceived poor conditions of service weakened FLP commitment to quality maternal and child care delivery. Findings suggest the need for strategies to induce behaviour change in FLP, strengthen district administrative structures, and improve on the supply chain and logistics

  3. Comprehensive approach to improving maternal health and achieving MDG 5: report from the mountains of Lesotho.

    Directory of Open Access Journals (Sweden)

    Hind Satti

    Full Text Available BACKGROUND: Although it is now widely recognized that reductions in maternal mortality and improvements in women's health cannot be achieved through simple, vertical strategies, few programs have provided successful models for how to integrate services into a comprehensive program for maternal health. We report our experience in rural Lesotho, where Partners In Health (PIH in partnership with the Ministry of Health and Social Welfare implemented a program that provides comprehensive care of pregnant women from the community to the clinic level. METHODS: Between May and July 2009, PIH trained 100 women, many of whom were former traditional birth attendants, to serve as clinic-affiliated maternal health workers. They received performance-based incentives for accompanying pregnant women during antenatal care (ANC visits and facility-based delivery. A nurse-midwife provided ANC and delivery care and supervised the maternal health workers. To overcome geographic barriers to delivering at the clinic, women who lived far from the clinic stayed at a maternal lying-in house prior to their expected delivery dates. We analyzed data routinely collected from delivery and ANC registers to compare service utilization before and after implementation of the program. RESULTS: After the establishment of the program, the average number first ANC visits increased from 20 to 31 per month. The clinic recorded 178 deliveries in the first year of the program and 216 in the second year, compared to 46 in the year preceding the program. During the first two years of the program, 49 women with complications were successfully transported to the district hospital, and no maternal deaths occurred among the women served by the program. CONCLUSIONS: Our results demonstrate that it is possible to achieve dramatic improvements in the utilization of maternal health services and facility-based delivery by strengthening human resource capacity, implementing active follow-up in the

  4. Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study.

    Science.gov (United States)

    Bentley, Michael; Freeman, Toby; Baum, Fran; Javanparast, Sara

    2018-05-01

    This article draws on data from a 5-year project that examined the effectiveness of Comprehensive primary healthcare (CPHC) in local communities. A hallmark of CPHC services is interprofessional teamwork. Drawing from this study, our article presents factors that enabled, or hindered, healthcare teams working interprofessionally in Australian primary healthcare (PHC) services. The article reports on the experiences of teams working in six Australian PHC services (four managed by state governments, one non-government sexual health organisation, and one Aboriginal community-controlled health service) during a time of significant health sector restructure. Findings are drawn from two key methods: an online survey of practitioners and managers (n = 154), and interviews with managers and practitioners (n = 60) from the six study sites. The majority of survey respondents worked with other health professionals in their service to provide interprofessional care to clients. Processes included formal team meetings, case conferencing, referring clients to other health professionals if needed, informal communication with other health professionals about clients, and team-based delivery of care. A range of interrelated factors affected interprofessional work at the services, from contextual, organisational, processual, and relational domains. Funding cuts and policy changes that saw a reorientation and re-medicalisation of South Australian services undermined interprofessional work, while a shared CPHC culture and commitment among some staff was helpful in resisting some of these effects. The co-location of services was a factor in PHC teams working interprofessionally and not only enabled some PHC teams to work more interprofessionally but also created barriers to interprofessional teamwork through disruption resulting from restructuring of services. Our study indicates the importance of decision makers taking into account the potential effects of policy and structural

  5. Technical assistance from state health departments for communities engaged in policy, systems, and environmental change: the ACHIEVE Program.

    Science.gov (United States)

    Hefelfinger, Jenny; Patty, Alice; Ussery, Ann; Young, Walter

    2013-10-24

    This study assessed the value of technical assistance provided by state health department expert advisors and by the staff of the National Association of Chronic Disease Directors (NACDD) to community groups that participated in the Action Communities for Health, Innovation, and Environmental Change (ACHIEVE) Program, a CDC-funded health promotion program. We analyzed quantitative and qualitative data reported by community project coordinators to assess the nature and value of technical assistance provided by expert advisors and NACDD staff and the usefulness of ACHIEVE resources in the development and implementation of community action plans. A grounded theory approach was us