Primary Health Care Activities Research Articles

Intersectional equity in Brazil's remote rural municipalities: the road to efficiency and effectiveness in local health systems.

The Brazilian remote rurality has been classified more reliably only recently, according to demographic density, proportion of urban population, and accessibility to urban centers. It comprises 5.8% of the municipalities, in nearly half of the states, with a population of 3,524,597 (1.85%). Remote rural localities (RRL) have reduced political/economic power, facing greater distances and barriers. Most health strategies are developed with the urban space in mind. We aim to understand how RRL are positioned concerning efficiency/effectiveness in health, compared to other urban-rural typologies of Brazilian localities, focusing on Primary Health Care (PHC), and its organizational models. We evaluated the efficiency and effectiveness of the organizational models using the health production model, from 2010-2019, gradually deepening the immersion into the RRL reality. We analyzed the human and financial resources dimensions, emphasizing teams, the results of PHC actions, and health levels. We used the fixed effects model and data envelopment analysis, cross-sectioned by intersectional inequities. We compared the Brazilian states with and without RRL, Brazilian municipalities according to rural-urban typologies, and RRL clusters. Brazilian RRL states show superior resource/health efficiency through services utilization according to health needs. The remote rural typology demonstrated greater efficiency and effectiveness in health than the other typologies in the RRL states. The organizational models with the Family Health Strategy (FHS) teams and the Community Health Worker (CHW) visits played a key role, together with local per capita health expenditures and intergovernmental transfers. Thus, financial resources and health professionals are essential to achieve efficient/effective results in health services. Among the RRL, the Amazon region clusters stand out, denoting the importance of riverine and fluvial health teams, the proportion of diagnostic/treatment units in addition to the proportion of illiteracy and adolescent mothers along with the inequity of reaching high levels of schooling between gender/ethnicity. Hopefully, these elements might contribute to gains in efficiency and effectiveness, prioritizing the allocation of financial/human resources, mobile FHS teams, availability of local diagnosis/treatment, and basic sanitation. Finally, one should aim for equity of gender/ethnicity in income and education and, above all, of place, perceived in its entirety.

The Use of COVID-19 Mobile Apps in Connecting Patients with Primary Healthcare in 30 Countries: Eurodata Study.

The COVID-19 pandemic has necessitated changes in European healthcare systems, with a significant proportion of COVID-19 cases being managed on an outpatient basis in primary healthcare (PHC). To alleviate the burden on healthcare facilities, many European countries developed contact-tracing apps and symptom checkers to identify potential cases. As the pandemic evolved, the European Union introduced the Digital COVID-19 Certificate for travel, which relies on vaccination, recent recovery, or negative test results. However, the integration between these apps and PHC has not been thoroughly explored in Europe. To describe if governmental COVID-19 apps allowed COVID-19 patients to connect with PHC through their apps in Europe and to examine how the Digital COVID-19 Certificate was obtained. Design and setting: Retrospective descriptive study in PHC in 30 European countries. An ad hoc, semi-structured questionnaire was developed to collect country-specific data on primary healthcare activity during the COVID-19 pandemic and the use of information technology tools to support medical care from 15 March 2020 to 31 August 2021. Key informants belong to the WONCA Europe network (World Organization of Family Doctors). The data were collected from relevant and reliable official sources, such as governmental websites and guidelines. Patient's first contact with health system, governmental COVID-19 app (name and function), Digital COVID-19 Certification, COVID-19 app connection with PHC. Primary care was the first point of care for suspected COVID-19 patients in 28 countries, and 24 countries developed apps to complement classical medical care. The most frequently developed app was for tracing COVID-19 cases (24 countries), followed by the Digital COVID-19 Certificate app (17 countries). Bulgaria, Italy, Serbia, North Macedonia, and Romania had interoperability between PHC and COVID-19 apps, and Poland and Romania's apps considered social needs. COVID-19 apps were widely created during the first pandemic year. Contact tracing was the most frequent function found in the registered apps. Connection with PHC was scarcely developed. In future pandemics, connections between health system levels should be guaranteed to develop and implement effective strategies for managing diseases.

Financial constraints and incentives for the prevention and control of obesity in the state of Rio de Janeiro, Brazil.

The present study aimed to analyze how these changes, both at the national and state levels, could affect the conditions of the implementation of obesity prevention and control (OCP) actions in primary health care (PHC) in the Rio de Janeiro State from 2014 to 2021. This study was based on policy analysis methods that emphasize the understanding of the implementation contexts, as well as the induction mechanisms and government incentives for the development of actions and integration of two projects that analyzed the OPC actions in PHC in the 92 municipalities of RJS between 2014 and 2018 (PPSUS-RJS) and between 2019 and 2021 (PEO-RJS). The results indicate that, by 2016, it was possible to observe the positive impacts of the structuring of PHC and the federal induction mechanisms in RJS. However, inflections in the expansion and funding of PHC contributed to the weakening of units, teams, and strategies, and led to retraction of resources for both state and municipal actions. Between 2016-2018, RJS's political and financial scenario deteriorated due to national crises, and the positive counterpoints since then were the induction mechanisms and federal resources that remained, in addition to the technical areas of the RJS-HD and state co-financing resources.

Effects of Isolation and Social Distancing on the Fragility of Older People and the Physical Activities They Perform

Introduction: The association between reduced physical activity and social isolation has been described in the literature, but the relationship between the level of adherence to protective measures among older adults during the COVID-19 pandemic and the effects of physical inactivity on frailty remains a significant knowledge gap. Objective: To analyze the effects of social distancing and isolation caused by the COVID-19 pandemic on frailty in the elderly and on their physical activities in primary health care in a basic health unit in Brazil. Materials and methods: A prospective cohort study conducted in households and basic health units. In the first wave, before the pandemic, the sample consisted of non-frail elderly (n = 168). After a mean follow-up of 762 days, a second wave was conducted in which the elderly were classified according to their level of exposure to social distancing and isolation (n = 100) and the outcomes “level of physical activity” and “frailty status” were observed. Sociodemographic and clinical questionnaires, the Mini-Mental State Examination, physical markers of frailty, and level of exposure to social distancing and isolation were used. Descriptive statistics, association, survival curves, and proportional hazards regression were used. Results: Of the elderly, 53% transitioned to pre-frailty and 21% showed a decrease in physical activity. There was a high percentage of low adherence to social distancing and isolation, and there was no association with physical activity and frailty (p = 0.288; p = 0.351, respectively). Women had a higher risk of being classified as pre-frail or frail (2.53; 95% CI, 1.01-6.34) and of having a decrease in physical activity (2.13; 95% CI, 1.06-4.26). Conclusion: There was no association between protective measures of social distancing and isolation, physical activity, and frailty. Older people with reduced levels of physical activity should be encouraged to exercise to remain active and avoid the transition to frailty, functional decline, and dependency.

Biological screening for congenital toxoplasmosis in newborns from Jataí, Goiás, Brazil: a cross-sectional study.

To conduct a serological screening for toxoplasmosis in the heel prick test and to evaluate its epidemiological aspects in newborns and postpartum women in Jataí, Goiás. Cross-sectional epidemiological study for the biological screening of newborns in Jataí, Goiás. The study participants amounted to 228 newborns, whose samples were collected between the third and seventh day of life. IgG antibodies against Toxoplasma gondii were detected in 40.79% (93/228) of the samples; out of these, 23.6% (22/93) had high IgG antibody titers, leading to the collection of two other peripheral blood samples and the detection of a decrease in these titers. The findings show the importance of strengthening actions in primary health care to prevent infection and training health professionals in this area to equip them with information regarding cases of reinfection and reactivation of infection in pregnant women, minimizing risks for babies.

Federal government budgetary and financial resources for body practices and physical activities in the Unified Health System: analysis of the 2019-2022 governmental cycle.

Through quantitative exploratory research, the present study analyzed the amount foreseen in the Federal Budget and the amounts paid (nominal and deflated) for programs and actions to promote body practices and physical activities (Health Academy Program and the Federal Incentive for Physical Activity in Primary Health Care) from 2019 to 2022. The values of investment in body practices and physical activities in SUS per capita, according to the population covered by Primary Health Care (PHC) and per participant in public programs, were also calculated. The following was found: (1) that the resources that were actually paid were 3.31% to 15.06% lower than those approved in the budget (nominal) and (2) the low annual (maximum) values found, regardless of whether nominal or deflated - per capita (R$ 0.21 to 0.30) per population covered by PHC (R$ 0.25 to 0.40) and per participant (R$ 10.61 to 14.61). It was concluded that the low investment in the promotion of body practices and physical activities decreases access and does not contribute to the full functioning of SUS by preventing or hindering the expansion of possibilities of comprehensive health care.

Information technologies as organizational support for the COVID-19 coping actions: Nurses' discourse.

to analyze nurses' discourse about the potentialities in using information technologies as organizational support for the COVID-19 coping actions in Primary Health Care. a qualitative and exploratory study conducted in the Family Health Strategy units from the city of João Pessoa, Paraíba, Brazil. Data collection was carried out from September to November 2021 with 26 nurses selected through the snowball technique, resorting to a semi-structured interview script. The empirical material was organized in the Atlas.ti 9 software and grounded on the theoretical-methodological contribution of Discourse Analysis, French Line. three discursive blocks were evidenced: innovation based on social media; health education actions; resoluteness in organizational actions, presenting the relevance of the WhatsApp®, Instagram® and Facebook® apps as strategic resources, in order to collaborate in the Primary Health Care are with the organization of health actions against COVID-19 by nurses. health units have the potential to strengthen the assistance provided through digital organizational devices; however, they need political support that invests in the structure and strategies to enhance organization of the health actions.

Evaluating local primary health care actions to address health inequities: analysis of Australia’s Primary Health Networks

BackgroundMeso-level, regional primary health care organisations such as Australia’s Primary Health Networks (PHNs) are well placed to address health inequities through comprehensive primary health care approaches. This study aimed to examine the equity actions of PHNs and identify factors that hinder or enable the equity-orientation of PHNs’ activities.MethodsAnalysis of all 31 PHNs’ public planning documents. Case studies with a sample of five PHNs, drawing on 29 original interviews with key stakeholders, secondary analysis of 38 prior interviews, and analysis of 30 internal planning guidance documents. This study employed an existing framework to examine equity actions.ResultsPHNs displayed clear intentions and goals for health equity and collected considerable evidence of health inequities. However, their planned activities were largely restricted to individualistic clinical and behavioural approaches, with little to facilitate access to other health and social services, or act on the broader social determinants of health. PHNs’ equity-oriented planning was enabled by organisational values for equity, evidence of local health inequities, and engagement with local stakeholders. Equity-oriented planning was hindered by federal government constraints and lack of equity-oriented prompts in the planning process.ConclusionsPHNs’ equity actions were limited. To optimise regional planning for health equity, primary health care organisations need autonomy and scope to act on the ‘upstream’ factors that contribute to local health issues. They also need sufficient time and resources for robust, systematic planning processes that incorporate mechanisms such as procedure guides and tools/templates, to capitalise on their local evidence to address health inequities. Organisations should engage meaningfully with local communities and service providers, to ensure approaches are equity sensitive and appropriately targeted.

I-MoMCARE: Innovative Mobile Technology for Maternal and Child Health Care in Cambodia—study protocol of a cluster randomized controlled trial

BackgroundThe Government of Cambodia established the village health support groups (VHSGs) in 2003 to facilitate primary healthcare activities, including maternal and child health (MCH) services. However, VHSGs face several challenges that hinder them from performing optimally, including a lack of regular structured training and remuneration and limited and inconsistent support and supervision from the health centers (HCs). This implementation research aims to develop, implement, and evaluate a digital health intervention to improve the performance of VHSGs through better support and supervision and increase the MCH service coverage in rural Cambodia.Methodsi-MoMCARE, a two-arm cluster randomized controlled trial, will be conducted between 2022 and 2025. Five operational districts (ODs) have been randomized to an intervention arm and the other five ODs to the control arm. The intervention will last for 24 months. Around 200 VHSGs in the intervention arm will be equipped with a mobile application as a job aid and 20 HC staff with a web interface to improve support and supervision of VHSGs. The potential beneficiaries will include pregnant women, mothers, and children under 2 years old. We will measure the outcomes at baseline and endline. The primary outcomes will consist of a composite MCH index constructed from maternal and newborn care indicators, child immunization, and treatment of under-two children. Secondary outcomes will include coverage of selected MCH services. We will conduct the intention-to-treat and per-protocol analyses. We will conduct qualitative interviews with selected beneficiaries and stakeholders to evaluate the intervention’s acceptability, feasibility, and scalability. We will also conduct a cost-effective analysis using decision-analytic modeling incorporating a societal perspective that explores different time horizons, intervention effects, and when scaled up to the national level.Discussioni-MoMCARE is expected to increase MCH service access and coverage in rural Cambodia. It will contribute to advancing digital health use in primary healthcare interventions, which remains in its infancy in the country. Furthermore, the study findings will be a valuable addition to a growing body of literature on the effectiveness and feasibility of mobile health to improve coverage of MCH services in rural low- and middle-income country settings.Trial registrationClinicalTrial.gov NCT05639595. Registered on 06 December 2022.

PHC service resilience during COVID19 in Brazil’s Northeast

Abstract COVID19 affected health system, including its ability to care for other health issues. Health System Resilience is related to the ability of a health service to continue to offer ongoing care for health issues while under a stressor. Brazil has a public-funded unified health system with a Primary Health Care (PHC) organized by the Family Health Strategy (FHS), which comprise a family doctor, a nurse, a dentist, nurse auxiliaries and Community Health Agents (CHAs). The CHAs are individuals from the community trained to provide a range of services in the territories, including home visits, and act as liaisons between health units and communities-key informant on the reality faced in the public services during COVID19. Brazil's northeast region is one of the country's poorest regions, with poor social indicators, including low HDI and high illiteracy, utilization of Brazil's conditional cash transfer program and COVID19 mortality. This study evaluated aspects regarding the impact of COVID19 in PHC activities related to diabetes&hypertension, tuberculosis, leprae, pre-natal care, pap smear and oral health care in Brazil's northeast region public service. Questionnaires were applied to CHAs from 8 different cities - 4 capitals and 4 country-side municipalities. A total of 1935 CHAs were interviewed. The data show unequal COVID19 impact in PHC (different impact of COVID19 in the various municipalities and health care services). For 21.3% of CHW, the activities related to pre-natal care diminished during 2021 COVID19 pandemia, this percentage was 25.6%, 30.2%, 41.9%, 79.9% and 79.3% for tuberculosis, leprae, diabetes & hypertension, pap smear and oral health respectively in the PHC. The lack of a unified federal plan, due to a political misleading perspective may have negatively influenced the PHC. Understand how PHC was affected in different scenarios is important to strength the system in a more resilient manner, which is central in the event of other stressful events Key messages • There was an unequal impact of COVID19 on different PHC public services, which may be due to political tension and lack of federal guidance of the health system. • Understand how PHC was affected is important to reorganize the system in a more resilient manner, which is central in the event of another COVID19 wave or other stressful event.

Exploration of the Need for Integration of Cervical Cancer Information into Postnatal Services at Primary Health Care Centers in Ibadan Nigeria

Background: Cervical cancer (CC) is a preventable disease yet it is one of the leading causes of death, especially in low-income countries. In Nigeria, information on CC is yet to be part of routine health talk at Postnatal Clinics (PNC) at the Primary Health Care (PHC) level. The PNC would however have been a good avenue to reach women at risk of CC. This study explored health care workers (HCWs)’ willingness to integrate CCS services (CCSS), and women’s readiness to uptake the services at PHCs in Ibadan, Nigeria. Method: A qualitative study design was employed in this study. Data were collected through four sessions of Focus Group Discussions (FGDs) among the women attending PNC, and 20 Key Informant Interviews (KIIs) for health workers in PHC facilities. The Atlas.ti software, version 8 was used for the analysis. Thematic contents from the study were presented as quotes and streams of thoughts. Results: Information on CCS is currently excluded from the list of PNC activities such that most women have never heard of the need for CCS. They were interested in receiving CCS information and services. Women pleaded for the integration of CCS information in PHC clinic activities but preferably in a free or subsidized format in order to encourage utilization of the services. Challenges identified were mainly a shortage of manpower and a lack of training on CCS. Conclusion: Health workers were willing to integrate CCS services in PHC activities, however, recommended recruitment of more hands to ensure effective service delivery in line with National health policy on PHC in Nigeria.

Managerial Competencies Engaged in Innovative Actions in Primary Health Care: A Qualitative Study of Brazilian Nurses

Aim. To explore the managerial competencies engaged in innovative actions among Brazilian nurses working in primary health care. Background. The mobilization of managerial competencies favors environments that are in transformation. There is a lack of studies that recognize the managerial skills which influence the implementation of innovative actions in PHC. Method. A qualitative exploratory descriptive approach was developed in the PHC of a municipality in Brazil. A total of 76 nurses who worked in management and care participated with a semistructured script being applied on innovative actions implemented in the service. The data were processed in IraMuTeQ 0.7 and later analyzed by descending hierarchical classification. Results. The managerial competencies that influenced the development of innovative actions implemented were as follows: communication and teamwork in planning innovative actions, continuing education for application and implementation, and leadership and people management. Conclusions. Managerial competencies were used as strategies by nurses to implement innovative actions and contribute to engagement and generating positive results, emphasizing autonomy and the role of nurses as agents of change. Implications for Nursing Management. The identified management competencies contribute to directing and sustaining innovative actions, as well as to identifying critical nodes that need support and innovation.

Main Challenges of Primary Health Care in Five Latin American Countries

This article provides a description of integrated primary healthcare strategies in five Latin American countries to assess options for the implementation of a healthcare system based on Primary Care. Based on a document review of scientific articles and official documents from multilateral organisations, ministries, or health entities, it was possible to synthesise the Primary Health Care strategies that had been implemented to derive the main proposals that were potentially transferable. Argentina, Chile, Colombia, and Mexico have Primary Health Care actions aimed at promoting health and preventing diseases; Cuba is highlighted as a reference because of its family health model. The main difficulties are from healthcare system based on the neoliberal model and segmentation and fragmentation of healthcare services.This study provides important aspects of Primary Health Care, in terms of the need to revitalise with a family and community approach, integrating health services at three levels of primary prevention, intersectoral factors, community empowerment, resource allocation and training in human skills, as well as strengthening mental health and sexual health programmes. It concludes with suggestions for a more integrated Primary Health Care based on the strategies implemented and the local needs of the countries under study.

O.6.2-2 Building momentum: lessons learned in the promotion of physical activity in primary healthcare settings

Abstract Purpose Physical activity plays a vital role in promoting and maintaining good physical and mental health, but too many individuals are not meeting recommendations. Policies that support physical activity prescription (PAP) within primary healthcare (PHC) settings are a key tenet of a comprehensive, systems-wide approach to increase physical activity and help prevent and manage many non-communicable diseases, including cancers. The fourth Building Momentum report sets out the emerging evidence for the benefits of promoting physical activity in PHC, and explains why designing and enacting such policies is good for individual health and economies. This is the first known report of its kind, offering a global policy perspective on developments and progress, as well as guidance on foundational policy processes and components. Description Physical activity is a WCRF International policy priority, directly related to our cancer prevention recommendations and MOVING framework and policy database. Research, writing and publication were managed by WCRF International. The current state of evidence and policies were evaluated through a literature review, and interviews conducted with subject-matter experts selected for their knowledge and experience. The report was evaluated through two rounds of review, including by interviewees, physical activity experts, and individuals from the WCRF Network, Policy Advisory Group, and the WHO. The report will be disseminated through an initial online launch event that will showcase the main findings, country reflections and guidance. Further dissemination will be through WCRF International’s health professional and policy networks, social media, and potentially conferences like HEPA. Conclusions The fourth Building Momentum report provides guidance on how to establish successful policies for PAP in PHC. It addresses key issues and potential barriers to adoption, as well as identifying foundational policy processes, including: using the evidence, building shared policy objectives, the importance of local contexts and equity underpinning all policy elements. It also identifies components for designing effective policies, including: PHC professional training, health systems capacity, incentivizing structures, the importance of communication and collaboration, and creating supportive patient environments. Engaging with these findings, as well as examples of national programmes, will enable governments and health systems to enact well-designed policy on physical activity promotion in PHC.

Strengthening community-based surveillance: lessons learned from the 2018–2020 Democratic Republic of Congo (DRC) Ebola outbreak

IntroductionThere has been little documentation of the large networks of community health workers that contributed to Ebola Virus Disease (EVD) surveillance during the 2018–2020 Democratic Republic of Congo (DRC) epidemic in the form of community-based surveillance (CBS). These networks, comprised entirely of local community members, were a critical and mostly unrecognized factor in ending the epidemic. Challenges with collection, compilation, and analysis of CBS data have made their contribution difficult to quantify. From November 2019 to March 2020, the DRC Ministry of Health (MoH), the World Health Organization (WHO), and Médecins Sans Frontières (MSF) worked with communities to strengthen existing EVD CBS in two key health areas in Ituri Province, DRC. We describe CBS strengthening activities, detail collaboration with communities and present results of these efforts. We also provide lessons learned to inform future outbreak responses.MethodsAs the foundation of CBS, community health workers (CHW) completed training to identify and report patients who met the EVD alert definitions. Alerts were investigated and if validated, the patient was sent for isolation and EVD testing. Community members provided early and ongoing input to the CBS system. We established a predefined ratio of community- elected CHW, allocated by population, to assure equal and adequate coverage across areas. Strong performing CHW or local leaders managed the CHWs, providing a robust supervision structure. We made additional efforts to integrate rural villages, revised tools to lighten the reporting burden and focused analysis on key indicators. Phased roll-out of activities ensured time for community discussion and approval. An integrated treatment center (ITC) combined EVD testing and isolation with free primary health care (PHC), referral services, and an ambulance network.ResultsA total of 247 CHW and supervisors completed training. CBS had a retention rate of 94.3% (n = 233) with an average daily reporting rate of 97.4% (range 75.0-100.0%). Local chiefs and community leaders participated in activities from the early stages. Community feedback, including recommendations to add additional CHW, run separate meetings in rural villages, and strengthen PHC services, improved system coverage and performance. Of 6,711 community referrals made, 98.1% (n = 6,583) were classified as alerts. Of the alerts, 97.4% (n = 6,410) were investigated and 3.0% (n = 190) were validated. Of the community referrals, 73.1% (n = 4,905) arrived for care at the ITC. The contribution of CBS to total alerts in the surveillance system increased from an average of 47.3% in the four weeks prior to system strengthening to 69.0% after. In one of the two health areas, insufficient reporting in rural villages suggested inadequate coverage, with 8.3% of the total population contributing 6.1% of alerts.DiscussionCBS demonstrated the capacity of community networks to improve early disease detection and expand access to healthcare. Early and consistent community involvement proved vital to CBS, as measured by system performance, local acceptance of EVD activities, and health service provision. The CBS system had high reporting rates, number of alerts signaled, proportion of alerts investigated, and proportion of community referrals that arrived for care. The change in contribution of CBS to total alerts may have been due in part to system strengthening, but also to the expansion in the EVD suspect case definition. Provision of PHC, referral services, and an ambulance network linked EVD response activities to the existing health system and facilitated CBS performance. More importantly, these activities provided a continuum of care that addressed community prioritized health needs. The involvement of local health promotion teams was vital to the CBS and other EVD and PHC activities. Lessons learned include the importance of early and consistent community involvement in surveillance activities and the recommendation to assure local representation in leadership positions.

Multisectoral actions in primary health care: A realist synthesis of scoping review.

Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems. We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley's realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level). A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals' social determinants of health. Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.

The role of onsite Implanon insertion training for HEWs for sustainable FP programs in Ethiopia: a mixed-method study

BackgroundTraining health extension workers on Implanon insertion offsite, or away from the workplace, can be cost-intensive, can depend on the human and financial resources of partners, and can compromise routine health services by taking health workers off the job. To address these limitations, the USAID Transform Primary Health Care Activity in Ethiopia designed an onsite Implanon insertion training at the primary health care level. This study compared and documented the implementation experience of onsite vs offsite Implanon insertion training for health extension workers.MethodsIn a mixed-method study conducted in March 2020, the team collected training data from 468 participants—half trained onsite and half offsite—and conducted key informant interviews with 20 purposively sampled individuals. The team analyzed this data, summarizing the data in tables and figures and performing a t test with p value < 0.05 using SPSS v.20. Qualitative data were analyzed manually in Excel and summarized in Word based on emerging themes.ResultsHealth extension workers trained onsite were away from routine work an average of 3 days compared to 8 days for those trained offsite (P < 0.001). The difference in average per-trainee cost of onsite (2707 Birr = 87.3 USD) and offsite (6006 Birr = 193.7USD) training was significant (P < 0.001). There was no significant difference in mean scores of onsite and offsite trainees on the knowledge pre-test (P < 0.947) and post-test (P < 0.220) or in simulated practice on an arm model (p < 0.202). Onsite trainees, assigned to their own health post for clinical practice, performed Implanon insertions on an average of 10 clients: offsite trainees on an average of 5 clients. Most interview participants reported that the onsite Implanon training was better organized, conducted, followed up, and monitored by health centers to ensure community-level access to Implanon services, with quality and continuity.ConclusionsOnsite training is a promising approach and minimizes service interruption. It is a likely strategy for on-demand training of health extension workers and immediate assignment of skilled providers to ensure access to and continuity of quality community-level Implanon care.Trial registration N/A.

Nursing actions in Primary Health Care to lesbian and bisexual women

Objective: to investigate the actions of nurses in regard to lesbian and bisexual women in the context of the National Policy for the Integral Health of Lesbians, Gays, Bisexuals, Cross-Dressers and Transgender Persons. Methods: qualitative study involving 25 nurses from the Family Health Strategy, contacted via electronic means. We applied a form containing sociodemographic data and an investigation of actions in primary health care, as well as a thematic content analysis. Results: we found there are professional capacitation activities, embracing of demands, and enhanced interprofessional work. Nonetheless, there were shortcomings in the knowledge regarding health care towards lesbian and bisexual women. Conclusion: there are still prejudices, difficulty to access, and little attendance of lesbian and bisexual women in health services, as well as a deficit in the support to health actions and lack of monitoring. Contributions to practice: the importance of the scientific, professional, and social experiences stand out, regarding the need to humanize the care to lesbian and bisexual women. It is a supporting material for researchers and nursing professionals, enabling them to direct their care to a holistic and integral care to be provided to these women, in addition to being an encouragement to further comparative studies.

Adoption of an Intervention to Promote Physical Activity and Healthy Eating in Brazilian Health Care Settings

We analyzed the adoption of the community intervention “VAMOS Program” in Primary Health Care (PHC). We carried out a community-based study using mixed-methods in Primary Care Units in Florianopolis, Brazil. We assessed adoption through the RE-AIM framework and conducted interviews and focus groups with 33 health professionals and 26 users participating in the intervention. The Primary Care Units adoption rate was 25%, and the adoption rate among professionals was 80%. We identified three themes related to adoption and we found that organizational factors are challenges that health professionals face when they implement collective actions in PHC but were not inherent factors in adopting VAMOS. We conclude that VAMOS Program has the potential to be offered as a new health promotion tool in PHC.

Elaboration of a multidisciplinary evaluation instrument in Primary Health Care during the confrontation of the Covid-19 Pandemic

COVID-19 is a respiratory infection that started in Wuhan, China, at the end of 2019 and, due to its geographic distribution, was classified as a pandemic, becoming a global public health concern. This work aimed to describe the development of an instrument to identify the consequences and repercussions of COVID-19 in users of Primary Health Care (PHC). This is an experience report on the interprofessional construction of an instrument to assess biopsychosocial changes in patients affected by the coronavirus. Each professional category listed questions relevant to their area of ​​expertise, composing a questionnaire divided into five main categories: identification data, data about COVID-19, socioeconomic data, questions about functionality and questions related to mental health. This instrument was effective and capable of identifying the main biopsychosocial repercussions of COVID-19 in the sample analyzed during the study, and can support the planning of PHC actions for those who experience the demands of COVID-19 after the infection phase.