Primary Health Care Capacity Research Articles

Assessing the knowledge, training and capacity of health workers in the diagnosis and management of soil-transmitted helminths and schistosomiasis in eastern Uganda.

Neglected tropical diseases (NTDs) affect millions of people in Africa, with Uganda bearing a significant burden. The World Health Organization (WHO) set a goal to reduce NTDs and improve access to diagnosis and management by 2030. However, NTDs have not been well integrated into primary healthcare in many countries, including Uganda, due to limited knowledge and resources among health workers. The study aimed to assess the readiness and capacity of primary healthcare centres to diagnose and manage soil-transmitted helminths (STHs) and schistosomiasis. A cross-sectional quantitative study was conducted among 204 health workers in 20 health facilities in four districts bordering Lake Kyoga. In this study we evaluated health workers' knowledge of symptoms, diagnosis and management of STHs and schistosomiasis as well as the availability of resources and training. Our findings indicate that health workers have strong knowledge about STHs (86.76%), with lower knowledge levels regarding Schistosoma haematobium (59.72%) and Schistosoma mansoni (71.43%). Regarding resources and training, 95% of health facilities had laboratory services, but the majority lacked diagnostic equipment. Furthermore, only 17% of health workers reported prior training on schistosomiasis and related topics and only 25% had training on surveillance and reporting. While health workers in eastern Uganda demonstrated a good knowledge base for some NTDs, there were knowledge gaps and challenges in training on surveillance and reporting mechanisms. Continuously building the capacity of health workers along with investing in diagnostic infrastructure is essential for improved NTD control and ultimately reducing associated morbidity and mortality in the region.

Increasing primary care capacity and referral efficiency: A case study of a telehealth centre eConsult service in Brazil.

eConsults are asynchronous digital communications for primary care professionals to seek timely specialist advice. Potential benefits include increased primary healthcare capacity and referral efficiency. Santa Catarina Telehealth Centre in Brazil has offered eConsults for an increasing number of specialties since 2008. This study described the characteristics of this service, including referral efficiency, sustainability, and satisfaction. Retrospective longitudinal analysis of eConsults activity data from 2015 to 2022 with three domains of the Model for Assessment of Telemedicine Applications used to structure the analysis. Characteristics of the application: The total number of eConsults performed in 2015 was 4764, reaching 41,178 in 2022. While 30.3% of eConsults were synchronous in 2015, only asynchronous communication remained from 2021. Clinical effectiveness: eConsults requested to refer patients to specialist care resulting in primary care management remaining above 30% of the total for all specialties from 2019 to 2022, with hematology having the highest percentage (>52%). Organizational aspects: Established workflows with local specialists responding to eConsults (cardiology, endocrinology, hematology and orthopaedics) kept a constant or increasing number of eConsults and maintained the proportion of primary care management from 2019 to 2022, once recovered from COVID-19 and funding restrictions-related reductions. Over 90% of primary care professionals are either satisfied or very satisfied with the eConsult service. Over 8 years, 223,734 consultations were conducted, with high satisfaction, demonstrating the substantial potential for increased primary care-sensitive conditions management. Hiring local specialists, fostering integrated care, and enabling sustainable workflows are key to eConsults' success.

How to improve the capacity of general practitioners? – a Flemish approach

“Barely any region left with freely accessible primary health care in Flanders.” This is one of the many newspaper headlines that was recently published to emphasize the fact that more and more general practitioners refuse to take in new patients, because they run out of capacity to provide patients with proper health care. Where does it go wrong? 
 Accessibilty to general practitioners is a hot topic for the Flemish policymakers. An aging population and an increase of mental health problems asks a lot from the general practitioners, as well as the shift of tasks from hospitals towards primary health care and the growing attention for prevention. However, is there a real shortage in general practitioners? Looking abroad learns that the number of general practitioners might not be the major cause of the capacity problem, but that the true bottleneck might lie in the way of organizing primary health care capacity and accessibility. Embedded in a landscape of health care where general practitioners mostly work on a self-employed base, and the fragmented governmental structure in Belgium as an extra obstacle makes this a major challenge for the near future.
 A dialogue between policy makers from all Belgian governments was opened to create a common approach: each government will take actions within their own authorities. The Flemish government worked out a plan to counter this massive challenge in primary health care through different initiatives, in cooperation with representatives of the general practitioners on the field, local authorities and umbrella organizations.
 Flanders commits itself by installing three major fundaments which can create change in the way general practitioners are organized: a first step is to create an accurate and up-to-date database of the current available general practitioners health care services compared with the local care need; in parallel the funding of general practitioners will be expanded in a way which stimulates interdisciplinary collaboration and optimizes health care capacity; on top of that the Flemish government is experimenting with new forms of primary care practices in which integrated care is the keystone and which are supported by local authorities and in close connection with welfare services. 
 These projects described above are in full development. On the working field more and more general practitioners are willing to put their shoulders under these initiatives to create solid solutions for the future. 
 The international audience of this lecture might recognize similar issues they encounter in their own countries and will be able to see similarities and differences compared to the Flemish context. By drawing these parallels one can have a broader view on the approach of improving health care capacity and accessibility. 
 These Flemish projects will be brought together with the initiatives from the other Belgian governments at a roundtable discussion to align all the initiatives on primary health care capacity and create a future proof primary health care capacity in Belgium.

Primary health care capacity assessment in Qatar: the primary health care progression model as an assessment method

Background: The Primary Health Care Performance Initiative (PHCPI) was developed as a measurement of Primary Health Care (PHC) to evaluate the PHC systems, improve services, and maximize health outcomes. With the limitation of data sources and metrics of PHC capacity, PHCPI designed the PHC Progression Model, as a rubric-based mixed-methods assessment tool for capacity measurement through a participatory process. This paper uses the PHC progression model to assess the system capacity of primary health care in Qatar. Methods: The PHC Progression Model consists of a set of 33 quantitative and qualitative measures, each of which is assessed using a rubric that classifies the level of performance into 4 levels, ranging from Level 1 (low capacity) to Level 4 (high capacity). The assessment measured both quantitative and qualitative information. Results: The assessment showed that PHC in Qatar has a strong capacity with an overall score of the key measures of capacity governance (3.6), inputs (4.0), and population health management (4.0). Conclusion: The main strength of the system was in the key inputs such as facility, workforce, fund, information system, and drugs and supply. Also, the assessment showed strong population health and facility management including standardized team organization, measuring performance, community engagement, and use of the information system data. Keywords: Primary health care, progression model, health system evaluation, health care capacity, Qatar

COVID-19 pandemic has disrupted the continuity of care for chronic patients: evidence from a cross-sectional retrospective study in a developing country

BackgroundAny disruption in continuity of care for patients with chronic conditions can lead to poor outcomes for the patients as well as great damage for the community and the health system. This study aims to determine the continuity of care for patients with chronic conditions such as hypertension and diabetes during COVID-19 pandemic.MethodsThrough a cross-sectional retrospective study, data registered in six health centers in Yazd, Iran were analyzed. Data included the number of patients with chronic conditions (hypertension and diabetes) and average daily admission during a year before COVID-19 pandemic and the similar period after COVID-19 outbreak. The experience of continuity of care was assessed applying a validated questionnaire from a sample of 198 patients. Data analysis was done using SPSS version 25. Descriptive statistics, independent T-Test and Multivariable regression were used for analysis.FindingsResults indicate that both visit load of the patients with chronic conditions (hypertension and diabetes) and their average daily admission were decreased significantly during a year after COVID-19 pandemic compared to the similar period before COVID-19 outbreak. The moderate average score of the patients` experience towards continuity of care during the pandemic was also reported. Regression analysis showed that age for the diabetes patients and insurance status for the hypertension patients affect the COC mean scores.ConclusionCOVID-19 pandemic causes serious decline in the continuity of care for patients with chronic conditions. Such a deterioration not only can lead to make these patients` condition worse in a long-term period but also it can make irreparable damages to the whole community and the health system. To make the health systems resilient particularly in disasters, serious attention should be taken into consideration among them, developing the tele-health technologies, improving the primary health care capacity, designing the applied responsive models of continuity of care, making multilateral participations and inter-sectoral collaborations, allocating sustainable resources, and enabling the patients with selfcare skills are more highlighted.

Determinan Rujukan Non Spesialistik Dengan Kriteria TACC di FKTP Kabupaten Batang Hari Tahun 2022

The capacity of primary healthcare as gatekeepers to handle 144 comprehensive and independent primary diagnoses is a form of strengthening primary healthcare facilities for the implementation of both quality and cost control. Non-specialist Referral diagnoses with TACC (Time, Age, Comorbidity, Complication) included in the 4A competency level for primary doctors allows the doctors to refer patients to Advanced Referral Health Facilities. This study aimed to identify the determinants that affect Non-Specialistist Referral with TACC in FKTP Batang Hari Regency. This research was a cross-sectional mixed-method study with a sequential explanatory design using primary doctors as the total sampling and heads of FKTP and National Health Insurance patients as sample representatives. The quantitative method using Chi-square analysis was used to determine the effect of each independent variable on the dependent variable. Qualitative analysis was carried out by quantitative data triangulation. The results of the statistical test show that there was a significant association between the availability of medical devices and drugs wNon-Specialististtist Referral with TACC (medical devices p=0.017, drugs p=0.002), while doctors’ knowledge, doctors’ competence, FKTP location, and type did not show a significant association. In-depth interviews revealed that patients’ request was one of the reasons for doctors’ referral. There is a significant association between the availability of medical devices and drugs with NonSpecialistst Referral with TACC supported by patients’ request for referral.

Strengthening the primary health care system in the face of emerging and re-emerging epidemics; providing a native and applicable model based on best practices of countries

INTRODUCTION: Disasters affected the primary health care system in many ways. Maintaining primary health care services is a challenging issue during disasters such as epidemics. A review was conducted to study the lessons learned and successful experiences of other countries in opposing the spread of infectious diseases using the capacity of primary health care. MATERIAL AND METHODS: The present study is a comprehensive review of countries’ experiences, successful models, and structural components for development of a model for Iran. A systematic search with suitable keywords was conducted in many databases including web of science, PubMed, Scopus, Science Direct, Google Scholar, and Persian databases; Magiran, and SID. RESULTS: The results showed that generally, the successful actions of countries in case of emergency are divided into disaster cycles including preparedness, response, and recovery. PHC can help health systems to identify new epidemics through surveillance system as an early warning system. Because of the importance of continuity of care in primary health care facilities, business continuity plans are needed. CONCLUSIONS: In order to use the consequences and play an effective role in this field, Iran should use the country’s capacity and inter-sectoral cooperation to establish a comprehensive system for telemedicine programs Providing people with doctors and health professionals can strengthen the performance of the primary health care system finally can strengthen the performance of the primary health care system.

Does increasing physician volume in primary healthcare facilities under the hierarchical medical system help reduce hospital service utilisation in China? A fixed-effects analysis using province-level panel data

ObjectiveTo examine whether increases in physician volume in primary healthcare facilities are associated with reduced utilisation of hospital outpatient and inpatient services after China facilitated the establishment of the hierarchical...

Changes in prevalence and the cascade of care for type 2 diabetes over ten years (2005-2015): results of two nationally representative surveys in Mozambique

BackgroundSub-Saharan Africa is predicted to have the steepest increase in the prevalence of diabetes in the next 25 years. The latest Mozambican population-based STEPS survey (STEPS 2005) estimated a 2.9% prevalence of diabetes in the adult population aged 25-64 years. We aimed to assess the change in prevalence, awareness, and management of diabetes in the national STEPS survey from 2014/2015 compared to 2005.MethodsWe conducted an observational, quantitative, cross-sectional study following the WHO STEPS surveillance methodology in urban and rural settings, targeting the adult population of Mozambique in 2015. We collected sociodemographic data, anthropometric, and 12 hour fasting glucose blood samples in a sample of 1321 adults. The analysis consisted of descriptive measures of the prevalence of impaired fasting glucose (IFG), diabetes and related risk factors by age group, sex, and urban/rural residence and compared the findings to those of the 2005 survey results.ResultsThe prevalence of IFG and diabetes was 4.8% (95CI: 3.6-6.3) and 7.4% (95CI: 5.5-10.0), respectively. These prevalence of IFG and diabetes did not differ significantly between women and men. The prevalence of diabetes in participants classified with overweight/obesity [10.6% (95CI: 7.5-14.6)] and with central obesity (waist hip ratio) [11.0% (95CI: 7.4-16.1)] was almost double the prevalence of their leaner counterparts, [6.3% (95CI, 4.0-9.9)] and [5.2% (95CI: 3.2-8.6)], respectively. Diabetes prevalence increased with age. There were 50% more people with diabetes in urban areas than in rural. Only 10% of people with diabetes were aware of their disease, and only 44% of those taking oral glucose-lowering drugs. The prevalence of IFG over time [2.0% (95CI: 1.1-3.5) vs 4.8% (95CI: 3.6-6.3)] and diabetes [2.9% (95CI: 2.0-4.2) vs 7.4% (95CI: 5.5-10.0)] were more than twofold higher in 2014/2015 than in 2005. However, awareness of disease and being on medication decreased by 3% and by 50%, respectively. Though this was not statistically significant.ConclusionsWhile the prevalence of diabetes in Mozambique has increased from 2005 to 2015, awareness and medication use have declined considerably. There is an urgent need to improve the capacity of primary health care and communities to detect, manage and prevent the occurrence of NCDs and their risk factors.

Utilisation of village health workers' services for tuberculosis screening in Lesotho.

BackgroundVillage health workers (VHWs) play an essential role because they extend the capacity of primary healthcare, particularly for developing countries. In Lesotho, VHWs are part of the primary healthcare connecting the community with clinics in their respective villages. They contribute to the prevention of the spread of tuberculosis (TB) within their catchment areas by encouraging communities to partake in TB screening. This study aimed at identifying factors associated with the utilisation of VHWs’ service to undertake TB screenings in Lesotho.MethodsThis study emanates from the main study that used a cross-sectional descriptive design. A total of 19 health service areas (HSAs) comprised 17 catchment areas and two clinics, each randomly selected from the District Health Management Team (DHMT) and the Lesotho Flying Doctors Service (LFDS), respectively. A total of 2928 individual household members aged 15 and above were included in the study. Data analysis included descriptive and inferential statistics.ResultsThere were more female than male respondents, with a majority (77%) below 65 years of age. Tuberculosis knowledge of respondents was mostly on the TB symptoms and curability of TB, but they were less knowledgeable about the causes of TB. The use of VHWs’ services for TB screening was very low (23.3%).ConclusionThe study revealed that while respondents were to some extent knowledgeable about TB, their utilisation of VHWs’ services for TB screening varied with education level, having worked in South Africa and the household size at α = 0.01.

Chronic kidney disease in Ecuador: An epidemiological and health system analysis of an emerging public health crisis.

The absence of a chronic kidney disease (CKD) registry in Ecuador makes it difficult to assess the burden of disease, but there is an anticipated increase in the incidence of CKD along with increasing diabetes, hypertension and population age. From 2012, augmented funding for renal replacement therapy expanded dialysis clinics and patient coverage. We conducted 73 in-depth sociological interviews with healthcare providers in eight provinces and collected quantitative epidemiological data on patients with CKD diagnoses from six national-level databases between 2015 and 2018. Datasets show a total of 17,484 dialysis patients in 2018, or 567 patients per million population (pmp), with an annual cost exceeding 11% of Ecuador’s public health budget. Each year, there were 139–162 pmp new dialysis patients, while doctors reported waiting lists. The number of patients on peritoneal dialysis was static; those on hemodialysis increased over time. Only 13 of 24 provinces were found to have dialysis services, and nephrologists were clustered in major cities, which limits access, delays medical attention, and adds a travel burden on patients. Prevention and screening programs are scarce, while hospitalization is an important reality for CKD patients. CKD is an emerging public health crisis that has increased dramatically over the last decade in Ecuador and is expected to continue, making coverage for all patients impossible and the current structure, unsustainable. A patient registry would help health policymakers and administrators estimate the demand and progression of patients with consideration for comorbidities, disease stage, requirements and costs, mortality and follow-up. This should be used to help identify where to focus prevention and improved treatment efforts. Organized monitoring of CKD patients would benefit from improvements in patient referral. Community-based education and prevention programs, the strengthening of primary healthcare capacity (including basic routine tests) and improved nephrology services are also urgently needed.

Assessing the capacity of primary health care centres to provide tuberculosis services in Kaduna State, North-Western Nigeria

Background: Despite earlier successes achieved in combating it, cases of tuberculosis in Nigeria are now on the increase, affecting more people and communities. Primary health care in Nigeria is through ward health system, designed to provide minimum health package to the communities including TB services. This study aimed to ascertain the capacity of PHC centres to provide TB services in Kaduna North senatorial district, Kaduna State, Nigeria.Methods: Four out of eight local Government areas in the district were randomly selected and one PHC per ward was recruited in the study. In each facility, questionnaires developed from the TB tracer items of the WHO service availability and readiness assessment tool were administered to the facility in-charges and TB/DOTS focal persons.Results: Forty four facilities were selected from Zaria, Sabon Gari, Makarfi and Kudan LGAs. Almost all facilities (98%) diagnosed TB clinically and 39 (90%) had anti-TB drugs available. National TB guidelines were lacking in 23 (52%) facilities and only 5 (11%) had additional capacity for sputum microscopy. While 35 (80%) TB/DOTS focal persons had received training on TB diagnosis and treatment, only 24 (55%)received training on TB/HIV co-infection and only 8 (18%) received training on multi-drug resistant TB.Conclusions: While TB services are widely available in the district, urgent need exists for all stakeholders to work together towards equipping those facilities with critical infrastructure that will improve their overall capacity, particularly with regards to comprehensive TB guidelines, laboratory diagnosis and personnel training for effective TB management.

Assessing the capacity of primary health care centres to provide routine immunization services amidst COVID-19 lockdown in Kaduna state, Nigeria

Background: The COVID-19 pandemic continues to disrupt health systems across the globe, preventing access to essential health services. Lockdown measures against the virus may impact negatively on immunization services. This study aimed to ascertain the capacity of primary health care centres in Kaduna North senatorial district to provide routine immunization services amidst a state-wide lockdown.Methods: Cluster sampling was used to select four among eight local Government areas in the district. Facility in-charges and RI focal persons were interviewed using service availability and readiness assessment tool, restricted to immunization tracer items. Paired sample t-test was used to compare the mean number of vaccine doses given in the first quarter of 2020 (pre-lockdown) and the number of doses given in the second quarter (lockdown period).Results: Forty four PHCs were selected from Zaria (29.6%), Sabon Gari (25.0%), Makarfi (22.7%) and Kudan (22.7%). In addition to well-trained RI focal persons, most facilities had vaccines and commodities available. Shortages were noted for EPI guidelines (46%), Meningitis-A vaccine (36%) and certain cold chain equipment (up to 18%). Tetanus-diphtheria (Td-1) doses given during lockdown period were significantly lower than pre-lockdown doses (Mean difference=-45.58, 95% CI: -74.78 to -16.38, d=0.48). No significant difference exists for infant doses.Conclusions: Despite widespread availability of PHC facilities, trained personnel, vaccines and commodities, gaps still exist in service delivery, cold chain practices and vaccine supply management. Lockdown measures significantly disrupted immunization services and effective risk communication was key to achieving sustained utilization.

Impact of team-based community healthcare on preventable hospitalisation: a population-based cohort study in Taiwan

ObjectivesThe objective of this study was to explore the impact of Taiwan’s Family Practice Integrated Care Project (FPICP) on hospitalisation.DesignA population-based cohort study compared the hospitalisation rates for ambulatory care...

Емдеу-профилактикалық мекемесінде медициналық көмекті ұйымдастыруды оңтайландыру

The aim: To develop recommendations aimed at optimizing the work of the Shymkent city multidisciplinary hospital by studying the main performance indicators. Methods.The research was carried out according to the traditional scheme and included the classical stages: drawing up a plan and program, collecting material, processing and analyzing it. Results. To improve the quality of medical care, targeted measures are being implemented. Thus, the design capacity of Primary Healthcare: polyclinic – 500 people per shift, actual attendance – 703 people per shift. The hospital has 330 beds. However, the rate of bed coverage per 10 000 people is low at 28.4. The overall incidence has decreased, and in 2019 it was 75 652. It was found that the number of visits to doctors has increased, thus, this figure in 2019 reached 66.5%. It was found that the volume of provision of free medicines increased and reached 47 420. The indicator of provision with medical technical means as a whole also increased and amounted to 82%. Conclusions. A set of measures aimed at improving the hospital's activities using the existing organizational structure will allow us to respond in a timely manner to changes in all areas of the hospital's activities, and the KPI system will help assess the effectiveness of managerial actions in the field of quality management to improve the quality of medical care and improve the weaknesses of healthcare facilities. Keywords: medical organization, medical care, KPI system.

The capacity of primary health care centers in Jordan to manage hypertension: areas for improvement.

The assessment of the capacity of Primary Health Care (PHC) settings for the management of hypertension is essential to identify areas for improving management outcomes. This study aimed to assess the capacity of PHC centers in Jordan to manage hypertension including the assessment of human resources, equipment, and infrastructure. All comprehensive PHC centers located in Irbid and Mafraq governorates in north of Jordan (n = 23) were assessed. An assessment tool from HEARTS Technical Package was adapted and used for assessment. All centers have general practitioners and half of the centers (n = 11, 47.8%) had at least one family doctor working full time. In only one center, all doctors, nurses, and other health workers were trained on the management of hypertension. All centers, except one, had at least one functional automatic blood pressure measuring devices (BPMDs). Almost two thirds of centers (43.5%) had no measuring tapes. ECG machines were present in all centers except two. One third (n = 8, 34.8%) of centers had no functional glucometers. The majority of health centres carry out the laboratory investigations. Educational materials on physical activity, hypertension, and diabetes were seen in four (17.4%) centers only. Necessary medications were always available in the majority of health centers. In conclusion, this assessment revealed many areas for improvement in human resources, equipment, infrastructures, and other resources, such as developing an updated guideline/protocol of hypertension management, training the PHC staff on these guidelines, providing PHC centers with the necessary equipment, and establishing e-registry to improve documentation of data.

Prevention of respiratory distress disease in pregnancy and newborn: a case review of the capacity of primary healthcare tier in Delta State Nigeria

The Universal Declaration on Human Rights regarding Primary Health Care (PHC) in Nigeria is to provide adequate and equitable healthcare to pregnant mothers and new born. This includes those who are at risk of respiratory distress disease. The objective of this work is to identify the capacity of PHC in the management of respiratory distress syndrome among pregnant mothers and new born. A narrative review of literatures on respiratory distress performed. There have been shortages of staff and health inequity while improvement in maternal and child mortality rates may be attributable to improved knowledge and health seeking behavior. PHC practitioners’ need to be motivated because they are available and useful in rendering preventive services for respiratory distress disease during pregnancy and new deliveries for better results.

Association between Primary Healthcare and Medical Expenditures in a Context of Hospital-Oriented Healthcare System in China: A National Panel Dataset, 2012-2016.

Total health expenditure in China has grown considerably since a new round of health system reform was enacted in 2009. Researchers have shown that strengthening primary healthcare may be an option for countries to solve the rapid expansion of their medical expenditures. This study was designed to explore the association between the strength of primary healthcare and medical expenditures, in the context of the hospital-oriented healthcare system in China. A longitudinal ecological study was conducted using a 5-year panel dataset of 27 provinces in mainland China. The linear mixed effects regression model was used to assess the effects of primary healthcare-related metrics on medical expenditures, controlling for the provincial level specialty care physician supply and socio-economic parameters. All of the three primary healthcare-related metrics showed negative associations with the two medical expenditure parameters. Primary care physicians per 10,000 population was significantly associated with the per capita hospital medical expenditures (p < 0.05), and the percentage of public health expenditure in total health expenditure was significantly associated with both per capita total medical expenditure and per capita hospital medical expenditures (p < 0.01 for both). Our study found negative associations between the primary healthcare capacity and medical expenditure in the context of hospital-oriented healthcare systems in China, adding to the previous evidence that primary healthcare may play a positive role in reducing medical expenditure. Policies on increasing the primary care physician supply and the public share of total health expenditure should be conducted to strengthen the primary healthcare system. With the gradual advance of medical reform and the policy inclination to primary healthcare, this will play a more important role in controlling the rapid growth of medical expenditure.

The Capacity Of Posyandu In Indonesia (Data Analysis Indonesia Family Life Survey (IFLS) 2007)

Each year, about 12 million children under five in developing countries died that the real problem can be prevented. Various interventions have also been made include the establishment of a service model based society Posyandu is a form of implementation of community-based health services. Nutritional problems in Indonesia has a fairly close relation with the activeness of Posyandu activities. The existence of Posyandu activities depend on the willingness of the public contribution to the activity. The purpose of this study is to determine the factors - factors that affect the independence of Posyandu in Indonesia and can formulate appropriate policy as an effort to increase the capacity of Posyandu in Indonesia in improving health of the people, especially women and children. This study is a quantitative analysis of secondary data IFLS 2007. The study population was individuals and households in 13 provinces in Indonesia, using the entire sample of 581 Posyandu in Indonesia who were respondents IFLS 2007. After statistical test showed that 64.89% Posyandu in Indonesia are categorized as independent Posyandu. Factors that most influence on the independence of Posyandu is locating the Posyandu (p value = 0.008), education cadre (p value 0.04), and the availability of funding sources Posyandu originating from the village budget (p value 0.007). The presence of independent Posyandu in Indonesia is still quite high. IHC in rural areas have the capacity of primary health care that is lower than the Posyandu in town. The number of active volunteers who are not always able to be a major factor as a component posyandu independence. Active cadres and cadres of education can be related components as an indicator of the capacity of the Posyandu.

Evaluation of healthcare networks by nurses in the Family Health Strategy.

To evaluate the capacity of Primary Healthcare to coordinate healthcare networks. A cross-sectional, population-based and descriptive study developed in the State of Minas Gerais through interviews with nurses working in the Family Health Strategy Sector (FHS) of the Unified Health System, using the Network Coordination Assessment Tool for Primary Healthcare. A descriptive statistical analysis was applied by implementing Fisher's exact test, Spearman's correlation coefficient and cluster analysis. Type I error was fixed at 5% for statistical significance. There were 49 nurses interviewed, evaluating the population and primary healthcare dimensions as excellent. Support, logistical, governance and overall assessment systems were classified as having good condition in the network coordination for Primary Healthcare. The dendograms showed that the work process has similarities between Nurses, as well as the structure between the municipalities. Primary Healthcare has the ability to coordinate networks, constituting a process in which nurses have a central role. There were similarities in the work processes between evaluated municipalities and a deficit in information and pharmaceutical assistance systems.