Concept Of Primary Health Care Research Articles

Reorientation of Basic Medical Education Curriculum to Primary Healthcare: University of Southeastern Philippines School of Medicine

Abstract The University of Southeastern Philippines School of Medicine is reorienting its curriculum to emphasize primary health care (PHC), in response to the Universal Health Care Act (RA 11223) and the Department of Health-Commission on Higher Education (CHED)-Professional Regulation Commission Joint Administrative Order 2021-0001. This initiative includes embedding PHC principles across all educational levels through new modules, extensive faculty training workshops, and the development of a primary care facility for hands-on training. Educational strategies, such as case-based collaborative learning, promote active, learner-centered education and practical PHC concept application. The curriculum emphasizes community-based education, interdisciplinary collaboration, and preventive medicine. Faculty development features regular training and mentorship programs to ensure educators are well-equipped to teach PHC principles. Success is assessed through academic evaluations, student self-assessments, and stakeholder feedback. Future success can also be measured by the students’ performance in the physician’s licensure examinations and the number of graduates who eventually decide to practice in the community. Despite challenges such as resistance to change and resource limitations, strategic planning and stakeholder engagement support successful integration. The project began in 2022 and will span several years for full implementation and evaluation.

Primary health care expenditure in the Americas: measuring what matters.

ABSTRACTThis special report compares the measurement of primary health care (PHC) expenditure proposed by the Organization for Economic Cooperation and Development (OECD) and by the World Health Organization (WHO), according to the global framework for reporting health expenditures (SHA 2011) in three countries in the Region of the Americas. There are conceptual differences: (1) operationalization as basic care, by OECD, versus first contact, by WHO; (2) a wider range of goods and services in the WHO definition (including medicines, administration, and collective preventive services); and (3) consideration only of services in outpatient providers by OECD. PHC expenditures as a percentage of current healthcare spending in 2017 for WHO and OECD: Mexico (43.6% vs. 15.1%); Dominican Republic (41.1% vs. 5.75%), and Costa Rica (31.4% vs. 5.7%). The broad WHO definition of PHC as first contact facilitates inclusion of services that reflect the way countries provide care to their populations. Even so, WHO could improve its category descriptions for the purposes of international comparison. Restricting PHC to outpatient providers (as the OECD does) greatly limits measurement and excludes interventions intrinsic to the concept of PHC, such as collective preventive services. As a transitional step, we recommend that countries should monitor PHC funding and should explain what they include in their definition. SHA 2011 makes it possible to identify and compare these differences.

Primary health care expenditure in the Americas: measuring what mattersGasto en atención primaria en salud en las Américas: medir lo que importa

RESUMOEste informe especial apresenta uma comparação entre a medida do gasto em atenção primária à saúde (APS) conforme as propostas da Organização para a Cooperação e o Desenvolvimento Econômico (OCDE) e da Organização Mundial da Saúde (OMS), usando a metodologia mundialmente aceita para reportar gastos em saúde – o System of Health Accounts (SHA 2011) – em três países da Região das Américas. Observam-se divergências conceituais entre os métodos: 1) operacionalização do conceito como atenção básica pela OCDE ou primeiro contato pela OMS; 2) maior abrangência de bens e serviços de acordo com a definição da OMS (englobando medicamentos, administração e serviços de prevenção em âmbito coletivo) e 3) inclusão exclusivamente de serviços ambulatoriais de acordo com a OCDE. Os gastos em APS como percentual do gasto corrente em saúde (GCS) em 2017, de acordo com os métodos propostos pela OMS e pela OCDE, foram: 43,6% vs. 15,1% no México; 41,1 vs. 5,75% na República Dominicana; e 31,4% vs. 5,7% na Costa Rica. A definição ampla de APS como primeiro contato proposta pela OMS permite incluir os diferentes arranjos de atenção existentes nos países. No entanto, as categorias deveriam ser mais bem detalhadas para facilitar a comparação internacional. Por outro lado, a proposta da OECD restringe a APS aos prestadores de serviços ambulatoriais, o que limita muito a medição e exclui intervenções próprias do conceito de APS, como serviços de prevenção no âmbito coletivo. Numa etapa de transição, recomenda-se aos países monitorar o financiamento da APS, explicitando os itens incluídos na definição empregada. A metodologia SHA 2011 possibilita identificar e comparar essas diferenças.

Universal Health Coverage; A Way Forward

Universal health coverage means every person has access to quality health care without suffering financial hardships. The basis of universal health coverage lies in the primary health care concept, which was envisioned way back in 1978, as mentioned in Alma Ata Declaration1. The "World Health Report" published by the World Health Organization (WHO) in 2008 structures primary health care reforms in four groups. One of the crucial reforms was universal coverage reform to improve health equity2. WHO and UNICEF in 2018 documented how primary health care will be in the 21st century? The approach was towards universal health coverage and sustainable development goals. Sustainable development goals were to be achieved by 2030, and they were a continuation of millennium development goals 2000–20153. The resolution on Transforming our world: the 2030 Agenda for Sustainable Development adopted the target of universal health coverage by 2030, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all4. Currently, many developing nations do not have access to health services. About 100 million people are pushed into extreme poverty each year because of out-of-pocket spending on health. To make health for all, we need individuals and communities to have high-quality health services to take care of their families health. Skilled health workers providing quality, people-centred care and policy-makers should be committed to investing in universal health coverage. Universal health coverage should be based on intense, people-centred primary health care. Good health systems are rooted in the communities they serve. They focus not only on preventing and treating disease and illness but also on helping to improve well-being and quality of life5. Pakistan, the developing country, is struggling to provide good quality health services, mostly availed from the out-of-pocket expenditure.
 Both private and public sector hospitals were trying to deliver health services, but poor people failed to have access to many services due to poverty. To overcome this obstacle and address indicator 3.8 of SDGs, the current government developed a five-year program to improve the targeted population's health by increasing their access to quality health services. The initiative will also reduce poverty, as the government will cover most of their health budget through the "Sehat Sahulat Program". The program was part of the National vision to ensure Universal Health Coverage (UHC) for all Pakistani families. No one is denied quality healthcare services only because of financial constraints. Initially, it was piloted in selected four districts of Khyber Pakhtunkhwa, which was later extended to all over the province. Currently, 7.2 million families are getting free in-patient health care services, and the program's annual cost is 18 billion. It was a bold initiative of the current government, which helped improve access to UHC, thus addressing one of the sustainable development goals6,7.

Global health and its role

Global health and its role

Enfermagem na segurança do paciente na Atenção Primária

The aim was to describe how nursing should act in primary health care to ensure patient safety, with the specific objectives of describing the concept of primary health care, understanding the importance of patient safety in primary health care and discussing how nursing must act in primary care to ensure patient safety. The methodology used in this project was through a bibliographic literature review research, where information on the chosen topic was researched, thus raising texts published in Portuguese, produced in Brazil, through a SciELO database, and LILACS, selection of the texts was made by means of survey on the internet, such as academic books, articles and magazines relevant to the subject, with a period between 2015 and 2019. It was evidenced that increasing the structure and services in primary health care represents an excellent strategy to ensure the support of health systems around the world, providing assistance to users in a preventive, continuous and integrated manner.

Improving Last-mile Delivery of COVID-19 Vaccines: The Cluster Strategy.

Vaccination against the COVID 19 virus is the most effective way to prevent infection and save lives. It is estimated that 285 million doses per month will be needed over the next five months to vaccinate all remaining adults by the end of 2021. To accelerate the vaccination coverage for its population, the state of Uttar Pradesh, North India, has planned a cluster approach to vaccination in rural areas. The cluster strategy is a micro-plan for vaccination by the government of U.P involving intensive mobilisation activities followed by vaccination at centres set up in schools, Panchayat Bhavans and other selected places. It is a people-centred and comprehensive approach, modelled on listening to the intended beneficiaries and stakeholders is vital. It will reduce expenses related to travel and loss of wages for those missing work while travelling far to get vaccinated. The cluster approach is also along the lines of the Near to Home COVID Vaccination Centres (NHCVC) for Elderly and Differently Abled Citizens. The main fear of the health workers regarding the cluster approach is concerning adverse events and their management at the peripheral level. This strategy is only practically possible if an adequate supply of vaccines is available. The cluster approach to vaccination ensures accessibility, includes community participation and is provided free of cost. This is thus in line with the concept of Primary Health Care (PHC) which is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost the community and country can afford. Popularising this strategy and applying it to other states in a tailored manner based on social and cultural practices can give the nation the necessary momentum to attain the target of herd immunity quickly and curb the COVID-19 pandemic.

Lived Experiences of Diabetes Patients in Rural Areas of Ghana: Discovering the Forces that Determine Psychosocial Care

Aim: Diabetes has been identified to cause prolonged ill health in many people living in rural communities in Ghana where access to health care delivery appears to be inadequate and of low quality due to financial constraints, limited health resources, poor road network, low literacy levels and limited access to specialist care. Individuals diagnosed with diabetes often express varied psychological and emotional imbalances. Therefore, immediate psychosocial care is needed to prevent patients living in rural areas from getting into severe depression mode and other mental health complications. Yet, understanding how people diagnosed with diabetes should react in order to prevent severe psychological implications has not been adequately explored in Ghana. This study explored the lived experiences of diabetes patients living in rural areas of the Eastern Region of Ghana with the aim of discovering the forces that determine appropriate psychosocial care for patients.
 Study Design: Using the Interpretative Phenomenological Analysis (IPA), 31 diabetes patients were purposively selected from four hospitals in the region, and interviewed using a semi-structured interview guide to investigate participants’ perceptions, thoughts, feelings, and experiences about the disease and how the participants own experiences could be used to construct a framework of immediate care applicable in their own social certain.
 Results: The study generated themes along productive and unproductive lines to demonstrate the lived experiences of diabetes patients. Psycho-emotional reactions, psychological shock and emotional outbursts constitute unproductive forces. This caused some of the patients to express suicidal ideations at the extreme point. On the other hand, individual resilience and disposition, guidance and support from care providers, family and community members constitute the productive forces that provide an appropriate framework for psychosocial care for diabetes patients.
 Conclusion: The study has shown the need to adequately address the psychological and emotional needs of diabetes patients to prevent extreme forms of psychological distress (anxiety and depression). The authors, therefore, recommend an integrated care model for diabetes patients’ in rural areas that encompass a psychosocial therapy built around the primary healthcare concept with the establishment of counseling units in all Primary Health Care facilities. This will offer a platform to generate personal and community actions and decisions to adequately address the immediate psychological and emotional needs of diabetes patients in rural areas.

The North Karelia Project (1972-1997) and the Origins of the Community Approach to Cardiovascular Disease Prevention.

Community-based risk factor modification is today an established approach to chronic disease control and public health practice. This article analyzes the shaping of the North Karelia Project (NKP), an early and influential formulation of the community approach that focused on coronary heart disease prevention in Finland. Instead of targeting only high-risk individuals, NKP aimed to change the culture of the local community. On the basis of archival material and interviews, I first trace the multiple origins of the notion of community in NKP, which combined "internal" factors (local risk factor distribution, the role given to the social environment in chronic disease prevention) and "external" influences (regional origin of the initiative, World Health Organization and national policy concepts of community control and primary health care). Second, I describe the shape of the community intervention in NKP. The project foregrounded social relationships as a way to educate the public and influence norms guiding individual behaviors while subordinating environmental changes of a more structural nature.

AN INVESTIGATION INTO STRATEGIC MANAGEMENT ADJUSTMENTS MADE BY AFROCENTRIC GROUP IN PREPARATION FOR THE NATIONAL HEALTH INSURANCE (NHI) IMPLEMENTATION IN GAUTENG PROVINCE

Ponte Academic JournalDec 2021, Volume 77, Issue 12 AN INVESTIGATION INTO STRATEGIC MANAGEMENT ADJUSTMENTS MADE BY AFROCENTRIC GROUP IN PREPARATION FOR THE NATIONAL HEALTH INSURANCE (NHI) IMPLEMENTATION IN GAUTENG PROVINCEAuthor(s): Jeremiah Madzimure ,Anton M. Pillay, M.M. XimbaJ. Ponte - Dec 2021 - Volume 77 - Issue 12 doi: 10.21506/j.ponte.2021.12.7 Abstract:This study aimed to explore and understand strategic adjustments that had been made by the largest medical scheme administrator in South Africa, Afrocentric Group to prepare for the NHI implementation in the Gauteng province. The study followed an exploratory qualitative approach and data was collected through semi-structured interviews in which 10 participants occupying middle to senior management positions in their various organisations took part. The most predominant theme that emerged from the interviews was that of partnerships and collaboration between the public and private healthcare sectors to make NHI a success. The findings revealed the significant role that medical schemes and medical scheme administrators such as the Afrocentric Group can play before and after the initial implementation of NHI. Private healthcare organisations already have the knowledge, expertise and digital systems needed to make NHI a reality. In addition, medical schemes and administrators could play a key role in providing public education and creating products and services that are based on the primary healthcare concept. This would help contribute towards expanding healthcare access to more members of the community and would expedite the general understanding of NHI. Download full text:Check if you have access through your login credentials or your institution Username Password

Concepts and guidelines steering Primary Health Care in diverse Colombian territories (2017)

To unveil the concepts of Primary Health Care among institutional and community actors in diverse municipalities of Colombia and point out the health planning guidelines that steer its implementation. Multi-case study in 13 municipalities with a hermeneutical approach using the patchwork quilt technique in 21 workshops with different actors. Four conceptual trends in Primary Health Care were found: i) access to quality health services; ii) emphasis on actions to promote health and prevent disease; iii) basic care provided at the first level of complexity, and iv) a broad perspective, interested in the right to health and the intervention of social determinants. The predominant concept was basic care provided at the first level of complexity. The main guideline was the Ten-Year Public Health Plan. The heterogeneity of guidelines and the conceptual differences imply positions that reveal ethical-political stakes in relation to the organization of health systems and health justice. In Colombia, persisting structural conditions typical of the insurance model restrict the appropriation of a comprehensive conception and the development of a public policy based on Primary Health Care.

Primary health care, the Declaration of Astana and COVID-19.

Four decades after the Declaration of Alma-Ata, its vision of health for all and strategy of primary health care are still an inspiration to many people. In this article we evaluate the current status of primary health care in the era of the Declaration of Astana, the sustainable development goals, universal health coverage and the coronavirus disease 2019 pandemic. We consider how best to guide greater application of the primary health care strategy, reflecting on tensions that remain between the political vision of primary health care and its implementation in countries. We also consider what is required to support countries to realize the aspirations of primary health care, arguing that national needs and action must dominate over global preoccupations. Changing contexts and realities need to be accommodated. A clear distinction is needed between primary health care as an inspirational vision and set of values for health development, and primary health care as policy and implementation space. To achieve this vision, political action is required. Stakeholders beyond the health sector will often need to lead, which is challenging because the concept of primary health care is poorly understood by other sectors. Efforts on primary health care as policy and implementation space might focus explicitly on primary care and the frontline of service delivery with clear links and support to complementary work on social determinants and building healthy societies. Such efforts can be partial but important implementation solutions to contribute to the much bigger political vision of primary health care.

Epidemiology and health consequences of early marriage: focus on Delta State Nigeria

Early marriage occurs for several reasons including gender inequality, poverty, insecurity and tradition. Marrying at such a young age means that these young girls are forced into sexual relations and often get pregnant when they are not ready, causing health challenges and adding to the health burden in developing countries. This paper reviews the epidemiology of early marriage with particular regards to the public health concepts and negative consequences of early marriage. This was a narrative review of previous works on early marriage. Evaluations included the statistics of the negative consequences on women and how best the practices have been ameliorated to its barest minimum. No data available on the previous works dearth of contextualized epidemiological information about Delta State Nigeria. However, available data shows as high as 88% prevalence rate of child marriage in Nigeria, with unexpected pregnancy at 23% being the major cause, maternal mortality at 90%, VVF over 500,000–1,000,000 reported annually in developing countries as the major health consequences. The causes, consequences and prevalence of early marriage constitute reasons for public health concerns to stem the tide. Willful and urgent attention is needed to prevent the pitiable situation of the victims, especially girls. Health literacy is a primary healthcare concept of community educational outreach to adopt.

Adults with intellectual and developmental disabilities and interprofessional, team-based primary health care: a scoping review.

This scoping review aimed to examine the state of the evidence for interprofessional, team-based primary health care for adults with intellectual and developmental disabilities. Adults with intellectual and developmental disabilities are a complex, vulnerable population known to experience health inequities. Interprofessional primary health care teams are recommended to improve access to comprehensive and coordinated health care for these individuals. Limited information is available regarding what services interprofessional primary health care teams provide and how services are evaluated specific to the care of this population. This scoping review considered all studies that referenced individuals with intellectual and/or developmental disabilities who were 18 years or older. It considered all studies that referred to health care provision within a primary health care context. All studies that discussed the provision of interprofessional primary health care services were included. "Interprofessional primary health care team" was the term used to describe services provided by health providers (e.g. physicians, nurse practitioners, nurses, dietitians, social workers, mental health workers, occupational therapists, physical therapists) working in a team-based model of care. This scoping review was conducted in accordance with JBI methodology for scoping reviews. Quantitative, qualitative, and mixed methods study designs were considered for inclusion. In addition, systematic reviews, program descriptions, clinical reviews, and opinion papers were considered. Studies published in English and French were included. The period considered was from 2000 to the date of the searches (July and August 2018 for bibliographic databases and January 2019 for the final searches of unpublished studies and selected papers from key authors). The search identified 2761 records. Despite the global search strategy, only 20 records were included in the final review, mainly consisting of work based in the United States and Canada. Results were heterogeneous and descriptive in nature, consisting of cross-sectional designs, program descriptions, and clinical reviews. The findings represent only a few distinct interprofessional primary health care team models of care and multiple contributions from a small pool of researchers. Roles for physicians, nurse practitioners, nurses, social workers, and mental health providers were identified. Ten studies identified either patient-reported outcomes or health-utilization outcomes. Overall, there was no consistent reporting of outcomes across studies, and outcomes specifically related to many interprofessional services were not captured. Although interprofessional, team-based approaches are supported at a policy and practice level, the concept of interprofessional primary health care for this population remains understudied and is challenged by differences in primary health care provision across the world, complexity in how the field is defined, as well as a lack of consistent reporting of the organizational attributes and processes that support interprofessional primary health care provision. To fully realize the potential of interprofessional primary health care teams, health services research is needed to describe organizational attributes and processes, and evaluate interventions for this population. Engaging in this work will ultimately provide a more fulsome evidence base to support high-quality, interprofessional primary health care provision for adults with intellectual and developmental disabilities.

Patients' Experiences With a Digital Primary Health Care Concept Using Written Dialogues: A Pilot Study.

Background: The changing health care environment promotes the adoption of new information technologies to connect patients and health care providers. However, individuals greatly vary in their ability to use new digital systems, and in their feelings regarding integrity and validation. Caregivers in southern Sweden plan to implement a new digital primary health care (DPHC) service, and patients’ experiences must be studied to guide the best possible implementation of this service. Purpose: To examine the patients’ experiences with DPHC using written dialogues. Method: Patients were consecutively recruited from June 2018 to April 2019. This prospective pilot study used questionnaires with fixed response options, summarized as index values (IV, 0-1.0) in the following domains: communication, technical functionality, and general experience of DPHC. Results: Participants included 286 patients with a mean age of 40 ± 15 years. The response rate was 49% (n = 140), including 40 men (29%) and 100 women (71%). Communication using DPHC was experienced as fairly good (IV, 0.58), technical functionality was experienced as good (IV, 0.80), and the general experience of DPHC was positive with an IV of 0.76. The overall experience of the concept (IV, 0.71), corresponds to a median satisfaction value of 8.0 (interquartile range, 6-9). The patients felt well-prepared and experienced reasonable time aspects. Of the responding patients, 81% would recommend DPHC to others, and a notable reason for satisfaction was availability. However, patients expressed some uncertainty regarding the physician’s ability to assess correct care needs. Conclusion: The patients in our pilot study described their satisfaction and expressed good experiences with the concept of DPHC using written dialogues.

Inspiration of the Astana Declaration to the prevention and control of non-communicable diseases in China

2018 witnessed the 40(th) anniversary of the Alma-Ata Declaration. On October 25, 2018, the World Health Organization issued a new Astana Declaration, which reiterates and further develops the concept and core elements of primary health care. It is also proposes that the implementation of the primary health care concept will facilitate to cope with the increasing burden of non-communicable diseases in different countries. Based on the analysis on the policies and practices of the prevention and control of non-communicable diseases in China, this paper points out that the "government-leading, multi-sectoral collaboration, social mobilization and participation by all people" which we have always emphasized is just the application of this primary health care concept, and the Astana Declaration also brings a new and important inspiration to the prevention and control of non-communicable diseases in China.

Access to a quality healthcare among prisoners - perspectives of health providers of a prison infirmary, Ghana.

The purpose of this paper is to explore the influence of health system factors on access to a quality healthcare among prisoners in Ghana. Data were gathered using different qualitative methods (interviews and participant observation) with staff of the James Camp Prison, Accra. Findings were analyzed using a framework method for the thematic analysis of the semi-structured interview data; and interpreted with the theoretical perspective of health systems thinking and innovation. The study concludes that health system factors such as inadequate funding for health services, lack of skilled personnel and a paucity of essential medical supplies and drugs negatively affected the quality of healthcare provided to inmates. The limited facilities available and the sample size (healthcare workers and prison administrators) impeded the achievement of varied views on the topic. The paper recommends the need for health policy makers and authorities of the Ghana Prison Service to collaborate and coordinate in a unified way to undertake policy analysis in an effort to reform the prisons healthcare system. The national health insurance scheme was found to be the financing option for prisoners' access to free healthcare with supplementation from the Ghana Prison Service. The study recommends that policy makers and healthcare stakeholders should understand and appreciate the reality that the provision of a quality healthcare for prisoners is part of the entire system of healthcare service delivery in Ghana and as such should be given the needed attention. This is one of few studies conducted on male only prisoners/prison in the context of Ghana. It recommends the need for an integrated approach to ensure that the entire healthcare system achieves set objectives in response to the primary healthcare concept.

International Health Research and the Emergence of Global Health in the Late Twentieth Century.

An influential policy network emerged from two overlapping developments of the 1970s and 1980s: new research programs focusing on tropical diseases and debates about how to implement the concept of primary health care at the World Health Organization. Participating actors came together in an informal network that, by the late 1980s, expanded advocacy to include the promotion and reorganization of all forms of research that might improve health in the Global South. This goal became associated with a search for new research methods for determining priorities, a quest that reached a peak in the early 1990s when the World Bank entered the picture. The bank brought money, economic analyses, and neoliberal ideology to the research advocacy movement and helped stimulate an upsurge of cost-effective forms of economic thinking in global health (GH) circles. This expanded research network provided some of the conceptual foundations and leadership for several of the most emblematic institutions of the new GH. These included new organizations to bring together and coordinate public and private actors in pursuit of common aims and new forms of economic rationality. The network's advocacy work contributed as well to a massive expansion of GH research at the turn of the century.

Knowledge And Case Management Status On Acute Respiratory Infection Among Female Community Health Volunteers Of Kaski District-Nepal

In Nepal, female community health volunteers are considered as front-line health service providers in a rejuvenated concept of primary health care by acting as a bridge between the health care delivery system and the community.

Quality Indicators of Primary Health Care Facilities in Austria

The strengthening of primary health care is one major goal of the current national health reform in Austria. In this context, a new interdisciplinary concept was developed in 2014 that defines structures and requirements for future primary health care facilities. The aim of this project was the development of quality indicators for the evaluation of the scheduled primary health care facilities in Austria, which are in accordance with the new Austrian concept. We used the RAND/NPCRDC method for the development and selection of the quality indicators. We conducted systematic literature searches for existing measures in international databases for quality indicators as well as in bibliographic databases. All retrieved measures were evaluated and rated by an expert panel in a 2-step process regarding relevance and feasibility. Overall, the literature searches yielded 281 potentially relevant quality indicators, which were summarized to 65 different quality measures for primary health care. Out of these, the panel rated and accepted 30 measures as relevant and feasible for use in Austria. Five of these indicators were structure measures, 14 were process measures and the remaining 11 were outcome measures. Based on the Austrian primary health care concept, the final set of quality indicators was grouped in the 5 following domains: Access to primary health care (5), quality of care (15), continuity of care (5), coordination of care (4), and safety (1). This set of quality measures largely covers the four defined functions of primary health care. It enables standardized evaluation of primary health care facilities in Austria regarding the implementation of the Austrian primary health care concept as well as improvement in healthcare of the population.