Primary Health Care Delivery Research Articles

Telemedicine: Bridging the Gap in Providing Primary Care to Rural Area Patients Across India

Telemedicine has emerged as a transformative solution to address the significant healthcare disparities faced by rural India, where over 70% of the population resides. In this article, the evolution of telemedicine in India, its current landscape, and its potential to revolutionize primary healthcare delivery in rural areas are reviewed. Despite progress in establishing Primary Health Centers, rural healthcare infrastructure remains underutilized due to staffing shortages and other challenges. Telemedicine offers a lifeline by bridging critical gaps in primary care, with government initiatives such as E-Sanjeevni and private entities such as M-Swasth and Apollo TeleHealth expanding access to healthcare services. The COVID-19 pandemic accelerated the adoption of more advanced, patient-centric telemedicine models incorporating artificial intelligence, machine learning, and Internet of Things technologies. These innovations aim to provide rural communities with healthcare standards comparable to urban areas. However, challenges persist, including technological barriers, digital literacy gaps, and concerns about data security and privacy. To fully realize telemedicine’s potential, a multifaceted approach is necessary. This includes culturally adapting platforms for rural populations, strengthening data protection legislation, enhancing digital infrastructure, and increasing digital literacy. The collaborative efforts of government bodies, private enterprises, healthcare professionals, and non-profit private organizations are crucial in overcoming these challenges. By embracing telemedicine and addressing its implementation barriers, India can bridge the healthcare gap, improve the quality of life for millions of rural residents, and potentially catalyze economic development in rural areas.

Healthcare in police custody: a conceptual framework for measuring and improving quality of care

Abstract Background Individuals in police custody are often in poor (mental) health and can be in need of medical attention. The delivery of primary healthcare in police custody differs from other custodial and non-custodial settings, due to its short-term character and the reliance on custody officers and healthcare professionals to access care. Therefore, medical care for detainees in police custody requires its own standards and indicators to measure the quality of care. We aimed to develop a conceptual framework for (actionable) indicators to measure the quality of care for people detained in short-term police custody settings in the Netherlands. Methods We conducted a scoping review and consulted with experts. The scoping review involved Embase, Medline, PsycINFO, CINAHL, Criminal Justice Abstracts, PiCarta and Cochrane, and was supplemented with grey literature searches. We consulted twenty-seven stakeholders with a wide variety of expertise in the field of healthcare in police custody to discuss and validate the conceptual framework. Results The conceptual framework consists of 14 domains of structures (e.g. staff and facilities), processes (e.g. triage and coordination of care) and outcomes (e.g. effectiveness and satisfaction) that need to be considered when developing quality indicators for the healthcare provision in police custody. The scoping review yielded 68 publications providing information on common health issues and recommendations related to quality assurance or improvement. Conclusions The conceptual framework will guide the development of (actionable) quality indicators, which will be evaluated on relevance and measurability. These are crucial for monitoring care quality and enhancing a learning health systems approach. This study fills a gap in the existing scientific literature by shedding light on the factors contributing to the quality of primary healthcare provision for people detained in short-term custody settings. Key messages • The conceptual framework guides the development of (actionable) quality indicators for healthcare in police custody. • This study contributes to the creation of a learning health system for healthcare in short-term police custody settings.

Ideal Clinic Realisation and Maintenance programme implementation in rural KwaZulu-Natal.

The delivery of quality primary healthcare (PHC) services is vital for enhancing the health status of rural communities, yet persistent barriers exist in resource-constrained rural settings. The study explored perspectives on the barriers to and facilitators of implementing the Ideal Clinic Realisation and Maintenance (ICRM) programme as a quality assurance initiative in a rural KwaZulu-Natal subdistrict. Professional nurses and healthcare managers from seven PHC clinics in a rural subdistrict of KwaZulu-Natal and supervising managers from a district hospital participated in this study. Telephonic semi-structured interviews were conducted using a qualitative case study approach with the purposively selected sample. Data were inductively and thematically analysed. Themes included ICRM programme organisation, barriers and facilitators for implementing the ICRM programme. Barriers in rural PHC settings included overburdened clinics, suboptimal infrastructure, staff burnout, poor communication and non-adherence to clinical guidelines. Despite obstacles, programme implementation was facilitated through stakeholder support and teamwork. Participants emphasised the need for infrastructure upgrades, more human and physical resources, and maintenance of stakeholder support. If challenges are mitigated and supportive factors are leveraged, the potential for successful programme implementation and improved healthcare delivery can benefit both healthcare providers and recipients.Contribution:Through providing insight into the perspectives of both implementers and supervisors, the study informs stakeholders and policymakers about difficulties encountered and potential improvements to be made in the implementation of the ICRM programme in rural PHC.

Navigating the Challenges of Primary Health Care in Selected Local Government Authorities in Tanzania: Bringing Lipsky’s Theory in Its Requisite Panorama

Introduction The robust delivery of primary health care (PHC) service is a complex interplay of key stakeholders, including policymakers, citizens, the government, parliamentarians, academics, and street-level bureaucrats - health staff in this context. While each of these players has a stake in ensuring robust PHC delivery, this paper specifically examines the role of street-level bureaucrats (SLBs) in dealing with service delivery challenges in Local Government Authorities (LGAs) in Tanzania. Although the engagement with these actors gained momentum in the decentralization reforms of the 1990s, their contribution has been slow. The question remains: How can SLBs cope with LGAs’ predicaments to enhance service delivery? Lipsky’s (1980) theory focuses on this contention by proposing that under challenging encounters, SLBs can develop specific patterns of practices to deal with the status quo. Methods Data were collected through interviews with policymakers at Mvomero District and Moshi Municipal Councils. To assess the effectiveness of primary health care services attributes such as authority, accountability, and access were closely examined. A thematic review of the literature was conducted to corroborate the findings from the interviews. Results The findings indicate that SLBs can cope with complex and challenging situations related to PHC delivery by rationing resources, simplifying their work environment, or exiting from turbulent environments. Although the engagement of SLBs gained momentum during the decentralization reforms of the 1990s, their contribution has been slow. The primary factor hindering their effectiveness is the inability to establish a mutually beneficial relationship between the Central Government and LGAs. Conclusion The government's attempts to control SLBs' behaviors, including limiting their intrinsic and extrinsic motivation, undermine their client responsiveness. Empowering SLBs and fostering a more collaborative relationship between the central government and LGAs is essential to enhance PHC delivery.

An Overview of Factors affecting Women Performance in Some Primary Health Care Delivery in Jere Local Government Area of Borno State, Nigeria

An Overview of Factors affecting Women Performance in Some Primary Health Care Delivery in Jere Local Government Area of Borno State, Nigeria

Care seeking during pregnancy: testing the assumptions behind service delivery redesign for maternal and newborn health in rural Kenya

Abstract A health systems reform known as Service Delivery Redesign (SDR) for maternal and newborn health seeks to make high-quality delivery care universal in Kakamega County, in western Kenya, by strengthening hospital-level care and making hospital deliveries the default option for pregnant women. Using a large prospective survey of new mothers in Kakamega County, we examine several key assumptions that underpin the SDR policy’s theory of change. We analyse data on place of delivery, travel time and distance, out-of-pocket spending, and self-reported quality of care for 19 127 women prospectively enrolled during antenatal care (ANC) and surveyed two times after their delivery. We analyze changes in womens’ delivery location preferences in recent years in Kakamega, and over the course of their most recent pregnancy. We also evaluate travel time, out-of-pocket expenditures and patient satisfaction for women who deliver in public hospitals vs primary health centres. We find substantial changes in delivery location at the population level over time and for individual women over the course of pregnancy. Facility delivery has increased from 50.4% in 2010 to 89.5% in 2019; 70% of respondents deliver at a different facility than their reported intention at ANC. Out-of-pocket delivery expenditures are on average 1351 Kenyan shillings (Ksh) in hospitals compared to 964 Ksh in PHC (primary health care)s (P < 0.01). Transport expenditures are 337 Ksh for PHC level deliveries vs 422 Ksh for hospitals (P < 0.01). Self-reported average travel time is 51 min (PHC delivery) vs 47 min (hospital delivery) (P = 0.78). The average distance to a delivery location is 15.1 km for PHC deliveries vs 15.2 km for hospitals (P = 0.99). There were no differences in overall patient-reported quality scores, while some subcomponents of quality favoured hospitals. These findings support several key assumptions of the SDR theory of change in Kakamega County, while also highlighting important challenges that should be addressed to increase the likelihood of successful implementation.

Geospatial and Path Analysis for Enhancing Malaria Control and Primary Healthcare Delivery in Low-Income Nations: A Case Study of Uganda

Geospatial and Path Analysis for Enhancing Malaria Control and Primary Healthcare Delivery in Low-Income Nations: A Case Study of Uganda

Towards the new primary care reform in Greece: a focus on patients' expectations, views and perceptions from rural healthcare centres.

Patient perception of quality of care is an essential component in evaluating healthcare delivery. This article reports data from primary health care (PHC) centers before Greece's most recent PHC reform. The study was undertaken to offer some baseline information about patient experience, support the decision-making processes taking place, and provide valuable input for future policy-making comparisons in Greece. The research was conducted across the 16 PHC centers of Epirus, a region of north-western Greece, from June to September 2017, with 532 patients rating the importance of different aspects of three main healthcare domains (clinical behavior, support and services, and organization of care) of PHC provision. The Greek version of the European Task Force on Patient Evaluations of General Practice (EUROPEP) questionnaire was implemented for research purposes. Univariate comparisons were performed for patients with and without chronic disease, using Pearson's χ2 test for categorical data. Study findings support that the organization of care domain is of highest importance and priority, with clinical behavior and support and services following closely. Among recruited patients, on average, only 2.1% of patients with a chronic disease were satisfied (rated 4 or 5 on the Likert scale) with the organization of care aspects under consideration, compared to 18.4% of patients without a chronic disease. Furthermore, only 4% of patients with a chronic disease were satisfied with the aspects examined in the clinical behavior domain, compared to 27% of patients without a chronic disease. Finally, 18% of sampled patients with a chronic disease reported being satisfied with the quality of support and services provided, compared to 38% of patients without a chronic disease. It is necessary to back up available past information to afterwards estimate reform imprinting on expectations and perceptions. The items and aspects of EUROPEP, in line with the new tasks of the personal doctor within the PHC system that patients perceive as most essential, can be used to prioritize quality improvement activities to strengthen PHC delivery in Greece. Communication skills, practices, and behavioral change skills seem to need more attention for an efficient PHC model.

Assessing Consumer Perception of Effective Health Service Delivery: A Study of The Perspectives of Users of Diocesan Health Services in Sunyani

Background: The standard of the healthcare provided predicts a population's health. The purpose of this study is to comprehend how consumers perceive the effective management and provision of health services at the Diocesan Health Services in Sunyani, Ghana. Materials and Methods: The study used a mixed methodology in which both quantitative and qualitative data were utilized. Semi-structured interviews and a questionnaire were used to collect the data. The nested case study design approach was used for this investigation. The study was carried out in a few chosen facilities of Diocesan Health Services Sunyani. The sample included 331 people from the facilities. Respondents’ data were subjected to descriptive and inferential data analysis. Results: The findings revealed focused primary healthcare delivery, good management and leadership, community engagement, and integration of traditional and complementary medicine into the national health systems as quality healthcare. Conclusion: Users view increased accessibility, acceptability, availability, and good service outcomes as quality health service planning and delivery.

Budget Implementation and Socio-Economic Development in Akwa Ibom State

This study examined the influence of the implementation of the annual budget on the socio-economic sector of the state with emphasis on education & health. It was observed that in most states of the federation, the factors responsible for budget failures included but were not limited to budget indiscipline, lack of accountability, inadequate oversight functions on the side of lawmakers, and untimely release of funds, amongst others. It was the objective of this study to establish how the implementation of annual budgets in Akwa Ibom State has impacted the level of secondary and primary healthcare delivery in the State as well as the educational facilities in Akwa Ibom State. To achieve the above objectives, the survey research design was employed to gather data from a large population through the instrumentality of the research questionnaire. Hard data were also obtained from the state’s budget office. To explain this study, the Elite Preference Model which is a variant of the Elite Theory was employed. The findings of this study revealed that the implementation of the budget had a significant negative relationship with secondary and primary healthcare delivery and the attainment of educational services/facilities in Akwa Ibom State. Given the above findings, it was recommended amongst others that, as a matter of policy, budget discipline should be enforced in all its three dimensions, namely, numerical discipline, timing discipline and policy discipline. It was also recommended that a target budgeting strategy should be adopted by the Akwa Ibom State government.

Working practices and integration of primary health care doctors in remote rural areas in Brazil: a qualitative study

Health care challenges in remote rural municipalities (RRMs) emphasize the importance of primary health care (PHC) and require an expanded scope of practice. Doctors are key actors in this context. The aim of this study was to explore the level of integration of doctors in RRMs and working practices. We conducted a qualitative study involving semi-structured interviews with 46 PHC doctors working in 27 RRMs in Brazil. Content analysis was performed, resulting in the identification of categories of analysis grouped under three core dimensions: doctor training and experience; comprehensive care and timely access; and the community-based approach. Doctors working in RRMs were mainly recent graduates with limited experience who had undertaken their degree outside Brazil, and care was focused on the individual. The findings also revealed weak sociocultural adaptation and a harsh working environment and issues related to social status that reinforced prejudice against rurality and poverty. Practice was limited in scope and care tended to be oriented towards acute problems, disease-centered and focused on the biomedical model of medicine. Barriers to the delivery of comprehensive care include both structural constraints, such as poor facilities and centralization of services in administrative centers, and the lack of professional competencies necessary for PHC in these areas. The findings point to the need to promote an expanded scope of practice in PHC delivery in RRMs, with major public investment in the promotion of training and strengthening career pathways in these areas.

High Responsibility, limited authority, and endless expectations: a policy critique of the Community Health Officer’s role in the government healthcare delivery systems in India

BackgroundThe shortage of qualified healthcare providers in rural areas of India has led to a emergence informal and unqualified practitioners and poses significant risks to population health. Community Health Officers (CHOs) were introduced as mid-level health providers (MLHP) at Sub-health Centres (SHC) to bridge the healthcare resource gap and serve as the primary point of contact for rural communities.MethodsThis qualitative cross-sectional study aimed to explore the CHOs experiences and performance at sub-health centre Health and Wellness Centres (SHC-HWCs) in India. CHOs and Medical Officers (MOs) from randomly selected SHC-HWCs and Primary Health Centre-Health and Wellness Centres (PHC-HWCs) across different geographic zones were interviewed. Semi-structured interviews were conducted with CHOs, MOs, and State Nodal Officers (SNOs) to gather information on drug provisioning, prescription practices, and perspectives on the roles and capacities of CHOs. The study is based on 40 in-depth interviews of health providers sampled at different levels of healthcare system in India.ResultsThe study revealed barriers and challenges faced by CHOs in meeting the expectations outlined in the Comprehensive Primary Health Care (CPHC) guidelines. These included a lack of agency, difficulties in team dynamics with existing healthcare professionals, and inadequate availability of medicines at sub-health centres. Due to the existing contradictions and prescription restrictions, CHOs found themselves failing to meet community expectations and foster trust.ConclusionCHOs encounter significant challenges in fulfilling their roles as mid-level health providers. Addressing these challenges is crucial for optimizing their effectiveness and strengthening the delivery of primary healthcare in rural areas. Clear protocols, supportive policies, and capacity-building initiatives are necessary to enhance the role and impact of CHOs in the healthcare system.

FRAP 2.0: a community engagement method applied to cervical cancer disparities among Hispanic women

focused Rapid Assessment Process (fRAP) 2.0 is a community engagement approach combining geospatial mapping with rapid qualitative assessment in cyclical fashion within communities to capture multifactorial and multilevel features impacting...

Nurse Practitioners (NPs) as Game Changers in Tanzania Health Delivery System: Lessons Learnt from Fujita Bantane Hospital in Japan

AbstractShortage of physicians/doctors in the primary health care system has been evidenced in various countries. Among other things, these countries deployed nurse practitioners (NPs) in the health care delivery system to address this shortage. Countries in America, Europe, and Asia use NPs to address physicians/doctors shortage in the primary health care delivery systems. Various studies have shown that NPs have been deployed in primary health care facilities to curb these shortages.While in Tanzania shortage of physicians/doctors and other health professionals is evidenced in every sector of the health care system, nurses play a crucial role to cover this shortage by providing care and support for individuals and communities. Nurses work in various settings from being a nurse, counselor, laboratory technologist, social worker, educationist, and physician, to name a few. Nurses play a key role in preventing, diagnosing, and attending to common health problems. The question is, “When will the Tanzanian health delivery system recognize the pivotal role of these nurses and upgrade them to NPs?” This study suggests that deployment of NPs in Tanzania's health care systems could be a “game changer.” As a fellow on Critical Care Nursing Course at Fujita Health University Bantane Hospital in Japan, witnessed deployment of NPs in health care delivery and the reaped benefits are enormous; increased access to health care services, reduction in health care costs, reduced hospital stays, and customer satisfaction through client empowerment and comfort. This is an observational study of tasks performed by NPs in Fujita Health University Bantane Hospital and their relevance as a positive innovation to curb physician shortages for effective health care delivery. The duration of the study at Bantane Hospital was 2 months from January 15 to March 16, 2024. One-to-one interviews with NPs on duty were conducted. Also, collected and reviewed information from Tanzanian government Web sites, published government documents, and academic literature. Results show that NPs perform a lot of procedures that physicians/doctors were supposed to do. In the wards, theater, laboratories, and clinics, they play a pivotal role to curb shortage of physicians/doctors in health settings. NPs are an effective addition to medical facilities. They perform various procedures in the absence of the doctors. The findings from this study have important implications for improving health care delivery in Tanzania. NPs could be “game changers” in the health care landscape in Tanzania. Investment on nurses' education, proper training, and policy changes in nurse practice regulations are key for this to succeed.

Primary health care utilisation and delivery in remote Australian clinics during the COVID-19 pandemic

IntroductionThe COVID-19 pandemic period (2020 to 2022) challenged and overstretched the capacity of primary health care services to deliver health care globally. The sector faced a highly uncertain and dynamic period that encompassed anticipation of a new, unknown, lethal and highly transmissible infection, the introduction of various travel restrictions, health workforce shortages, new government funding announcements and various policies to restrict the spread of the COVID-19 virus, then vaccination and treatments. This qualitative study aims to document and explore how the pandemic affected primary health care utilisation and delivery in remote and regional Aboriginal and Torres Strait Islander communities.MethodsSemi-structured interviews were conducted with staff working in 11 Aboriginal Community-Controlled Health Services (ACCHSs) in outer regional, remote and very remote Australia. Interviews were transcribed, inductively coded and thematically analysed.Results248 staff working in outer regional, remote and very remote primary health care clinics were interviewed between February 2020 and June 2021. Participants reported a decline in numbers of primary health care presentations in most communities during the initial COVID-19 lock down period. The reasons for the decline were attributed to community members apprehension to go to the clinics, change in work priorities of primary health care staff (e.g. more emphasis on preventing the virus entering the communities and stopping the spread) and limited outreach programs. Staff forecasted a future spike in acute presentations of various chronic diseases leading to increased medical retrieval requirements from remote communities to hospital. Information dissemination during the pre-vaccine roll-out stage was perceived to be well received by community members, while vaccine roll-out stage information was challenged by misinformation circulated through social media.ConclusionsThe ability of ACCHSs to be able to adapt service delivery in response to the changing COVID-19 strategies and policies are highlighted in this study. The study signifies the need to adequately fund ACCHSs with staff, resources, space and appropriate information to enable them to connect with their communities and continue their work especially in an era where the additional challenges created by pandemics are likely to become more frequent. While the PHC seeking behaviour of community members during the COVID-19 period were aligned to the trends observed across the world, some of the reasons underlying the trends were unique to outer regional, remote and very remote populations. Policy makers will need to give due consideration to the potential effects of newly developed policies on ACCHSs operating in remote and regional contexts that already battle under resourcing issues and high numbers of chronically ill populations.

Protocol to develop strategies to improve the effectiveness and efficiency of Village Health Workers in service delivery in a selected district of Zimbabwe

Village Health Workers (VHWs) in Zimbabwe complement the healthcare staff in primary health care delivery. In 2015 the Ministry of Health streamlined services offered by the VHWs with the VHW Strengthening Plan to improve the effectiveness of the program. However, these continue to offer services not addressing the current and emerging health problems. This three-phased study seeks to develop strategies to improve the effectiveness and efficiency of VHWs in service delivery. Systematic literature review shall be used to develop a conceptual framework to guide the development of VHWs service delivery strategies. Exploratory sequential mixed methods design shall explore VHWs roles in primary health care. A survey in the first stage shall collect qualitative data from 45 purposely selected healthcare workers and VHWs using interviews and then thematically analyzed with MAXQDA. The variables generated will have a cross-sectional survey used to collect quantitative data from 134 VHWs and analyzed on SPSS. The SWOT and basic logic models shall be used to develop strategies validated by the Delphi Technique and Key Stakeholders. Informed consent will be maintained in the study with findings published in journals and presentation symposiums. This protocol was approved by the University of Venda Research Ethics Committee (Registration FHS/23/pH/11/0709).

An examination of the structural linkages between households and community health services in realization of accelerated primary healthcare delivery in Kisumu County, Kenya: a systematic review

Background The provision of community health services (CHS) is critical in accelerating primary health care delivery to vulnerable and deprived populations. This systematic review study has been conducted to interrogate the interrelationship between households and community health services in accelerating primary healthcare delivery synthesizing the available empirical studies. The findings are to inform a primary research on structural linkages between households and CHS in Kisumu County, Kenya. Methods This study applied a descriptive approach using a systematic review technique to provide context and substance to the two main research questions: (1) how does the interaction between households and CHWs affect utilization of CHS to promote equity and right to health? (2) How do health-seeking behaviours of households influence their decision-making regarding choices of CHS? We screened the literature from Google scholar, JSTOR, SAGE and EBSCO based on our inclusion criteria, resulting in 21 studies. These studies were assessed for quality and eligibility and data extracted based on relevance to the research study. Results Households place primacy on trust and confidentiality in the interaction with CHWs and this affects uptake of CHS. The social determinants of health are also critical in influencing the health-seeking behaviour of households and individuals and their choice of CHS. The successful models of CHS share the characteristic of community ownership and participation and provides for comprehensive health care teams. Conclusion CHS are critical for the acceleration of primary health care delivery. It forms an important pathway for the achievement of universal health coverage, which is an outcome required for Sustainable Development Goal 3 on health.

Assessing the Role of Nursing Professionals in the Delivery of Integrated Primary Health Care

Background: The integration of Primary Health Care (PHC) services is crucial for improving health outcomes and efficiency in health systems globally. Nursing professionals play a critical role in delivering these integrated services. Understanding their contribution and the impact of their involvement is essential for optimising PHC delivery. The objective of this systematic review is to evaluate the roles and contributions of nursing professionals in the delivery of integrated primary healthcare services. Methods: A comprehensive search strategy will be implemented across electronic databases, including PubMed, CINAHL, and Cochrane Library, to identify relevant studies. Studies published from [start date] to [end date] will be considered. Two independent reviewers will screen titles and abstracts for eligibility, followed by a full-text review of potentially relevant articles. Data extraction and quality appraisal will be conducted using standardised forms. A narrative synthesis will be performed to analyse and summarise the findings. Conclusion: This systematic review will provide evidence on the contributions of nursing professionals to integrated primary health care delivery. The findings will recommend policy and practice in primary health care services.

The Role of Community Health Volunteers in Promoting Health Equity: Opportunities and Challenges in Accelerating Primary Healthcare Delivery in Kisumu County, Kenya

The Role of Community Health Volunteers in Promoting Health Equity: Opportunities and Challenges in Accelerating Primary Healthcare Delivery in Kisumu County, Kenya

Economics of primary healthcare: cost estimation of clinical services at primary care facilities in the six countries of the Gulf Cooperation Council

ObjectiveWhile the Gulf Cooperation Council (GCC) countries have demonstrated a strong commitment to strengthening primary healthcare (PHC), the costs of delivering these services in this region remain relatively unexplored. Understanding...