Essential Primary Health Care Research Articles

Holistic support framework for doctors training as rural and remote general practitioners: a realist evaluation of the RVTS model.

To develop theory about how and why the supervision and support model used by the Remote Vocational Training Scheme (RVTS) addresses the professional and non-professional needs of doctors (including many international medical graduates) who are training towards general practice or rural generalist fellowship while based in the same rural or remote practice. We conducted a realist evaluation based on the RAMESES II protocol. The initial theory was based on situated learning theory, networked ecological systems theory, cultural theory and geographical narcissism theory. The theory was developed by collecting empirical data through interviews with 27 RVTS stakeholders, including supervisors, participants and RVTS staff. The theory was refined using a project reference and a stakeholder advisory group and confirmed using individual meetings with experts. Theory about how the contexts of person, place and program interacted to address professional and non-professional needs. The RVTS program offers remote access to knowledgeable and caring supervisors, real-time tailored advice, quality resources and regular professional networking opportunities, including breaks from the community. It worked well because it triggered five mechanisms: comfort, confidence, competence, belonging and bonding. These mechanisms collectively fostered resilience, skills, professional identity and improved status; they effectively counteracted the potential effects of complex and relatively isolated work settings. This theory depicts how a remotely delivered supervision and support model addresses the place and practice challenges faced by different doctors, meeting their professional and non-professional needs. The participants felt valued as part of a special professional group delivering essential primary health care services in challenging locations. The theory could be adapted and applied to support other rural and remote doctors.

Global acute malnutrition is associated with geography, season and malaria incidence in the conflict-affected regions of Ouham and Ouham Pendé prefectures, Central African Republic

BackgroundOngoing conflict between multiple armed groups, including pastoralist herders in the Central African Republic (CAR) causes frequent population displacements, food insecurity and scarcity of healthcare services. The inaccessibility and insecurity of many areas of CAR limit data collection and assessments from national nutritional surveys. Community health workers (CHWs) trained by an international non-governmental organisation, The MENTOR Initiative, deliver basic healthcare to children under 5 years old living in hard-to-reach and conflict-affected areas in eight subprefectures of north-west CAR. Their nutritional status and its associations with geography, malaria, season and conflict are unknown.MethodsCHW monthly records (October 2015–August 2021), Armed Conflict Location and Event Data project conflict data and The World Bank Group meteorological data for eight subprefectures of north-west CAR were analysed. Associations between counts of global acute malnutrition (GAM) assessed by mid-upper arm circumference and malaria, season and conflict were investigated using negative binomial regression.ResultsOf the 457,325 consultations with children aged 6–59 months, 6.2% and 0.4% were classified as moderately or severely malnourished, respectively. The negative binomial model demonstrated differences in counts of GAM by subprefecture. Counts of GAM were positively associated with the case rate of severe malaria (IRR = 1.045; 95% CI: 1.04–1.06) and the rainy season (July–September) (IRR = 1.10; 95% CI: 1.03–1.17). Conflict events coded as Battles in ACLED were associated with lower counts of GAM (IRR = 0.78; 95% CI: 0.62–0.97).ConclusionsThis analysis shows geographical differences in levels of malnutrition in north-west CAR and demonstrates clear associations between malnutrition, season and malaria. It provides evidence that levels of GAM may be underestimated in north-west CAR in areas experiencing conflict. These findings highlight the need for targeted nutritional support to reach children most at risk of malnutrition. CHWs are a proven effective means of delivering essential primary healthcare services in hard-to-reach, conflict-affected areas.

P043 PREACH IMPLEMENTATION PROJECT A SOCIO-ECOLOGICAL FRAMEWORK FOR HYPERTENSION IN PAKISTAN

Background: Worldwide hypertension prevalence is projected to reach 1.56 billion by 2025, affecting 29% of the global population according to the WHO1. It contributes to 7.5 million deaths, 3.7% of total disability-adjusted life years (DALYs) and is responsible for causing stroke in 54% of hypertensives2,3. Pakistan has a prevalence of 43% hypertension with merely 12.5% of controlled hypertensives4,5. There is a pressing need for a national level intervention through uniform clinical approaches for optimum hypertension prevention, treatment and control6, 7. Through PREACH project, we prioritize primary care physicians as first-line responders and are training them on standardized hypertension guidelines to alleviate the burden from tertiary care hospitals. To detect new onset hypertension the project also incorporates early surveillance and community level screenings. Objectives: • To build capacity of practitioners on standardized guidelines endorsed by health ministry, PCS (Pakistan Cardiac Society) & PHL (Pakistan Hypertension League) • To raise community awareness, to screen and develop self-referral pathways to specialty care • To develop a robust national hypertension registry • To include hypertension in essential primary healthcare packages Methodology: Hypertension guidelines are developed. Accredited national certified workforce of more than 14,000 general practitioners (GPs) will be built through guidelines trainings via train the trainer model. Impact assessment studies will be done to assess training effectiveness and implementation at clinics. Community mobilization and awareness campaigns will be run to identify and direct self-referral pathway to an accredited GP. Development of national hypertension registry as a centralized system for data collection to report actual disease burden. Ministry of health will be advocated to prioritize hypertension management via multi-sectoral collaboration i.e. medical societies, academic, non-profit and private-sector for incorporations into annual development programs. Results \Conclusion: We aim to create an impact in the lives of 4.3 million beneficiaries (anti-hypertensive naïve hypertensive patients of Pakistan) by increasing self-referral of hypertensive cases to specialists through PREACH implementation project at all healthcare service delivery levels.

Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review.

To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care. This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews. Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models. One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy. Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective. Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally. This review is reported against the PRISMA-ScR criteria. No patient or public contribution. The study protocol is published in BJGP Open (Moulton etal., 2022).

The impact of the COVID-19 pandemic on the provision & utilisation of primary health care services in Goma, Democratic Republic of the Congo, Kambia district, Sierra Leone & Masaka district, Uganda.

This study aimed to determine whether the COVID-19 pandemic had an impact on essential primary healthcare services at public primary healthcare facilities. The number of weekly consultations for antenatal care (ANC), outpatient (OPD), immunisations (EPI), family planning (FP) and HIV services, between January 2018 and December 2020, were collected from 25 facilities in Masaka district, Uganda, 21 in Goma, and 29 in Kambia district, Sierra Leone. Negative binomial regression models accounting for clustering and season were used to analyse changes in activity levels between 2018, 2019 and 2020. In Goma, we found no change in OPD, EPI or ANC consultations, FP was 17% lower in March-July 2020 compared to 2019, but this recovered by December 2020. New diagnoses of HIV were 34% lower throughout 2020 compared to 2019. In Sierra Leone, compared to the same periods in 2019, facilities had 18-29% fewer OPD consultations throughout 2020, and 27% fewer DTP3 doses in March-July 2020. There was no evidence of differences in other services. In Uganda there were 20-35% fewer under-5 OPD consultations, 21-66% fewer MCV1 doses, and 48-51% fewer new diagnoses of HIV throughout 2020, compared to 2019. There was no difference in the number of HPV doses delivered. The level of disruption varied across the different settings and qualitatively appeared to correlate with the strength of lockdown measures and reported attitudes towards the risk posed by COVID-19. Mitigation strategies such as health communications campaigns and outreach services may be important to limit the impact of lockdowns on primary healthcare services.

The Impact of COVID-19 on Access, Delivery, and Utilisation of Essential Primary Healthcare in Region 4 of Guyana

Background: The COVID-19 pandemic has posed considerable operational challenges for public health systems to deliver COVID-19 response and maintain essential health services simultaneously. Low-resource countries were significantly affected by the COVID-19 pandemic because of weak health infrastructure, reduced health systems capacity and significant socio-economic inequalities. Objectives: This study aimed to explore the impact of COVID-19 on access, delivery and utilisation of essential primary health services in Region 4 of Guyana. Methods: An explanatory sequential study design was used to collect data on health services utilisation from 41 health centres in Region 4. The statistical data informed a semi-structured questionnaire to explore community and healthcare providers' perceptions of the COVID-19 pandemic and their experiences concerning access and delivery of primary health services during the COVID-19 pandemic in Guyana. The statistical data were analysed descriptively with SPSS version 20 software and by time series trend analysis. The qualitative data were descriptively analysed with SPSS software and by thematic analysis. Results and Discussion: An analysis of the statistical data showed a stable trend of essential health services utilisation from January 2018 – May 2019. However, during the COVID-19 pandemic, there were significant decreases in utilising all essential health services across the 41 health centres of Region 4. Healthcare providers and community perspectives and experiences identified fear and anxiety among the common causes for decreased access to primary healthcare during the pandemic. Conclusions: This study confirmed that during the COVID-19 pandemic, access, delivery, and utilisation of essential health services were severely affected in the health centres of Region 4 in Guyana. COVID-19 pandemic, essential primary healthcare, health centres of Region 4 in Guyana.

A RETROSPECTIVE OBSERVATIONAL STUDY TO EVALUATE THE IMPACT OF COVID-19 PANDEMIC ON ROUTINE CHILDHOOD IMMUNIZATION AT THE PRIMARY HEALTH CARE CENTERS OF AHMEDABAD CITY.

Background: The COVID-19 pandemic has caused signicant disruptions in the delivery of essential primary health care services including routine immunization services in various countries including India. This temporary interference can lead to soaring of vaccine preventable illnesses. The recent outbreak of Measles worldwide in the last 12 months depicts a clear picture for a secondary health crisis. So, this study brings forth the impact of pandemic on the routine childhood immunizations in primary health care sectors of Ahmedabad, India and developing appropriate strategies to ensure continuity of services. A retrospective observational study wasMethods: carried out at the Urban primary health centers distributed across the seven zones/wards of Ahmedabad region and data of children (under 5 years) registered and vaccinated as per universal immunization Programme schedule were retrieved for a period of four years and divided into two comparison groups as pre covid sessions (1st January 2018 till 31st December 2019) and post covid sessions (1st January 2020 till 31st December 2021). The vaccination trends were compared for these two periods and analyzed. Routine childhood immunizationResults: coverage (among 0 to 5 years old children group) following the pandemic depicted a declining trend with a major set-back recorded in pentavalent and MR vaccination coverage (fall of 40%). Full immunization coverage falls short by 30% (95%+ 2.4% versus 66%+ 3.1%) and it was signicant with p<0.05 and chi square value of 27.7. Barriers to effective routine immunizations have also been enumerated with pandemic related anxiety and difculty in community mobilizations being most common. It is quite evident that the Covid-19 pandemic hasConclusions: been a major backslider for the routine childhood immunizations in India which needs immediate redressal to prevent the outbreaks of vaccine preventable diseases in future.

Minors using Ritalin: obstacles in Primary Health Care surveillance

Objective: to understand how nursing workers from Family Health Strategy teams track children and adolescents using Ritalin. Methods: qualitative study, based on the theoretical references of the essential primary health care attributes. The participants were 27 nurses from the Family Health Strategy. Data collection took place through interviews later submitted to content analysis in the NVivo software. Results: three categories emerged: (Lack of) knowledge about the population who uses Ritalin: co-responsibilities in the process of assistance and difficulties to follow up on the use of Ritalin; Primary care knowledge and know-how in the setting of Ritalin use; The prescription of Ritalin as a demand from schools. Conclusion: the monitoring of children and adolescents who use Ritalin has shortcomings, and primary health care must organize itself to increase and strengthen the care to this population.

Access to primary healthcare Services in Conflict-Affected Fragile States: a subnational descriptive analysis of educational and wealth disparities in Cameroon, Democratic Republic of Congo, Mali, and Nigeria

BackgroundMeasuring and improving equitable access to care is a necessity to achieve universal health coverage. Pre-pandemic estimates showed that most conflict-affected and fragile situations were off-track to meet the Sustainable Development Goals on health and equity by 2030. Yet, there is a paucity of studies examining health inequalities in these settings. This study addresses the literature gap by applying a conflict intensity lens to the analysis of disparities in access to essential Primary Health Care (PHC) services in four conflict-affected fragile states: Cameroon, Democratic Republic of Congo, Mali and Nigeria.MethodsFor each studied country, disparities in geographic and financial access to care were compared across education and wealth strata in areas with differing levels of conflict intensity. The Demographic Health Survey (DHS) and the Uppsala Conflict Data Program were the main sources of information on access to PHC and conflict events, respectively. To define conflict intensity, household clusters were linked to conflict events within a 50-km distance. A cut-off of more than two conflict-related deaths per 100,000 population was used to differentiate medium or high intensity conflict from no or low intensity conflict. We utilized three measures to assess inequalities: an absolute difference, a concentration index, and a multivariate logistic regression coefficient. Each disparity measure was compared based on the intensity of conflict the year the DHS data was collected.ResultsWe found that PHC access varied across subnational regions in the four countries studied; with more prevalent financial than geographic barriers to care. The magnitude of both educational and wealth disparities in access to care was higher with geographic proximity to medium or high intensity conflict. A higher magnitude of wealth rather than educational disparities was also likely to be observed in the four studied contexts. Meanwhile, only Nigeria showed statistically significant interaction between conflict intensity and educational disparities in access to care.ConclusionBoth educational and wealth disparities in access to PHC services can be exacerbated by geographic proximity to organized violence. This paper provides additional evidence that, despite limitations, household surveys can contribute to healthcare assessment in conflict-affected and fragile settings.

Estimating frontline health workforce for primary healthcare service delivery in Bauchi State, Nigeria

ABSTRACT Background In Nigeria, adoption of the primary healthcare approach led to the establishment of numerous primary healthcare facilities, and training of new cadres of community health officers (CHOs), community health extension workers (CHEWs) and junior community health extension workers (JCHEWs). These new groups complemented the work of nurses and midwives. Methods We conducted a workload indicators of staffing needs study in the 20 local governments of Bauchi State, from March 2016 to September 2018, in all 317 ward-level primary healthcare facilities. Results Findings show a total of 128 existing nurses/midwives, a calculated requirement of 402 and a shortage of 274 nurses/midwives. Existing CHOs/CHEWs were 735, a calculated requirement was 948 and a shortage of 213 CHOs/CHEWs. The JCHEWs were 477, a calculated requirement of 481, with a shortage of four JCHEWs. Conclusion Results from this study highlight the unequal distribution of health workers; the abundance of some frontline workers in some communities and dire need of others. We emphasize the need to strengthen health workforce planning to deliver essential primary healthcare services, particularly in rural and remote communities with high levels of vulnerability to diseases.

Strengthening midwifery education through clinical experience: Findings from a qualitative study in Indonesia

BackgroundOne of the Indonesian Government’s strategies to reduce maternal mortality rates has been to place a midwife in every village to provide midwifery care and facilitate essential primary healthcare services. To increase the numbers of midwives, the Indonesian Government began opening midwifery schools. However, Indonesia’s maternal mortality rates remained high. This raises the question of the quality of midwifery education in Indonesia and how this education could be strengthened so that midwifery plays a key role in reducing maternal mortality rates. Aim of the researchThe aim of this study was to identify the barriers and enablers to strengthening midwifery education in Indonesia. MethodsA qualitative descriptive approach and in-depth interviews was the method used with 37 participants from 12 midwifery schools in eight cities situated in six provinces in Indonesia. Indonesian midwives, midwifery lecturers, midwifery students, newly graduated midwives, and obstetricians were interviewed in Bahasa Indonesia. Interviews were transcribed, translated, and thematically analysed following Braun and Clark (2006). FindingsThis article focuses on findings on “midwifery clinical experience”, a theme which contained four sub-themes: “effective hands-on clinical experience”, “theory-practice gap”, “role of the mentor in practice”, and “the system in the clinical environment”. ConclusionThis study highlights barriers to preparing midwifery students for obtaining adequate midwifery knowledge and skills during clinical placement. Quality clinical experience would improve knowledge and skills for better preparedness for students to competently meet their role as midwives, contributing to the strengthening of midwifery education in Indonesia.

Stepping Up Lady Health Worker (LHW) Program and Integrating the Electronic Immunization Record and Tracking System into the Program as a Pilot Project in the Underserved District of Quetta, Balochistan, Pakistan

Pakistan is one of those countries which are continuously struggling with providing essential primary healthcare services, especially in rural and underserved areas. To combat vaccine-preventable diseases, the Expanded Program on Immunization (EPI) has been active since 1978. Additionally, Lady Health Worker Program (LHWP) fits best with district health priorities of mother and child healthcare, family planning and National Immunization Days (NIDs). However, Pakistan faces many challenges. One is significant disparities in allocation and retention of LHW between provinces such as Punjab and Balochistan. Others are the lack of formal training and management of LHWs and a lack of immunization record system leading to vaccine wastage and broken logistics. How other low to middle-income countries (LMIC) are addressing these issues, is evident from Bangladesh and India. The Shasthya Shebika (SS) Program of Bangladesh is unique in having strategies for focused, structured training and retention of community health workers (CHWs) who receive small loans to establish funds, which they use to sell medical products to the community. To tackle the issue of lack of immunization data and vaccination wastage due to inadequate inventory, India has launched an Electronic Vaccination Intelligence Network (eVIN). The Ministry of Health, Pakistan has the potential to start a healthcare project to address the challenges mentioned above. The recommendations include allocation of 500 LHW (lady health workers) in the underserved district of Quetta in Balochistan with the implementation of retention strategies by funding LHW for small businesses, providing a formal educational structure and training and supervision of LHWs for innovative electronic immunization system. LHWs will have access to relevant educational materials and electronic devices such as tablets.

Delivering rehabilitation services during the COVID-19 pandemic: How CAF Physiotherapy is using telehealth to ensure “physical and measurable solutions to maintain and enhance operational readiness, anywhere, anytime”

In response to COVID-19, the Canadian Armed Forces (CAF) activated Operation LASER, a force health protection strategy to preserve its operational capabilities. Operation LASER resulted in a quarantine of healthy CAF members to minimize the risk of contraction and transmission of COVID-19. The physical distancing inherent to quarantine challenged Canadian Forces Health Services to adapt its health care delivery. CAF Physiotherapy responded by integrating telehealth to maintain provision of essential primary health care services. A modified After-Action Report was used to capture preliminary telehealth experiences of Defence Team physiotherapists since the activation of Operation LASER. To date, seven Physiotherapy Officers and six civilian physiotherapists, have delivered a total of 196 assessments lasting an average of 45 minutes, and a total of 765 follow-ups lasting an average of 25 minutes. Most respondents reported no previous experience or formal training providing telehealth. Most respondents reported delivering telehealth by telephone and acknowledged challenges, including non-standardized patient instructions, inadequate equipment, unsuitable environments, and limited patient feedback. To maximize the quality of telehealth delivery, respondents recommended standardizing patient instructions, establishing suitable work environments, and using telephone headsets, videoconferencing, and digital exercise software. These recommendations are an investment in the capacity of CAF Physiotherapy to maintain rehabilitation services in the post-COVID-19 environment.

Delivering rehabilitation services during the COVID-19 pandemic: How CAF Physiotherapy is using telehealth to ensure “physical and measurable solutions to maintain and enhance operational readiness, anywhere, anytime”

In response to COVID-19, the Canadian Armed Forces (CAF) activated Operation LASER, a force health protection strategy to preserve its operational capabilities. Operation LASER resulted in a quarantine of healthy CAF members to minimize the risk of contraction and transmission of COVID-19. The physical distancing inherent to quarantine challenged Canadian Forces Health Services to adapt its health care delivery. CAF Physiotherapy responded by integrating telehealth to maintain provision of essential primary health care services. A modified After-Action Report was used to capture preliminary telehealth experiences of Defence Team physiotherapists since the activation of Operation LASER. To date, seven Physiotherapy Officers and six civilian physiotherapists, have delivered a total of 196 assessments lasting an average of 45 minutes, and a total of 765 follow-ups lasting an average of 25 minutes. Most respondents reported no previous experience or formal training providing telehealth. Most respondents reported delivering telehealth by telephone and acknowledged challenges, including non-standardized patient instructions, inadequate equipment, unsuitable environments, and limited patient feedback. To maximize the quality of telehealth delivery, respondents recommended standardizing patient instructions, establishing suitable work environments, and using telephone headsets, videoconferencing, and digital exercise software. These recommendations are an investment in the capacity of CAF Physiotherapy to maintain rehabilitation services in the post-COVID-19 environment.

Harm reduction in an emergency response to homelessness during South Africa\u2019s COVID-19 lockdown

BackgroundCaledonian Stadium, the main mass temporary shelter for homeless people in the City of Tshwane, was created as a local response to the imperatives of the novel coronavirus disease (COVID-19) National State of Disaster lockdown in South Africa. This is a case study of the coordinated emergency healthcare response provided by the University of Pretoria’s Department of Family Medicine between 24 March and 6 April 2020.MethodsThis study uses a narrative approach to restory situated, transient, partial and provisional knowledge. Analysis is based on documented data and iteratively triangulated interviews on the operational experiences of selected healthcare first responders directly involved in the shelter.ResultsThe impending lockdown generated intense interactions by UP-DFM to prepare for the provision of COVID-19 and essential generalist primary with partners involved in the Community Oriented Substance Use Programme (COSUP). With approximately 2000 people at the shelter at its peak, the numbers exceeded expectations. Throughout, while government officials tried to secure bedding, food and toilets, the shelter was poorly equipped and without onsite management. The COSUP clinical team prioritised opioid substitution therapy using methadone and COVID-19 screening over generalist healthcare to manage withdrawal and contain tension and anxiety. COSUP and its partners helped the city plan and implement the safe re-sheltering of all Caledonian residents.ConclusionThe Caledonian shelter is an account of organisational resilience in the face of homelessness and substance use emergencies triggered by lockdown. Through community-oriented, bottom-up self-organisation, a clinically led team navigated a response to the immediate needs of people who are homeless and/or use drugs that evolved into a more sustainable intervention. Key lessons learnt were the importance of communicating with people directly affected by emergencies, the value of using methadone to reduce harms during emergencies and the imperative of including OST in essential primary healthcare.

Recommendations to strengthen primary health care in BrazilRecomendaciones para el fortalecimiento de la atención primaria de salud en Brasil

RESUMOObjetivo.Elaborar recomendações estratégicas para fortalecer a atenção primária à saúde (APS) no Sistema Único de Saúde (SUS) no Brasil a partir da consulta a especialistas.Método.Este estudo qualitativo, desenvolvido de março a agosto de 2018, foi composto pela aplicação de questionário aberto e construção de consenso entre 20 participantes representativos das cinco macrorregiões brasileiras, selecionados a partir do critério de reconhecida experiência profissional na APS. Os participantes responderam 20 perguntas abertas em questionário on-line elaborado pelos pesquisadores. Os achados foram sistematizados na forma de recomendações, submetidas a avaliação de prioridade pelo grupo de especialistas utilizando a metodologia Delphi em rodada única. As recomendações finais foram discutidas em oficina presencial.Resultados.Dos 20 especialistas, 18 responderam ao questionário aberto, gerando 84 temas, sistematizados em 44 propostas. Após avaliação, foram elaboradas 20 recomendações, que enfatizaram a expansão da Estratégia Saúde da Família; a ampliação do acesso à APS; a formação de profissionais para atuação multidisciplinar na APS; a alocação de tecnologias para garantir resolutividade na APS; o aprimoramento da regulação/coordenação de serviços para fortalecer a APS como elemento estruturante do SUS; estrutura e financiamento; recursos humanos, provimento de profissionais, apoio e estímulo às equipes; produção e divulgação de conhecimento; transparência nas ações da APS; e o papel mediador da APS no sistema de saúde.Conclusões.Os achados reforçam a ESF como melhor modelo para garantir uma APS forte no SUS, aliada a políticas que priorizem os atributos essenciais da APS, sobretudo pela inovação em tecnologias assistenciais, de gestão e de comunicação.

Continuum of care for non-communicable diseases during COVID-19 pandemic in rural India: A mixed methods study.

Background:COVID-19 pandemic has resulted in disruption to routine health services delivery as strict lockdowns were implemented in India and health workforce redeployed for COVID-19 focused responses. We assess the perceptions about COVID-19, the impact of the lockdown on access to health services and continuum of care for Non-communicable diseases (NCDs) among a cohort of adults in rural India.Methodology:Since 2018, we have been following up a cohort of persons with non-communicable diseases in a high NCD burden region in Srikakulam District of Andhra Pradesh under the STOP CKDu study. We conducted this mixed methods study, administered through a structured telephonic questionnaire and interview to determine the awareness, perceptions and their compliance to ongoing treatment schedules.Results:Overall, 68% of the participants exhibited adequate knowledge of symptoms of COVID-19, while 43% were not aware of the mode of transmission of the virus. In all, 822 (36.1%) participants reported at least one NCD condition. Among them, 115 (14%) missed their follow-up visit, 110 (13.4%) reported facing challenges in medication procurement and 11.6% either developed new complaints or experienced worsening of pre-existing symptoms. A total of 233 (28.5%) used a telemedicine facility and took telephonic advice from (private) physicians. As the access to medicines was restricted due to the lockdown, majority of the respondents were depending on rural medical practitioners (RMPs) for the procurement of medication.Conclusion:Our finding implies the need for the future guidelines on adaptation of telehealth approaches within health systems to maintain the continuum of care, digital health tools to facilitate the patient's appointments including virtual follow-up visits for those with NCDs coupled with regular engagement by frontline healthcare workers at the local levels, evidence informed public health messaging taking into consideration the social and behavioural aspect and uninterrupted essential primary healthcare services.

Lebanon's essential health care benefit package: A gateway for universal health coverage.

Recent years have demonstrated the resurgence of a global commitment toward universal health coverage (UHC). The first step toward developing a sustainable primary health care (PHC)-oriented UHC program is the creation and service delivery of an explicit essential health care benefit package (EHCP). This paper aims to describe the development, features, and progress of the EHCP in Lebanon, in addition to outlining barriers, facilitators, and next steps. Building on the investments made in the PHC network, the ministry of public health in Lebanon piloted an essential PHC package program in 2016 targeting vulnerable Lebanese and was able to enroll over 87% of targeted population to date. In order to scale up the EHCP to the national level and achieve UHC, modifications need to be made to the package entitlements, provider payment mechanisms, and implementation arrangements. The paper also notes that further advocacy and lobbying are needed in order to place UHC and the EHCP on the national agenda and stimulate public demand.

Research, Practice, and Policy Strategies to Ensure Healthy Development for All Youths.

The Grand Challenges for Social Work introduced by the American Academy of Social Work and Social Welfare (AASWSW) bring a variety of opportunities for advancement throughout health social work fields. Although each challenge addresses a unique large-scale aim for the profession, they are all able to inform aspects of health and related social work roles across varied levels of practice. The challenge to ensure healthy development for all youths is rooted in essential primary health care through which family-centered prevention efforts can be introduced and implemented (AASWSW, 2017). From this perspective, health care settings afford several advantages and are therefore well suited to ensure healthy development. Fundamentally, primary health care settings are able to reach a sizable portion of the population inclusive of diverse socioeconomic factors starting in infancy and continuing through the life span (AASWSW, 2017; Leslie et al., 2016). Initial positive connections forged between families and health care providers can help to establish a basis for ongoing involvement with primary care services while opening the door to a range of prevention programs (Leslie et al., 2016). Early engagement in health care settings has been shown to increase the likelihood of parents and children participating in family-centered prevention programs throughout development (AASWSW, 2017; Piotrowski, Talavera, & Mayer, 2009). Prevention programs of this nature have resulted in positive outcomes among a host of health and behavior indicators for children (Hawkins et al., 2015; Leslie et al., 2016), beneficial effects on parenting (Berge, Law, Johnson, & Wells, 2010; Perrin, Sheldrick, McMenamy, Henson, & Carter, 2014), and implications for the improvement of broader population health (Morris et al., 2017; Patlak, 2014).

Evaluation of Primary Health Care performance in Florianopolis, Santa Catarina, Brazil, 2012: a cross-sectional population-based study.

to evaluate the performance of Primary Health Care (PHC) in Florianopolis, SC, Brazil. this was a cross-sectional population-based study with adults living in the catchment areas of the Health Centers (HC) located in the Northern Health District of Florianópolis in 2012; the Primary Care Assessment Tool (PCATool-Brazil) was applied do assess the presence and extent of PHC characteristics. of the 598 interviewees, 68,4% reported that they considered PHC centers to be their usual source of care; while the usage subdimension of the First Contact Access characteristic was the best evaluated (8.4; 95%CI 8.2;8.6), the service delivery subdimension of the First Contact Access/subdimension accessibility was the worst evaluated (3.5; 95%CI 3.3; 3.6); four (36.6%) of the eleven PHC centers evaluated had a high overall and essential PHC score, although their overall mean score was low (6.4; 95%CI 6.2;6.5). considering the PHC model evaluated by PCATool-Brazil, PHC services need to be improved, especially with regard to their process and structure components.