Implementation Of Primary Health Care Research Articles

Hypertension cascade across three healthcare systems and in relation to the level of implementation of the integrated care package of hypertension

Introduction: Primary health care (PHC) systems across the globe are struggling to produce an effective response to the rising burden of disease related to Type 2 Diabetes (T2D). However, effective T2D care at the PHC level – the ‘Integrated Care Package (ICP)’– exists and is cost-effective. Further, there is evidence that this integrated care package ((1) structure) leads to improved care processes (2), to health care responsive to people’s needs and eventually to better health outcomes (3). There is however a clear need for an assessment framework to enable countries to evaluate their progress towards integrated care for T2D.
 We aim to test an assessment framework incorporating these 3 elements: (1) a tool to assess the degree to which the T2D care provided corresponds to the ICP for T2D (structure); (2) cascades-of-care to visualize and detect the ‘leakages’ at each separate step of the care continuum (process and outcomes of T2D care); and (3) a contextualization of (1) and (2) in order to explain why the implementation of specific ICP elements has or has not led to the expected outcomes. This framework will be tested in 3 countries with different PHC approaches, namely Slovenia, Belgium and Cambodia.
 Methods: A mixed methods design is used. First, information about the level of ICP implementation is collected using the ICP Grid at the health care facility level. Secondly, patient level data is used to build de T2D cascades-of-care: we rely on representative survey data (5000 individuals) in Cambodia, on health insurance (+ laboratory) data in Belgium and routine data in Slovenia. Where feasible, we used ICP scores as explanatory variables explaining the drops in the cascade. Thirdly, expert consultations and stakeholder interviews were used to contextualize the findings.
 Results: The ICP grid scores showed considerable variations in the implementation of the ICP for patients with T2D between Belgium, Slovenia, and Cambodia – with Slovenia consistently reporting the highest scores. However, important in-country variations were observed for Belgium and Cambodia indicating that specific initiatives have resulted in higher levels of integrated care. In terms of T2D care process and outcomes, the country cascades-of-care display similar profiles with the biggest drops at the ‘diagnosis’ and ‘under control’-bars. The qualitative data on the health system clearly demonstrate that the context can hamper (1) the construction of the cascades (i.e. in Belgium and Cambodia due an absence of a routine monitoring system) and (2) the linking of the ICP grid data with the cascade-of-care data (i.e. in Cambodia where the private sector takes up a large proportion of T2D care).
 Conclusions: The developed framework offers a promising strategy to assess (1) the progress made in ICP implementation in PHC for T2D as well as (2) its impact on the T2D care process and outcomes. As such, the framework offers policy makers and stakeholders a tool to monitor T2D care and adapt specific elements where required. The study, however, also indicated severe challenges in collecting the required data which also limited the cross-country comparability of the produced outcomes.

Clinical Integration of Digital Patient-Reported Outcome Measures in Primary Health Care for Chronic Disease Management: Protocol for a Systematic Review.

Health measurement guides policies and health care decisions are necessary to describe and attain the quintuple aim of improving patient experience, population health, care team well-being, health care costs, and equity. In the primary care setting, patient-reported outcome measurement allows outcome comparisons within and across settings and helps improve the clinical management of patients. However, these digital patient-reported outcome measures (PROMs) are still not adapted to the clinical context of primary health care, which is an indication of the complexity of integrating these tools in this context. We must then gather evidence of their impact on chronic disease management in primary health care and understand the characteristics of effective implementation. We will conduct a systematic review to identify and assess the impact of electronic PROMs (ePROMs) implementation in primary health care for chronic disease management. Our specific objectives are to (1) determine the impact of ePROMs in primary health care for chronic disease management and (2) compare and contrast characteristics of effective ePROMs' implementation strategies. We will conduct a systematic review of the literature in accordance with the guidelines of the Cochrane Methods Group and in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for its reporting. A specific search strategy was developed for relevant databases to identify studies. Two reviewers will independently apply the inclusion criteria using full texts and will extract the data. We will use a 2-phase sequential mixed methods synthesis design by conducting a qualitative synthesis first, and use its results to perform a quantitative synthesis. This study was initiated in June 2022 by assembling the research team and the knowledge transfer committee. The preliminary search strategy will be developed and completed in September 2022. The main search strategy, data collection, study selection, and application of inclusion criteria were completed between October and December 2022. Results from this review will help support implementation efforts to accelerate innovations and digital adoption for primary health care and will be relevant for improving clinical management of chronic diseases and health care services and policies. PROSPERO International Prospective Register of Systematic Reviews CRD42022333513; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=333513. DERR1-10.2196/48155.

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

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

Beyond Astana: Configuring the World Health Organization Collaborating Centres for primary health care.

The understanding of primary health care (PHC) has evolved significantly, evident in key World Health Organization (WHO) reports, promoting PHC as a means for health for all, identifying key health systems reforms and focusing on health care experience. This study explores the WHO's current framing of PHC, and its configuration of WHO Collaborating Centres (WHOCCs) on PHC using the data available on the WHOCCs Portal. We analysed the following variables: title, institutions, location, economy, date of mandate, objectives, subject, and activity. There were 13 WHOCCs on PHC, nine based in North America and Europe, and none in Africa. Only three were in Low- and Middle-Income Countries (LMICs). The WHOCCs on PHC focused on three broad subjects: five focused on human resources for health (HRH); four on health systems research (HSR) and development, with an emphasis on family medicine; four on PHC systems. Activities were related to training and education, provision of technical advice, and research. Support to WHO on implementation of PHC was an activity for two LMIC based WHOCCs. The current configuration of WHOCCs on PHC is consistent with the evolution of PHC and its intersection with Universal Health Coverage and the Sustainable Development Goals. The increasing attention to people-centred health systems aligns with WHO's commitment to PHC in all health systems, though this needs special interpretation for LMICs with their limited HRH. There has been a shift in subjects from HRH towards primary care and family medicine, and HSR highlighting primary care and PHC systems. The concern is an absence of WHOCCs in the Africa and Latin and South Americas, and under-representation in LMICs. Designating more institutions from the South with expertise in PHC is necessary to address the challenges post-Astana.

Healthcare workers' perceptions and experiences of primary healthcare integration: a scoping review of qualitative evidence.

Primary healthcare (PHC) integration has been promoted globally as a tool for health sector reform and universal health coverage (UHC), especially in low-resource settings. However, for a range of reasons, implementation and impact remain variable. PHC integration, at its simplest, can be considered a way of delivering PHC services together that sometimes have been delivered as a series of separate or 'vertical' health programmes. Healthcare workers are known to shape the success of implementing reform interventions. Understanding healthcare worker perceptions and experiences of PHC integration can therefore provide insights into the role healthcare workers play in shaping implementation efforts and the impact of PHC integration. However, the heterogeneity of the evidence base complicates our understanding of their role in shaping the implementation, delivery, and impact of PHC integration, and the role of contextual factors influencing their responses. To map the qualitative literature on healthcare workers' perceptions and experiences of PHC integration to characterise the evidence base, with a view to better inform future syntheses on the topic. We used standard, extensive Cochrane search methods. The latest search date was 28 July 2020. We did not search for grey literature due to the many published records identified. We included studies with qualitative and mixed methods designs that reported on healthcare worker perceptions and experiences of PHC integration from any country. We excluded settings other than PHC and community-based health care, participants other than healthcare workers, and interventions broader than healthcare services. We used translation support from colleagues and Google Translate software to screen non-English records. Where translation was not feasible we categorised these records as studies awaiting classification. For data extraction, we used a customised data extraction form containing items developed using inductive and deductive approaches. We performed independent extraction in duplicate for a sample on 10% of studies allowed for sufficient agreement to be reached between review authors. We analysed extracted data quantitatively by counting the number of studies per indicator and converting these into proportions with additional qualitative descriptive information. Indicators included descriptions of study methods, country setting, intervention type, scope and strategies, implementing healthcare workers, and client target population. The review included 184 studies for analysis based on 191 included papers. Most studies were published in the last 12 years, with a sharp increase in the last five years. Studies mostly employed methods with cross-sectional qualitative design (mainly interviews and focus group discussions), and few used longitudinal or ethnographic (or both) designs. Studies covered 37 countries, with close to an even split in the proportions of high-income countries (HICs) and low- and middle-income countries (LMICs). There were gaps in the geographical spread for both HICs and LMICs and some countries were more dominant, such as the USA for HICs, South Africa for middle-income countries, and Uganda for low-income countries. Methods were mainly cross-sectional observational studies with few longitudinal studies. A minority of studies used an analytical conceptual model to guide the design, implementation, and evaluation of the integration study. The main finding was the various levels of diversity found in the evidence base on PHC integration studies that examined healthcare workers' perceptions and experiences. The review identified six different configurations of health service streams that were being integrated and these were categorised as: mental and behavioural health; HIV, tuberculosis (TB) and sexual reproductive health; maternal, women, and child health; non-communicable diseases; and two broader categories, namely general PHC services, and allied and specialised services. Within the health streams, the review mapped the scope of the interventions as full or partial integration. The review mapped the use of three different integration strategies and categorised these as horizontal integration, service expansion, and service linkage strategies. The wide range of healthcare workers who participated in the implementation of integration interventions was mapped and these included policymakers, senior managers, middle and frontline managers, clinicians, allied healthcare professionals, lay healthcare workers, and health system support staff. We mapped the range of client target populations. This scoping review provides a systematic, descriptive overview of the heterogeneity in qualitative literature on healthcare workers' perceptions and experience of PHC integration, pointing to diversity with regard to country settings; study types; client populations; healthcare worker populations; and intervention focus, scope, and strategies. It would be important for researchers and decision-makers to understand how the diversity in PHC integration intervention design, implementation, and context may influence how healthcare workers shape PHC integration impact. The classification of studies on the various dimensions (e.g. integration focus, scope, strategy, and type of healthcare workers and client populations) can help researchers to navigate the way the literature varies and for specifying potential questions for future qualitative evidence syntheses.

Evaluating the Primary Health Care implementation strategy in Brazil and its effects on child mortality

Evaluating the Primary Health Care implementation strategy in Brazil and its effects on child mortality

Influence of contextual factors on strengthening key strategic and operational levers of primary healthcare to achieve universal health coverage: a protocol for a realist review

IntroductionExisting scoping reviews on the link between primary healthcare (PHC) and universal health coverage (UHC) have not sufficiently addressed the underlying causal mechanisms in which key strategic and operational PHC...

Strengthened primary health care for universal health coverage through improved community diagnosis and management of pneumonia in Zimbabwe

Pneumonia is the world’s leading infectious killer, claiming the lives of an estimated 2.5 million including more than 670,000 children under five years and 1.2 million adults in 2019 alone. Caused largely by viruses, and bacteria, COVID-19 also increased the pneumonia burden, while environmental factors, poor hygiene, sanitation and underlying conditions including malnutrition predispose. The latter translates into a considerable pneumonia burden that is preventable, provided the requisite provisions are made for community-level protection such as environmental management, water, sanitation and hygiene; and key persons are informed and educated on preventive and therapeutic measures, especially what to look for and what to do at home while seeking medical attention. Irked by the high numbers of under-five deaths against a background of limited case management caused by the system-wide collapse of the health services in the country, we sought to utilize the opportunity offered by world pneumonia day 2022 to go down to the community and elicit both the disease burden and strategies to address pneumonia that can be applied within the home and community. We also wanted to hear from the community their experiences with and functionality of the referral system. This paper presents the findings, challenges and suggestions for improving primary healthcare implementation to address the current high morbidity and mortality attributable to pneumonia. We found the Goromonzi community to be literate in many health issues but need more information and training to better manage pneumonia. They were knowledgeable about pneumonia, tuberculosis, and the recent COVID-19 through their interactions with the local clinic staff, the media, and interpersonal communication. Some were members of the health center committee or were village health workers or local leaders. We had limitations of resources and time for a detailed study, but conclude that the community visited had a sound understanding of health, primary health care and pneumonia, but lacked the comprehensive education and support to effectively manage pneumonia at home. More work needs to be done to quantify the pneumonia burden, the contribution of each intervention, (environment, vaccination, exclusive breastfeeding, safe water, sanitation, hand hygiene, reduced smoke and case management) the benefit of home and community management alongside an effective referral chain.

A Conceptual Model to Strengthen Integrated Management of HIV and NCDs among NIMART-Trained Nurses in Limpopo Province, South Africa

Integrated management of human immune deficiency virus (HIV) and non-communicable diseases (NCDs) in primary health care facilities remains a challenge. Despite research that has been conducted in South Africa, it is evident that in Limpopo Province there are slits in the implementation thereof. There is a need to develop a conceptual model to guide in strengthening the clinical competence of nurse-initiated management of antiretroviral therapy (NIMART)-trained nurses to implement the integrated management of HIV and NCDs to improve clinical outcomes of patients with the dual burden of diseases in Limpopo Province, South Africa. This study aimed to develop a conceptual model to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses to improve clinical outcomes of patients with the dual burden of communicable and non-communicable diseases in Limpopo Province, South Africa. An explanatory, sequential, mixed-methods research design was followed. Data were collected from patient records and the skills audit of 25 Primary Health Care (PHC) facilities and from 28 NIMART trained nurses. Donabedian's structure process outcome model and Miller's pyramid of clinical competence provided a foundation in the development of the conceptual model. The study revealed a need to develop a conceptual model to strengthen the implementation of integrated HIV and NCDs implementation in PHC, as evidenced by differences in the management of HIV and NCDs. Conclusion: The study findings were conceptualised to describe and develop a model needed to strengthen the implementation of integrated management of HIV and NCDs amongst NIMART nurses working in PHC facilities. The study was limited to Limpopo Province; the model must be implemented in conjunction with the available frameworks to achieve better clinical outcomes.

Ward Health System in Nigeria: An Assessment of the Awareness and Role of Community Members

Ward Health System is an implementation strategy of Primary Health Care in Nigeria. It was introduced in 2001 and is aimed at promoting community mobilization and participation in health care, thereby enhancing an effective, efficient and sustainable health care system. This study assessed the awareness and role of community members in the Ward Health System. A semi-structured interviewer administered questionnaire was used to conduct an exit poll of 240 Primary Health Care facility clients. Approximately 12%, 13% and 29% of the respondents had ever heard of the terms Ward Health System, Village Development Committee and Ward Development committee respectively, while up to 73% have no idea of the role of any of the stakeholders. Inadequate knowledge and involvement of the community members in the Ward Health System constitutes a big challenge to the effective and efficient implementation of Primary Health Care in Nigeria. Efforts towards community education on Ward Health System should be intensified.

Implementation considerations for non-communicable disease-related integration in primary health care: a rapid review of qualitative evidence

BackgroundIntegrated delivery of primary health care (PHC) services is a health reform recommended for achieving ambitious targets of the Sustainable Development Goals and Universal Health Coverage, responding to growing challenges of managing non-communicable and multimorbidity. However, more evidence is needed on effective implementation of PHC integration in different country settings.ObjectiveThis rapid review synthesized qualitative evidence on implementation factors affecting integration of non-communicable disease (NCD) into PHC, from the perspective of implementers. The review contributes evidence to inform the World Health Organizations’ guidance on integration of NCD control and prevention to strengthen health systems.MethodThe review was guided by standard methods for conducting rapid systematic reviews. Data analysis was guided by the SURE and WHO health system building blocks frameworks. We used Confidence in the Evidence of Reviews of Qualitative Research (GRADE-CERQual) to assess the confidence of the main findings.ResultsThe review identified 81 records eligible for inclusion, from 595 records screened. We sampled 20 studies for analysis (including 3 from expert recommendations). Studies covered a wide range of countries (27 countries from 6 continents), the majority from low-and middle-income countries (LMICs), with a diverse set of NCD-related PHC integration combinations and implementation strategies. The main findings were categorised into three overarching themes and several sub-themes. These are, A: Policy alignment and governance, B: Health systems readiness, intervention compatibility and leadership, and C: Human resource management, development, and support. The three overarching findings were assessed as each having a moderate level of confidence.ConclusionThe review findings present insights on how health workers responses may be shaped by the complex interaction of individual, social, and organizational factors that may be specific to the context of the intervention, the importance of cross-cutting influences such as policy alignment, supportive leadership and health systems constraints, knowledge that can inform the development of future implementation strategies and implementation research.

Challenges of a Program for Public Mental Health Education with an Emphasis on Self-Care in Primary Health Care: A Qualitative Study

Introduction: Mental health education aims to increase mental health literacy plays a crucial role in community members mental health, but its implementation in primary health care faces obstacles and problems. Therefore, this study was conducted to explain the challenges of the public mental health education program with an emphasis on self-care in Iran primary health care.
 Methods: The present study was a qualitative study with a content analysis approach. Research sample consisted of 20 stakeholders through purposive sampling with maximum diversity. This study was conducted in Tehran and Alborz, Iran. Data were collected through in-depth and semi-structured interviews and analyzed by Graneheim and Lundman approach.
 Results: By analyzing the data, the challenges were categorized into six main themes and 15 categories. The six main themes included educational challenges, Inefficiency of the Educational Method, Unsuitable intersect oral collaboration, infrastructural challenges, inadequate resources and barriers to participation in education.
 Conclusions: Considering the key role of mental health education in promoting mental health literacy and prioritizing prevention in the field of mental health in primary health care, especially achieving universal health coverage; Given multidimensionality challenges and obstacles, reform and adoption of appropriate implementation methods using mental health experts seem necessary. Future research and policies could explore ways to optimize program implementation in primary health care.

Situational analysis of the smoking cessation program in a Brazilian capital during the COVID-19 pandemic.

Smoking is a public health problem associated with high morbimortality. Smoking cessation services, although effective, have limited reach and have been compromised by the pandemic. This study aimed to analyze the care for smokers in João Pessoa (PB), Brazil, during the COVID-19 pandemic. A descriptive, exploratory, and quantitative study was conducted in two phases: a survey of health indicators and an evaluation of sociodemographic profiles of professionals and service clients during the study years. Seven professionals, smoking group coordinators, and 20 clients participated in the research. The results showed low program coverage, with a declining number of smokers treated during the pandemic, down from 419 in 2019 to 129 in 2020. Interviews identified the program's positive aspects and limitations, good effectiveness, and low access, especially in primary health care. Tobacco consumption and risk reduction strategies during the COVID-19 pandemic originated from services and professionals involved. We can conclude that the National Tobacco Control Program has an incipient implementation in primary health care in this region and that the number of services offered was reduced during the pandemic, decreasing demand and actions.

Análise situacional do programa de cessação tabágica em uma capital brasileira na pandemia da COVID-19

Abstract Smoking is a public health problem associated with high morbimortality. Smoking cessation services, although effective, have limited reach and have been compromised by the pandemic. This study aimed to analyze the care for smokers in João Pessoa (PB), Brazil, during the COVID-19 pandemic. A descriptive, exploratory, and quantitative study was conducted in two phases: a survey of health indicators and an evaluation of sociodemographic profiles of professionals and service clients during the study years. Seven professionals, smoking group coordinators, and 20 clients participated in the research. The results showed low program coverage, with a declining number of smokers treated during the pandemic, down from 419 in 2019 to 129 in 2020. Interviews identified the program’s positive aspects and limitations, good effectiveness, and low access, especially in primary health care. Tobacco consumption and risk reduction strategies during the COVID-19 pandemic originated from services and professionals involved. We can conclude that the National Tobacco Control Program has an incipient implementation in primary health care in this region and that the number of services offered was reduced during the pandemic, decreasing demand and actions.

Primary care in supplementary health: assessment of costs in the care of older adult patients with heart diseases.

to identify whether implementing a supplementary Primary Health Care (PHC) system makes it possible to reduce care costs for older adults with heart diseases. a retrospective cohort of 223 patients with heart disease aged ≥ 60 years. Data were obtained from medical records and cost databases, assessed for a period of one year before and after PHC implementation. The results were expressed as mean absolute frequencies for number of hospitalizations and as average annual expenses expressed in dollars (US$) in relation to cost data. there was a reduction in hospitalization expenses after implementing supplementary PHC (p=0.01) and a decrease in the frequency of hospitalizations for the entire sample (p=0.006). There was a reduction in the frequency of consultations at the Emergency Room among frail older adults (p=0.011). there was a reduction in hospitalization costs and frequency of visits to the Emergency Room after supplementary PHC.

Investigação sobre Atenção Primária durante a pandemia em territórios vulneráveis de Campinas, São Paulo e Rio de Janeiro, Brasil

Abstract The COVID-19 pandemic found favourable conditions to spread in Brazil. A lack of coordinated action by the federal government, together with already weak Primary Health Care (PHC) had consequences for workers and users. This study examined PHC management and work process in response the COVID-19 pandemic in three municipalities, in view of the history of how PHC was set up, its relationship with the national public health system (SUS), and PHC and social activism in vulnerable territories, from the perceptions of users and workers. The study included a literature search, participant observation and 97 in-depth interviews of PHC workers and users. The results were organised into four areas: PHC implementation and management in the municipalities; the PHC work process; workers’ and users’ perceptions of PHC and the SUS; and territories, organised groups and social activism. Workers faced an environment of fear, overwork and changes in their work process, none of which prevented them from persisting and reinventing their practice. Users encountered barriers to access and difficulties in complying with public health measures, but the study found experiences of organised groups that emerged as means of coping with the pandemic.

Subthreshold Depression: A Systematic Review and Network Meta-Analysis of Non-Pharmacological Interventions.

Subthreshold depression (StD) is considered to be the "precursor" stage of major depressive disorder (MDD), which could cause higher risk of suicide, disease burden and functional impairment. There have been various non-pharmacological interventions for StD. However, the comparison of their effectiveness still lacks sufficient evidence. We performed a systematic review and network meta-analysis to evaluate and rank the efficacy of multiple non-pharmacological interventions targeting StD. We conducted a thorough search across various databases including PubMed, Medline, Embase, Web of Science and PsycINFO from inception to December 2022. All included studies were randomized controlled trials (RCTs) of non-pharmacological interventions for patients with StD compared with control group (CG). Several universal scales for measuring depression severity were used as efficacy outcomes. The surface under the cumulative ranking curve (SUCRA) was used to separately rank each intervention using the "Stata 17.0" software. A total of thirty-six trials were included, involving twenty-eight interventions and 7417 participants. The research found that most non-pharmacological interventions were superior to controls for StD. In each outcome evaluation by different scales for measuring depression, psychotherapy always ranked first in terms of treatment effectiveness, especially Problem-solving Therapy (PST), Behavioral Activation Therapy (BAT), Cognitive Behavioral Therapy (CBT)/Internet-based CBT (I-CBT)/Telephone-based CBT (T-CBT). Since different groups could not be directly compared, the total optimal intervention could not be determined. Here, we show that psychotherapy may be the better choice for the treatment of StD. This study provides some evidence on StD management selection for clinical workers. However, to establish its intervention effect more conclusively, the content, format and operators of psychotherapy still require extensive exploration to conduct more effective, convenient and cost-effective implementation in primary healthcare. Notably, further research is also urgently needed to find the biological and neural mechanisms of StD by examining whether psychotherapy alters neuroplasticity in patients with StD.

Strategy for Strengthening Implementation of The Posyandu Program in theWork Area of Uptd Puskesmas Ii Health Department of Denpasar Utara District

The Sustainable Development Goals (SDGs) at ensuring a healthy lifeand promote well-being for all at all ages. In order to increase public access To quality health services, the World Health Organization introduced Primary Health Care. In Indonesia, the implementation of Primary Health Care was carried out based on community and community participation, namely Posyandu in every sub-district and village areas. This study at explore internal and external factors and to analyze strategies in the implementation of the Posyandu program. The research design used were qualitative and quantitative approaches where purposive sampling was applied to gathered the research subjects. The data was collected through a questionnaire, and then an Focus Group Discussion will be conducted. The data analysis used was theStrengths, Weaknesses, Opportunities, Threatsanalysis which followed by the Quantitative Strategic Planning Matrix analysis. The results showed that the internal and external position factors were in a strong position in the range of 3.00-4.00 which placed the implementation of posyandu in cell I in the internal and external matrix. The alternative strategy that gets the highest score is strategy 1 with a Total Attractive Score of 7.47. The conclusions from the results of the data analysis were: the dominant internal factor as a strength was the availability of cadres during the implementation of Posyandu should consist at least with 5 people, while the weakness found was that they did not have standard operating procedure for the implementation of Posyandu. External factors as the biggest challenges were choosing other health services, while as an opportunity was the policy of the central government by including Posyandu as one of the criteria for Puskesmas to be able to foster active Posyandu. The main priority strategy was to garner support from the business world and traditional leaders. The implication of this research was to socialize it to the business world and traditional leaders related to the Posyandu program to further garner support and cooperation.

Capacity issues in primary health care implementation: examples from Ghana

PurposeResources as well as the capacity to employ them judiciously may well be the key to the attainment of the SDGs and other related health goals through primary health care (PHC). Within this PHC framework, however, the source of resources for PHC as well as the systems for managing these associated resources remain unclear, complex and lack substantive integration systems of implementing ministries, departments and agencies (both local and international) in Ghana. These issues are addressed by this study.Design/methodology/approachThe framework approach to thematic analysis was used to analyse qualitative data collected from key PHC managers in Ghana selected purposively from the national, regional and district levels. Data were collected through in-depth interviews specially designed in line with the study objectives. The study was also governed by the Noguchi Memorial Institute for Medical Research which provided ethical clearance for the study.FindingsAs per Alma Ata's recommendation, PHC in its purest form is a resource dense activity with far-reaching implications on individuals and communities. Without adequate resources, PHC implementation remained merely on paper. Findings show that the key capacities required for PHC implementation were finance, human resource, technology and logistics. While significant cases of shortages and inadequacies were evident, management and maintenance of these capacities appeared to be another significant determinant of PHC implementation. Additionally, the poor allocation, distribution and sustainability of these capacities had a negative effect on PHC outcomes with more resources being concentrated in capital towns than in rural areas.Research limitations/implicationsThis study has significant implications on the way PHC is seen, implemented and assessed not in Ghana but in other developing countries. In addition to examining the nature and extent of capacities required for PHC implementation, it gives significant pathways on how limited resources, when properly managed, may catalyse the attainment of the PHC goals. Subsequently, PHC implementation will profit from stakeholder attention and further research into practical ways of ensuring efficiency in the allocation, distribution and management of resources especially considering the limited resources available and the budding constraints associated with the dependency on external stakeholders for PHC implementation.Originality/valueThis study is part of a series on PHC implementation in Ghana. Quite apart from putting core implementation issues into perspective, it presents first-hand information on Ghana's PHC implementation journey and is thus relevant for researchers, students, practitioners and the wider public.

Models of care for low back pain patients in primary healthcare: a scoping review protocol

IntroductionLow back pain (LBP) is the most prevalent musculoskeletal condition worldwide and it is responsible for high healthcare costs and resources consumption. It represents a challenge for primary care services...