Medicine For Primary Health Care Research Articles

Relationship between orthodox and traditional medical practitioners in the transmission of traditional medical knowledge in Nigeria.

The problem of incomplete transmission of traditional medical knowledge to the younger generation is of concern to information professionals especially in developing countries where most rural communities depend on traditional medicine for primary health care. The purpose of this study was to investigate the collaboration between orthodox and traditional medical practitioners as well as the implication of the collaboration for transmission of traditional medical knowledge in Nigeria. Eighteen communities were purposively selected from six states in south-western Nigeria. Snowball technique was used in selecting 110 traditional medical practitioners. Three key informant interviews and two focus group discussion sessions were conducted in each state. Data were analysed thematically. Results showed the existence of a low level of collaboration mainly in the form of patient referrals which were not performed officially and mostly one sided. This was attributed to the negative perception of traditional medicine by orthodox practitioners and the failure of government to give traditional medicine its due recognition. This was reportedly responsible for the lack of interest by children of traditional medical practitioners to acquire traditional medical knowledge. The study recommends inclusion of traditional medicine in the health policy and educational curriculum from the basic level.

ETHNOBOTANICAL STUDY ON MEDICINAL PLANTS USED BY THE LOCAL COMMUNITIES IN ACHANAKMAR AMARKANTAK BIOSPHERE RESERVE, CENTRAL INDIA

An ethno-botanical survey was conducted in Achanakmar Amarkantak Biosphere Reserve (AABR) of central India to document the indigenous knowledge and utilization pattern of medicinal plants for primary health care by local communities mainly comprised of Baigas, Gonds, Oraons and Pradhans. The communities still rely on herbal medicines for primary health care due to inadequate modern health care facilities. The rich wealth of traditional knowledge and repository of herbal resources are rapidly eroding due to over exploitation in unscientific manner over the last few decades. This has spurred an interest to undertake the present investigation on ethno botanical studies in biosphere reserve. Data collection was done by participatory rural appraisal (PRA) and focus group discussion methods. The different age groups, gender and communities were considered in collecting the data and gathering information on traditional knowledge. The study revealed that a sum total of 70 plants representing 37 families were identified as potential medicinal values by local communities. Out of which 31species were trees represented by18 families, 24 species of shrubs by19 families, 15 species of herbs by 11 families and 16 species of climbers belonging 10 families. The highest number individuals were recorded in Fabaceae family.Seventeen (17) plants are used in home remedies by local communities.There are traditional healers popularly known as Baiga Vaids had rich knowledge of herbal medicines and utilizing almost 48 species belonging to 28 families for preparing crude drugs treating the various ailments like diarrhoea, wounds, fever, cough, cold, jaundice, snake and scorpion bite, infections, malaria, filarial, digestive, gynaecological problems etc. Besides, the local communities were using herbal drugs as home remedies for primary health problems. The study also documented a list of ten rare, endangered and threatened (RET) medicinal flora, which require special attention for their protection and conservation. The study further suggests exploiting potential medicinal flora by detailed pharmacological investigations to design and synthesize novel drugs. Article DOI: https://dx.doi.org/10.20319/mijst.2017.32.577587 This work is licensed under the Creative Commons Attribution-Non-commercial 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc/4.0/ or send a letter to Creative Commons, PO Box 1866, Mountain View, CA 94042, USA.

Technical issues and conservation conditions of medicines in the primary health care of the Brazilian Unified Health System.

ABSTRACTOBJECTIVE To characterize the technical issues and conditions of medicines conservation in Primary Health Care of Brazilian regions, responsible for pharmacy/dispensing unit profile; environmental, storage, and dose fractioning conditions; inventory control and waste management; fire and electrical failure safety items; transportation problems; advertising regulation; and pharmacovigilance.METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços (National Survey on Access, Use and Promotion of Rational Use of Medicines – Services)–, a cross-sectional and exploratory study, of evaluative nature, consisting of an information survey within a representative sample of municipalities, stratified by Brazilian regions, which constitute the study domains, and a sample of Primary Health Care services. Pharmaceutical services (PS) were directly observed with photographic record and face-to-face interviews with those responsible for the dispensing of medicines and over the telephone with those responsible for pharmaceutical services. Data were processed with the SPSS® software version 21.RESULTS The investigated dimensions showed relevant deficiencies and inequalities between the regions, generally more favorable in the Southeast and Midwest regions and weaker in the Northeast and North regions. We verified non-compliance with technical requirements and conditions essential to the conservation of medicines, which may interfere with the maintenance of stability and, thus, on their quality, efficacy, and safety. The regulation of advertising/promotion of medicines is still incipient and there is some progress in the structuring of mechanisms regarding pharmacovigilance.CONCLUSIONS The sanitary situation of medicines in Brazilian Primary Health Care is alarming due to the violation of the specific sanitary legislation for dispensing establishments and due to a wide range of requirements essential to the conservation of medicines. We observed a disconnection between the efforts made in the Brazilian Unified Health System to promote access to medicines for all population and the organization and qualification of pharmaceutical services.

Characterization of the selection of medicines for the Brazilian primary health care.

ABSTRACTOBJECTIVE To characterize the process of selection of medicines for primary health care in the Brazilian regions.METHODS This article is part of the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015), a cross-sectional study that consisted of an information gathering in a sample of cities in the five regions of Brazil. The data used were collected by interviews with those responsible for pharmaceutical services (PS) (n = 506), professionals responsible for the dispensing of medicines (n = 1,139), and physicians (n = 1,558). To evaluate the difference between ratios, we adopted the Chi-square test for complex samples. The differences between the averages were analyzed in generalized linear models with F-test with Bonferroni correction for multiple comparisons. The analyses considered significant had p≤0.05.RESULTS The professionals responsible for pharmaceutical services reported non-existence of a formally constituted Pharmacy and Therapeutics Committee (PTC) (12.5%). They claimed to have an updated (80.4%) list of Essential Medicines (85.3%) and being active participants of this process (88.2%). However, in the perception of respondents, the list only partially (70.1%) meets the health demands. Of the interviewed professionals responsible for the dispensing of medicines, only 16.6% were pharmacists; even so, 47.8% reported to know the procedures to change the list. From the perspective of most of these professionals (70.9%), the list meets the health demands of the city. Among physicians, only 27.2% reported to know the procedures to change the list, but 76.5% would have some claim to change it. Most of them reported to base their claims in clinical experiences (80.0%). For 13.0% of them, the list meets the health demands.CONCLUSIONS As this is the first national survey of characterization of the process of selection of medicines within primary health care, it brings unpublished data for the assessment of policies related to medicines in Brazil.

Availability of essential medicines in primary health care of the Brazilian Unified Health System.

ABSTRACTOBJECTIVETo characterize the availability of tracer medicines in pharmaceutical services in primary health care of the Brazilian Unified Health System (SUS).METHODSThis is a cross-sectional and evaluative study, part of the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Serviços, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines – Services, 2015). To analyze the availability of medicines, we verified 50 items selected from the Relação Nacional de Medicamentos Essenciais (Rename – National List of Essential Medicines) of 2012. Observation scripts were applied to medicine dispensing services in the primary health care. Interviews were carried out with patients, health care professionals, and public managers, using semi-structured questionnaires. The availability index was presented as the percentage of health units where the medicines were available. For statistical analysis, absolute, relative, and mean frequencies were presented (with 95% confidence intervals). The comparison of groups was carried out by Pearson Chi-square tests or variance analysis, when needed.RESULTSOne thousand, one hundred, and seventy-five observation scripts were filled in a national representative sample composed by 273 cities. Statistically significant differences were observed regarding the type of unit, infrastructure, and presence of a pharmacist between regions of Brazil. The average availability of tracer medicines in primary health care was 52.9%, with differences between regions and sampling strata. This index increased to 62.5% when phytotherapic medicines were excluded. We found limited availability of medicines for treatment of chronic and epidemiological diseases, such as tuberculosis and congenital syphilis.CONCLUSIONSThe low availability of essential medicines purchased centrally by the Brazilian Ministry of Health indicates deficiencies in supply chain management. The different views on the availability of tracer medicines in SUS confirm the general availability verified in this study. Among patients, about 60% said they obtain medicines in SUS units, data consistent with the lack of medicines reported by medicine dispensers and in line with physicians’ evaluations.

Access to medicines by patients of the primary health care in the Brazilian Unified Health System.

ABSTRACTOBJECTIVE To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective.METHODS This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators.RESULTS For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines.CONCLUSIONS Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population.

Medicinal Plants Used in the Management Hypertension

Hypertension or high blood pressure BP is a chronic medical condition and is a worldwide epidemic High percentage of the world hypertensive population use herbal medicines for primary health care because of their low cost better acceptability and lesser side effects Naturally occurring medicinal plants herbs having antihypertensive potential so several ethnobotanical studies performed in different parts of world showed that hundreds of plants are used worldwide for empirical hypertension treatment This work provides basic knowledge from medicinal plants used for high blood pressure treatment to support future pharmacological and phytochemical investigation

Sobrediagnóstico de enfermedad pulmonar obstructiva crónica en atención primaria. Prevalencia y condicionantes

IntroductionCOPD under-diagnosis is common in Primary Health Care medicine, due to the low use of spirometry, but there is less information about over-diagnosis of the disease in patients that have a clinical diagnosis of COPD. ObjectiveThe main objective of the study was to investigate the prevalence of COPD over-diagnosis in Primary Care medicine. Secondary objectives were to determine the factors associated with an incorrect clinical diagnosis of COPD and to analyse whether the pharmacological treatment is different for patients with correct or incorrect diagnosis. MethodA prospective, observational, cross-sectional study was conducted using the spirometry results of 206 patients with a clinical diagnosis of COPD, with no prior lung function testing, and who were treated with inhaled therapy. Characteristics and treatment of patients with a correct or incorrect COPD diagnosis were compared. ResultsThe prevalence of COPD over-diagnosis was 42.7% in the study population. Factors associated with an incorrect diagnosis were female sex (P<.0001), obesity (P=.009), absence of smoking history (P<.0001), lower age (P=.001), and less severe dyspnoea (P=.001). Long-acting muscarinic agents were more frequently prescribed to patients with a correct COPD diagnosis. There were no other differences regarding inhaled therapies between both groups. ConclusionsOver-diagnosis is a frequent phenomenon in patients with a clinical diagnosis of COPD managed in Primary Care medicine. There are different features between patients with a correct and incorrect diagnosis. Spirometry is an essential tool to reduce COPD over-diagnosis.

Integral Health Care As A Guiding Axis Of Medical Training: Case Studies

Objective: The aim is to report the experiences during the practical experiences in the territory assigned to a basic health unit provided by the module of Integral Health Care I.&#x0D; Methods: Case studies resulting from a process of critical reflections about practical experiences by medical students in a basic health unit from August to December 2015.&#x0D; Results: Through the module of Integral Health Care I, students were allowed to recognize the assigned area of a family health team, as well as to develop the territorialization process and to classify the demographic, epidemiological, socioeconomic and environmental profile in that place; in addition to perform other activities as a singular therapeutic project and intervention project.&#x0D; Conclusion: The activities developed motivated the students to be able to apply the concepts of family and community medicine in primary health care, in addition to bringing them closer to the reality of this work process.&#x0D; Descriptors: Integral Health Care; Family Health Strategy; Physician-Patient Relationship; Basic Health Unit.

KIRKIA ACUMINATA OLIV.: A REVIEW OF ITS ETHNOBOTANY AND PHARMACOLOGY.

Background:Local communities in sub-Saharan Africa have a long history of medicinal plant usage. Like in other parts of the developing world, rural and urban communities are still dependent on herbal medicines for primary health care, and the use of herbal medicines is still an integral part of their daily life and socio-cultural life style. The objective of this paper is to summarise information on the ethnobotany and pharmacology of Kirkia acuminata Oliv. throughout its distributional range.Materials and Methods:The information documented in this article is derived from books, theses, scientific journals and reports obtained from library collections, Scopus, Pubmed, MEDLINE, ISI Web of Science, Google Scholar and Science Direct.Results:Kirkia acuminata is the most known and widely distributed Kirkia species in the genus and is one of the most popular and promising plant resources due to its several beneficial uses. Kirkia acuminata is used to treat abdominal pains, backache, cholera, constipation, cough, diarrhea, dysentery, snake bites, toothache and wounds. Other applications include its use as charcoal; hedge, ornamental or shade; stock feed, timber and source of water during drought periods. Preliminary phytochemical assessment of roots and stem bark of K. acuminata showed presence of lignans, neo-lignans, nor-carotinoids and other compounds. The extracts of K. acuminata exhibited antibacterial and antimycobacterial activities. These phytochemical compounds may be responsible for the medicinal uses and biological activities demonstrated by K. acuminata.Conclusion:Detailed research is required aimed at exploring mode of action of bioactive compounds of Kirkia acuminata that are responsible for the documented pharmacological effects. Kirkia acuminata is an important plant species that has potential to contribute to the primary health care and livelihood improvement of local communities in the geographical areas where it is indigenous and found in abundance.

Travel medicine in primary health care

Travel medicine in primary health care

Antisickling, Antioxidant and Antibacterial Activities of &amp;lt;i&amp;gt;Afromomum alboviolaceum&amp;lt;/i&amp;gt; (Ridley) K. Schum, &amp;lt;i&amp;gt;Annona senegalensis&amp;lt;/i&amp;gt; Pers. and &amp;lt;i&amp;gt;Mondia whitei&amp;lt;/i&amp;gt; (Hook. f.) Skeels

In accordance with statistics from the World Health Organization, nearly 80% of populations depend on traditional medicine for primary health care. In order to scientifically validate the phyto-therapeutic wealth of the Democratic Republic of the Congo, three plants were chosen namely: Afromomum alboviolaceum, Annona senegalensis and Mondia whitei. The objective of our study was to assess the antisickling, antioxidant and antibacterial activities of the ethanolic extracts and the dichloromethane fractions of these three plants. Sickle cell blood was supplied from Centre de Medecine Mixte and Anemie SS of Yolo Sud, Kinshasa. Three bacterial strains were used including Staphylococcus aureus ATCC 25923, Escherichia coli ATCC 8739 and Pseudomonas aeroginosa ATCC 9027. The ethanolic extracts of A. alboviolaceum and A. senegalensis and dichloromethane fractions of A. alboviolaceum and M. whitei showed IC50 values < 100 μg/mL in the ABTS test. Only the dichloromethane fraction of A. senengalensis showed an IC50 value of less than 100 μg/mL for the DPPH test. The inhibitory concentration 50 (IC50) values obtained from the ABTS test are lower than those of the DPPH test. All tested extracts possess a high antisickling activity and only soluble dichloromethane extracts are active vis-a-vis Staphylococcus aureus (MIC = 31.5 μg/mL). These results constitute a scientific evidence validating the use of these three medicinal plants for the management of sickle-cell anemia in the Democratic Republic of the Congo.

TREATMENT OF DIARRHOEA USING TRADITIONAL MEDICINES: CONTEMPORARY RESEARCH IN SOUTH AFRICA AND ZIMBABWE.

Background:Gastrointestinal disorders, diarrhoea in particular remain a major concern in South Africa and Zimbabwe resulting in high mortality rates when left untreated. This investigation was aimed at documenting herbal medicines used in the treatment of diarrhoea in South Africa and Zimbabwe.Materials and Methods:A review of literature on plant species used as remedies for diarrhoea in South Africa and Zimbabwe was undertaken by the use of different electronic databases such as Google Scholar, ScienceDirect, Scopus as well as library searches at the University of Fort Hare, South Africa and the National Herbarium of Zimbabwe (SRGH) in Harare, Zimbabwe.Results:This study reported ten plant species most widely used to treat diarrhoea in South Africa and Zimbabwe. Of the lot, Sclerocarya birrea (A. Rich.) Hochst. was the most popular medicinal plant used as antidiarrhoeal remedy (11 literature citations) in South Africa and Zimbabwe, followed by Elephantorrhiza elephantina (Burch.) Skeels and Schotia brachypetala Sond. with eight literature citations each. The roots (47.4%) are the most frequently used plant parts, followed by bark (26.3%), leaves (21.1%) and rhizomes (5.3%).Conclusion:The documented antidiarrhoeal activities of this repository of selected plant species against diarrhoea causing agents such as rotavirus, Escherichia coli, Shigella, Campylobacter, Giardia, Entamoeba histolytica, Salmonella, Yersinia and Vibrio cholerae calls for further investigation aimed at isolating phytochemical compounds responsible for antidiarrhoeal activities, their mode of action, and also establish their safety and efficacy. This cross-cultural acceptance of antidiarrhoeal herbal medicines and the use of the same plant species in different geographical zones serve as an indication of the importance of herbal medicines in primary healthcare of local communities.

World Health Organization.

World Health Organization.

Availability and Accessibility to Medicines in Primary Health Care in a Brazilian Region

: Objective: The aim with the present study was to evaluate availability and accessibility to medicines in Primary Health Care in Northeast Health District, Belo Horizonte, Brazil. Method: It was an epidemiological, descriptive and cross-sectional study, conducted in the central warehouse and in twenty Primary Health Care units. The data was collected through direct observation, in information systems and in a survey with patients. Indicators proposed by World Health Organization were used to analyze the availability and accessibility. Results: The average availability of essential medicines from a key list in stock observed in visits in Primary Health Care units was 98,3 ± 3,7% and in the past 12 months was 42,5 ± 13,6%. One thousand and three hundred eighty-three medicines were prescribed to patients and 1066 (77,1%) of them were actually dispensed. An association of the presence of medicine in Essential Medicine List with dispensing of medicine was observed (p=0,00). It was observed that 93,2% of patients spent until 30 min in the way from their residence to Primary Health Care unit. Conclusion: The conditions of availability of medicines in stock in visits and the accessibility to services in PHC were satisfactory; however, limitations were observed in yearly availability of medicines and in the attendance of patient`s needs for prescribed medicines. Actions are recommended to improve availability of medicines such as the adoption of the Essential Medicine List.Key words: Health Services Accessibility, Pharmaceutical Services, Primary Health Care.

Factors affecting inappropriate prescription of antibiotics and the emergence of antibiotic resistance in patients in primary health care

Introduction. Increasing resistance to antibiotics is of great importance for health professionals around the world. The correlation between the use of antibiotics and rates of resistance has long been established. Physicians who work in primary health care make up a large part of health care personnel responsible for the use of these drugs. This study reveals factors that influence unduly prescribing antibiotics and the emergence of resistance to antibiotics in primary health care. Methodology. This study has been conducted at the Health center Danilovgrad, Montenegro from November 1st 2015 to June 1st 2016. We used a qualitative method - focus group, where one group consists of 8 members (six doctors for adults, 1 pediatrician am 1 pharmacist) and moderator. Based on previous systematic reviews, we made the agenda, which was followed during the group meetings to facilitate the identification of factors. During discussions within the meetings group audio recordings were made, and then their transcripts were individually analyzed by the researchers. Results. Our study showed that factors affecting the prescription of medicines in primary health care are: personal interest of referring physician; fear of referring physician; external factors relating to the patient, pharmacist and the influence of the pharmaceutical industry; as well as the patients lack of knowledge and lack of information. Members of the group agreed that the emergence of resistance should be monitored at the level of healthcare institutions. Conclusion. Identification of factors that influence inappropriate prescribing of antibiotics allows implementation of specific interventions with aim of improving antibiotic use and preventing antibiotic resistance, which is of special importance for developing countries where this problem affects their medical, economic and legal systems.

Programa Mais Médicos no Estado de Santa Catarina: breve relato de experiências iniciais

: No Programa Mais Médicos, a interiorização de faculdades de medicina e a inserção de médicos em áreas brasileiras socialmente vulneráveis, potencializando a aproximação entre formação e realidade da população, isto é, a integração ensino e serviços são duas dimensões priorizadas. O presente estudo objetivou apresentar aspectos históricos da criação do Programa e um breve relato dos movimentos iniciais de uma pesquisa estadual em andamento, na perspectiva de um informante chave. É um estudo social, qualitativo, de caráter exploratório, descritivo e compreensivo. O instrumento eleito para a coleta de dados foi a entrevista narrativa. A análise foi conduzida pela abordagem hermenêutico-dialética. Os resultados apontaram a categoria - Da intenção ao gesto: abraçando os inúmeros Brasis em defesa da garantia do direito universal à saúde. Observou-se que o Programa representa uma franca possibilidade de garantia de realização do direito à saúde em rincões sombrios, marginalizados pela ausência de médicos, bem como um projeto transformador efetivo em defesa de uma formação em medicina para a atenção básica, para o Sistema Único de Saúde de todos os brasileiros: a serviço do Brasil.

Propuesta de abastecimiento de medicamentos coordinando multiniveles de demanda. Un caso ilustrativo chileno

The supply system of medicines in primary health care in Chile has a unique nationwide provider and does not consider multilevel demand for calculating the procurement, generating inventory surplus. This paper proposes a regular supply policy review that uses a probabilistic demand forecasting modeling the dependence structure, individually and through bi-varied copulas, coordinating demand multilevel minimizing costs associated with the purchase, maintenance and storage. The validation of the proposal was conducted on a sample of 104 medicines supplied by three years in a Chilean family health center. When comparing the current policy with the proposal, such weekly decline a 8.22% in purchasing costs, a 95.47% cost of ordering and a 54.6% of total costs.

The gap between training and practice of prescribing of drugs by nurses in the primary health care: a case study in Brazil

In many countries, the inclusion of nurses as prescribers is considered to be an advanced practice. In Brazil, such prescriptions are legally regulated and restricted to primary health care protocols. The presence of prescribing nurses has provoked a debate among medical and nursing corporations. However, there are few studies examining the qualifications, protocols and in-service training that are aimed at prescribing nurses in primary health care. We sought to investigate possible gaps between the education, qualifications, self-assessments and practice of prescribing medicine in primary health care from the perspective of nurses. This investigation is a case study with a qualitative approach. This research was conducted in a Brazilian municipality with 84.04% family health strategy coverage and 400,002 inhabitants in northeast Brazil. The participants were an intentional sample of 37 nurses in primary health care who were linked to the family health strategy. The study was conducted between August and November 2011 with four focus groups, a script validated by the Delphi technique,and a pilot study. This study addressed the qualifications for the prescription of medication, the sufficiency of the Ministry of Health protocols and self-assessments of the ability to prescribe. Qualitative analysis was applied. All nurses reported having received insufficient training in the discipline of pharmacology to qualify them for prescriptive practice. The nurses emphasised the need for post-graduate training, the importance of clinical experience,and the lack of discussions and training. Only a small number of nurses self-assessed themselves as competent in prescribing drugs, and the others revealed fears of causing adverse reactions to medication. There are gaps in the education, training,and daily demands of the prescription of medication by nurses in primary health care. It is suggested that prescription practices should be incorporated into undergraduate studies and continuing education in health services.

Construcción de entornos saludables en el marco de la Atención Primaria en Salud: el caso de la enseñanza de Salud Comunitaria en el Programa de Medicina de la Universidad de La Sabana

This article presents the reflection of an education experience in community health, within the framework of Primary Health Care (PHC) in the program of Medicine at Universidad de La Sabana, a process that articulates students, citizens and managers of interdisciplinary teams to work for populations’ health collaborating in the making of environments. It delves into the elements that have characterized the experience of teaching and learning in PHC, the process of building the academic program, the confluence of Public Health and Family Medicine in PHC, the pedagogical orientation of theoretical and practical activities in health care education, the formulation and implementation of improvement plans in health, community health projects and promoting healthy environments in different organizations and communities, while describing the evolution of the process. Conclusions emphasize strategic areas necessary in physicians and other health professionals, competencies necessary to strengthen population health through this kind of programs, stressing the importance of PHC and healthy environments in teaching, researching, and social action in coordination with other sectors related to the initiative.