Primary Health Care Delivery System Research Articles

Use of Mental Health Services in Primary Health Care Delivery Systems in a Developing Country: A Survey of Selected General Hospitals in Delta State Nigeria

Studies on the use of mental health services in Nigeria are scarce. Most of the existing studies have focused on psychiatric illnesses. However the context for the assessment and treatment of many mental health disorders in developing countries including Nigeria is moving from mental hospitals to primary health care providers (PHC). This present study was conducted in Delta State Nigeria to assess the use and provision of mental health services in PHCs (General Hospitals). Two sets of questionnaires were used for the study; one set was given to health practitioners (15), while the other was given to 50 community respondents who were patients in these facilities. The results show that there is low utilization of mental health services in PHCs. In addition, patients do not have a positive attitude towards the use of formal mental health services and also lack an awareness of the availability of these services in PHC settings.

Readiness of Accredited Social Health Activist Workers for Tobacco Cessation Counseling after a Brief Intervention in Odisha, India: A Quasi-experimental Study.

The aim of the study was (1) to explore the baseline beliefs and practices of accredited social health activist (ASHA) workers of Khurda district of Orissa with respect to tobacco cessation and (2) to assess whether a brief intervention will be effective in improving the beliefs and practices of ASHA workers. The results of this study could be utilized by policy makers for framing important strategies for tobacco cessation in rural areas utilizing ASHA workers. A quasi-experimental study (before and after comparison) was performed in Khurda district of Orissa to find out whether a brief intervention could improve the beliefs and practices of ASHA workers related to antitobacco counseling in rural areas. A 14-item structured, interviewer-administered questionnaire, written in English (translated in Odiya), was used. The final sample size was estimated as 135. Data were entered into Statistical Package for the Social Sciences (version 21) for analysis. All the mean belief items, practice items, degree of preparedness, and interest in training scores of study population increased significantly from baseline to postintervention. The study population showed a statistically significant improvement in postintervention composite belief and composite practices score. The majority of ASHA workers had positive beliefs and favorable practices after attending a brief intervention toward smoking cessation in their community. After attending the intervention, nearly half of the respondents felt themselves either somewhat or very well prepared for tobacco cessation. Most of them showed their interest toward getting further training in the field. Training programs and regular tobacco cessation activities should be planned in the primary health-care delivery system of India.

Primary Health Care as a Foundation for Strengthening Health Systems in Low- and Middle-Income Countries

Primary health care (PHC) has been recognized as a core component of effective health systems since the early part of the twentieth century. However, despite notable progress, there remains a large gap between what individuals and communities need, and the quality and effectiveness of care delivered. The Primary Health Care Performance Initiative (PHCPI) was established by an international consortium to catalyze improvements in PHC delivery and outcomes in low- and middle-income countries through better measurement and sharing of effective models and practices. PHCPI has developed a framework to illustrate the relationship between key financing, workforce, and supply inputs, and core primary health care functions of first-contact accessibility, comprehensiveness, coordination, continuity, and person-centeredness. The framework provides guidance for more effective assessment of current strengths and gaps in PHC delivery through a core set of 25 key indicators (“Vital Signs”). Emerging best practices that foster high-performing PHC system development are being codified and shared around low- and high-income countries. These measurement and improvement approaches provide countries and implementers with tools to assess the current state of their PHC delivery system and to identify where cross-country learning can accelerate improvements in PHC quality and effectiveness.

Can communication media improve the KAP status of frontline health workers? A cross-sectional study on MCH indicators from Assam, India

Frontline health workers are now key component in any public health delivery system, providing essential information on basic components of health, nutrition and sanitation for improving the utilization of primary health care delivery system by the community. This study was conducted to find out the Knowledge Attitude and Practices (KAP) of Accredited Social Health Activist (ASHA) workers on maternal health and child health components, service delivery system and to find out the association of different communication media on KAP status regarding above components. It is a cross-sectional study. Data was collected using a pre-tested structured questionnaire from 264 ASHA workers from 8 blocks of 5 districts of Assam selected randomly. Multiple regression analysis has been used to associate various findings and variables. The overall KAP status of most of the ASHAs (72%) was found to be 'Good'. It was observed that 70.45% had good KAP regarding maternal health components, 82.2% had good KAP on child health components, and 78.79% on common diseases. Communication media like TV, radio and mobile have also been found to have significant effect on certain KAP by ASHAs. Most of the ASHAs have been found competent in some aspects of health and nutrition components which have direct impact on child survival and maternal health. But at the same time average to poor knowledge level have been seen in some other important indicators. Hence proper training and timely re-orientation and information sharing through different suitable medium would be helpful for improving the KAP status of ASHAs.South East Asia Journal of Public Health Vol.5(2) 2015: 57-64

Myanmar’s Mental Health System Undergoes Major Modernization

Myanmar’s Mental Health System Undergoes Major Modernization

Comparative Study of Oral Health Promotion Activities between Malaysia and Thailand- An Outbound Programme

The Comparative Study of Oral Health Care Delivery Systems (between Malaysia and other countries) is a compulsory course in the Master of Community Oral Health (MCOH) degree. In 2015, the Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, University of Malaya formed a partnership with Chiang Mai University to organise an outbound programme which took place from 3-7 August 2015. Three MCOH postgraduate students from UM and one accompanying lecturer participated in this outbound programme. The aim of the programme was to compare and evaluate the oral health care delivery systems between Malaysia and Thailand. The objectives of the outbound programme were 1) To observe the public health care services in Chiang Mai. 2) To observe the implementation of the central policy through a field visit at different levels, i.e. central (federal), intermediate (state & district level) and primary health care delivery system between Malaysia and Chiang Mai. During the outbound program, the places visited were Faculty of Dentistry, Chiang Mai University. Intercountry Centre for Oral Health (ICOH), a community-based defluoridation programme, hospital and district level oral healthcare facilities in Sansai district and Rajanagarindra Institute of Child Development. This report is aimed to describe the oral health promotion activities in Thailand in comparison to those activities in Malaysia. In Thailand, various programmes are being implemented to promote the health (including oral health) of the population. These activities are organized by the Thai Health Promotion Foundation (Thai Health). Many of the activities place emphasis on individualised oral health promotion activities. Thailand is also known for its community-based on oral health promotion programme which was developed and delivered by the ICOH.

Evidence-based characteristics of nurse-managed health centers for quality and outcomes

There are approximately 250 nurse-managed health centers (NMHC) in the United States, but there are few consistent descriptions of their functions and even fewer reports of their outcomes. Because NMHCs have been identified as a unique and effectual health care delivery care model (Patient Protection and Affordable Care Act), a description of their characteristics and a framework for outcome evaluation are required for their continued evolution and expansion. This study identifies the principal characteristics of U.S. NMHCs described in the professional literature through an integrative review and classifies these characteristics through a multistage qualitative analysis in relation to Donabedian's structure-process-outcomes model, a well-established model for evaluating quality in health care. This study yielded an evidence-based definition of NMHCs that is more reflective of current NMHC practice across settings and recognizes the full scope of nursing practice that is considered one solution to the health care crisis in the country. Using the results from this study, NMHCs will be able to structure self-evaluations of quality care and compare their quality related to structure, processes, and outcomes with other primary health care delivery systems.

Stories and metaphors in the sensemaking of multiple primary health care organizational identities

BackgroundThe Quebec primary health care delivery system has experienced numerous reforms over the last 15 years. In this study, we sought to examine how managers and primary care providers made sense of the creation of successive new primary care organizational forms.MethodsWe conducted a longitudinal qualitative case study in a primary care practice group located in Montreal, Quebec, for over 6 years (2002 to 2008). The data sources for the study include 31 semi-structured interviews with key informants, in-situ observations of group meetings, as well as documents and field notes. Textual material was submitted to narrative and metaphor analysis.ResultsThe core metaphor of the journey came from a set of stories in which the members of this primary care group depicted the processes undertaken towards developing a multidisciplinary cooperative practice, which include an uneasy departure, uncertainty about the destination, conflict among members who jump ship or stay on board, negotiations about the itinerary, and, finally, enduring challenges in leading the way and being pioneers of change in the organization of primary care in their institutional context. Identification with the initial family medicine unit identity was persistent over time, but successive reforms further enriched its meaning as it became a multidisciplinary primary care practice pioneering organizational change.ConclusionsIn order to support primary care reforms in complex institutional fields, this study proposes that decision-makers undertake a journey in which they recognize both the need to capitalize on existing meaningful and legitimated organizational identities, as well as the necessity for collective leadership in the management of multiple organizational identities over time.

Cost of ambulatory care by mobile health clinic run by a Medical College in India for the year 2008-09.

The feasibility of using mobile health clinics (MHCs) to deliver health services in urban poor areas has to be explored as the health needs of the residents are not sufficiently addressed by the existing primary health care delivery system in India. To estimate the cost of providing primary health care services and the out of pocket expenditure (OOPE) incurred, while utilizing these services provided through the MHC based Urban Health Program of a Medical College in North India for the year 2008-2009. A cross-sectional study to estimate OOPE was conducted among 330 subjects selected from patients attending the mobile health care facility. For estimation of provider cost, 5 steps process involving identification of cost centres, measurement of inputs, valuing of inputs, assigning of inputs to cost centers, and estimation of unit cost were carried out. Total annual cost of providing services under Urban Health Program in the year 2008-2009 was Rs. 7,691,943 Unit cost of providing outpatient curative care, antenatal care, and immunization were Rs. 107.74/visit, Rs. 388/visit and Rs. 66.14 per immunization, respectively. The mean OOPE incurred was Rs. 29.50/visit, while utilizing outpatient curative services and Rs. 88.70/visit for antenatal services. The MHC can be considered as a viable option to provide services to urban poor.

Bridging the Human Resource Gap in Primary Health Care Delivery Systems of Developing Countries With mHealth: Narrative Literature Review.

BackgroundMobile health (mHealth) has the potential to solve human resource issues in the health care sector. mHealth is of particular interest in developing countries, where widespread mobile networks and access to devices are connecting people like never before.ObjectiveThe aim of this paper was to review published and unpublished literature, field projects, and pilot studies on mHealth usage in overcoming shortage of human health resources in developing countries.MethodsA narrative literature review was undertaken using an iterative approach in extracting literature focused on mHealth and human health resources of low-income countries, especially India. The present review has undertaken comprehensive coverage of the work on related field projects that have been either published, accepted for publication, or pilot tested.ResultsThis review presented the use of mHealth across various dimensions of primary health care, including data collection, disease surveillance, health education, supervision, monitoring, and feedback. Field studies of fast, error-free data collection and transmission using mHealth were also documented. New apps for supervision, monitoring, and utilization of innovative health education tools were documented in the current review. Practical limitations of mHealth and challenges set forth in developing countries included issues of data security, cost constraints, health provider privacy, and technical barriers.ConclusionsIn the present review, we have documented a few mHealth projects that contribute to the proficient use of human resources. These projects pave the path for the efficient utilization of mHealth, offering solutions to emerging human resource challenges and simultaneously revamping the health care delivery in resource-limited settings.

Phytochemicals, Natural Products at a Crossroad: Current and Future Directions

The study of the chemistry of natural products is an indispensable tool in drug discovery and its importance will only increase in the future as pathogens develop resistance to current treatment regimes. Traditional medicinal practices are an important part of the primary health care delivery system in most of the developing world given the extremely low doctor to patient ratios and shortage of medical services (including health centers and pharmaceutical drugs). The use of traditional medicine and medicinal plants in Kenya as a normative basis for the maintenance of good health is still practised in most parts of the country. The vast knowledge of such plants is now beginning to be acknowledged by the scientific world; as is the role played by indigenous people as custodians of this genetic heritage. The striking coincidence between indigenous medicinal plant uses and scientifically-proven phytochemical and pharmacological properties shows that the traditional remedies are an important and effective part of indigenous healthcare systems. Medicinal plants provide huge opportunities for local communities' development, healthcare and livelihood improvement. The Sustainable Development Initiatives Center (SUDIC) at the United States International University -Africa (USIU-A) sought to isolate medicinally active compounds from the fruits of Balanites rotundifolia, a tree native to the Koriema village Baringo county. We isolated a total of two terpenoid compounds, (purple and pink). Our aim was to 1.) Test the effectiveness of the isolated compounds for arcaricidal activity 2.) Determine if compounds from fruit extracts can be isolated via the process of activity guided fractionation, (3) elucidate the structure of each compound through spectroscopic analysis (4) investigate the biosynthetic mechanisms associated with each compounds and (5) examine the bioactivity of the isolated compounds. The isolated active compounds from Balanites rotundifolia when applied on livestock infested with ticks showed arcaricidal activities by eliminating all the ticks from the animals. Also, at the laboratory level, when applied in cockroaches' hide-outs, they ended up dying and this concluded that further tests are needed to proof the efficacy of the plant.

The new face of rheumatic heart disease in South West Nigeria.

PurposeTo determine the current prevalence of rheumatic heart disease (RHD), clinical features, types of valvular lesions, complications and mortality, at Ladoke Akintola University of Technology (LAUTECH) Teaching Hospital, Osogbo, South West Nigeria.MethodsWe conducted a retrospective, descriptive study of all the cases of RHD seen in the medical outpatient clinics and wards of LAUTECH for 9 years, from January 2003 to December 2011. Statistical analysis of data obtained was done using SPSS 16.ResultsThe total number of attendees of all the medical outpatient clinics during the 9-year period was 67,378, with a subset of 9423 attending the cardiology clinic. There were 11 cases of RHD, which translates to a prevalence of 0.16/1000 and 1.2/1000 for medical outpatient clinics and the cardiology clinic respectively. The mean age of the patients was 25.64 ± 9.65 years, age range 14–40 years and male to female ratio of 1:1.2. The most common valve affected was mitral (90.9%), followed by the aortic (36.4%), and the tricuspid (18.2%). Mitral and aortic lesions coexisted in 18.2% of the patients, and late presentation was common in all RHD cases. Heart failure was the most common complication (90.9%). Other complications were secondary pulmonary hypertension (36.4%), infective endocarditis (27.3%), atrial fibrillation (27.3%), cardioembolic cerebrovascular disease (18.2%), and atrial flutter (9.1%). Mortality was 9.1%, while only one patient (9.1%) had definitive surgery. Financial constraints precluded others from having definitive surgery.ConclusionThe prevalence of RHD has declined considerably as a result of improvements in the primary health care delivery system, with widespread use of appropriate antibiotic therapy for sore throats resulting in the prevention of rheumatic fever and RHD. However, late presentation is still very common, hence we advocate a more aggressive drive to make the Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease functional in our practice area.

Organisation and Working of Health Department in Haryana: A Study

The State Government required efficient and dynamic health organisation at the state level to ensure effective and efficient primary health-care delivery system at all the levels within the state, especially, at the grass root and rural level. In the subsequent paragraphs, the organisational structure of health-care machinery in the state of Haryana is shown. The Health Department, Haryana, is committed to provide quality health services and raise the health status of its people. The health services are being provided through a network of 50 hospitals (including Hospital of Medical College, Rohtak), 86 community health centres, 420 primary health centres, 2,433 sub-centres (SCs), 20 district T.B. centres, 41 dispensaries, Post-Graduate Institute of Medical Education and Research at Rohtak and a Medical College at Agroha (Hisar) and Mullana (Ambala).

NHI will put GPs ‘back at the centre’ – Motsoaledi

Under universal health coverage South Africa’s general practitioners will reclaim their rightful place at the heart of the primary healthcare delivery system and slowly but surely increase their share of a hugely enlarged national ‘medical aid’ cake. That was the core message to thousands of private sector doctors from National Health Minister, Dr Aaron Motsoaledi, during an 8-month charm offensive across the 11 National Health Insurance (NHI) pilot districts which he completed this October . Speaking exclusively to Izindaba a fortnight after his marathon tour ended, an upbeat Motsoaledi believes his well-aimed arrows found their target. ‘I think I proved to them that the present system is making them poorer than an NHI ever could. I mean GPs getting R6 billion out of the R84.7 billion medical aid basket (2010 figures – 2011 was worse) with private hospitals’ specialists, pharmacies and even non-healthcare workers (administrators and brokers) getting more, is unfair and unsustainable,’ he said.

Role of GIS in Social Sector Planning: Can Developing Countries Benefit from the Examples of Primary Health Care (PHC) Planning in Britain?

Social sector planning requires rational approaches where community needs are identified by referring to relative deprivation among localities and resources are allocated to address inequalities. Geographical information system (GIS) has been widely argued and used as a base for rational planning for equal resource allocation in social sectors around the globe. Devolution of primary health care is global strategy that needs pains taking efforts to implement it. GIS is one of the most important tools used around the world in decentralization process of primary health care. This paper examines the scope of GIS in social sector planning by concentration on primary health care delivery system in Pakistan. The work is based on example of the UK's decentralization process and further evidence from US. This paper argues that to achieve benefits of well informed decision making to meet the communities' needs GIS is an essential tool to support social sector planning and can be used without any difficulty in any environment. There is increasing trend in the use of Health Management Information System (HMIS) in Pakistan with ample internet connectivity which provides well established infrastructure in Pakistan to implement GIS for health care, however there is need for change in attitude towards empowering localities especially with reference to decentralization of decision making. This paper provides GIS as a tool for primary health care planning in Pakistan as a starting point in defining localities and preparing locality profiles for need identification that could help developing countries in implementing the change.

Antibacterial properties of some wild leafy vegetables of the Eastern Cape Province, South Africa

Wild medicinal leafy vegetables are consumed by many rural villagers of the Eastern Cape, South Africa. These vegetables are easily accessible at no cost. This paper presents findings of a survey of plants used as vegetables and for medicinal purposes in the Eastern Cape Province. Regular consumers of these plants interviewed revealed that four out of the possible twenty species were reported to be used for medical purposes besides consumption as food. Plants that were consistently mentioned in all the places visited were collected to evaluate their antibacterial properties. The following four species were collected; Bidens bipinnata, Physalis peruviana, Rumex obtusifolius, and Taraxacum officinale. These were reported to cure the most common diseases in the study area. Antibacterial screening was done on all the four collected species. All the aqueous extracts from these plants showed some antibacterial properties at concentrations ranging from 1.0 to 7.0 mg/ml. Acetone and aqueous extracts of B. bipinnata and P. peruviana inhibited both Gram-positive and Gram-negative bacteria. This may justify the use of these plants for the treatment of minor ailments as a primary health care delivery system. Key words: Wild vegetables, antibacterial, Bidens bipinnata, Physalis peruvian, Rumex obtusifolius, Taraxacum officinale.

Moving towards universal health insurance in China: Performance, issues and lessons from Thailand

China is now in the course of implementing a new round of health system reforms. Universal health insurance coverage through the basic social medical insurance system is high on the reform agenda. This paper examines the performance of China’s current social medical insurance system in terms of revenue collection, risk pooling, the benefit package, and provider payment mechanisms based on a literature review and publicly available data. On the basis of critical assessment, the paper attempts to address the issues challenging China as it moves towards universal coverage. Focusing in particular on the reform experience in Thailand as it implemented universal coverage, the following policy implications for further reform in China are articulated, taking into account China’s particular circumstances: firstly, the gaps in the benefit package across different schemes should be further reduced; secondly, the prevailing fee-for-service payment system needs to be transformed; thirdly, the primary health care delivery and referral system needs to be strengthened in coordination with the reform of the health insurance system; and fourthly, raising the risk pooling level and integrating fragmented insurance schemes should be long-run objectives of reform.

Post-Disaster Recovery: A Case Study of Human Resource Deployment in the Health Sector in Post-Conflict Kosovo

A professional understanding of disasters, paired with the need for health service development, can provide opportunities for the recovery and improvement of the health sector. Investment in training capacity ranks among the top priorities of a recovering health sector. The recovery and development of primary healthcare delivery systems has been implemented by various international and local health players in the aftermath of conflicts around the world. However, human resource development in the post-conflict environment has not been evaluated and/or published appropriately in the medical literature. In this retrospective, descriptive study, the authors describe the strategy and evaluate the effectiveness of a field-based training program for primary healthcare doctors implemented by the US-based international non-governmental organization, the International Medical Corps, after the conflict in Kosovo in 1999. A six-month, comprehensive education and training program on primary healthcare issues was delivered to 134 Kosovar primary healthcare physicians in 10 Kosovo municipalities in 1999 and 2000. Qualitative and quantitative data were collected. The qualitative methods included open-ended, semi-structured, key informant interviews, structured focus groups, and unstructured participant observations. The quantitative method was multiple-choice knowledge tests. The education and training program proved to be culturally appropriate and well-accepted by local communities. The program met its overall objective to refresh the knowledge of primary care doctors on various primary healthcare issues and set the stage for further strengthening and development of primary health services and their required human resources in Kosovo. The comprehensive education and training of primary healthcare doctors in Kosovo was a feasible, much appreciated, and effective intervention implemented in a difficult post-conflict environment. This training was one of the early steps in the modernization of primary healthcare services in Kosovo. Later, primary health care was strengthened by the introduction of a Department of Family Medicine at the university, which includes a residency program. The intervention described in this study has the potential to be reproduced in other post-disaster environments, especially in resource-poor settings with long-time troubled health sectors in developing countries.

The ayurveda education in India: how well are the graduates exposed to basic clinical skills?

“Ayurveda” is an ancient system of healthcare that is native to India. At present, in India, there are more than 240 colleges that offer a graduate-level degree (Bachelor of Ayurvedic Medicine and Surgery—BAMS) in Ayurveda. Even though the Central Council of Indian Medicine, the governing body that monitors the matters related to Ayurveda education, has imposed various educational norms and regulations, the standard of education has been a cause of concern in recent years. The mushrooming of substandard Ayurvedic colleges is the most important factor that is being held responsible for this kind of erosion in the standards. The present study is a mailed survey, which was carried out to evaluate the “Extent of exposure to basic clinical skills during BAMS course” as perceived by the sample groups of students and teachers drawn from 32 Ayurvedic educational institutions spread all over India. A methodically validated questionnaire was used as the tool in the study, to which 1022 participants responded. The study indicates that there are some serious flaws in the existing system of the graduate-level Ayurveda education. Since the Ayurvedic graduates play an important role in the primary healthcare delivery system of the country, governing bodies are required to take necessary steps to ensure the adequate exposure of the students to basic clinical skills. Along with the strict implementation of all the regulatory norms during the process of recognition of the colleges, introducing some changes in the policy model may also be required to tackle the situation.

Integrating syndromic case management of sexually transmitted diseases in primary healthcare services in Nigeria

Sexually transmitted diseases (STDs) are a huge public health problem; both the aetiological and clinical approaches to management have limitations. WHO has therefore developed an alternative strategy--the syndromic case management approach. This paper reports a training of healthcare providers at the Primary Health Centers aimed at integrating STD care into other services in the PHCs to improve management at the community level. Sixteen nurses, from eight PHCs were trained on this new strategy. The training included: identification of STDs, use of flow charts, patient education and counseling, clinic management issues and record keeping and reporting. Over a period of eight weeks post training, about 731 clients were attended to, 451 (61.7%) had signs and symptoms of various STDs (genital discharge, genital ulcer, genital warts and lower abdominal pains). They were treated using the syndromic case approach. About 18.6% (84/451) were males and 81.4% (367/451) were Females. Singles (never married) constituted 32.8% (148/451) while 28.6% were married. About 26.6% and 12.0% were divorced and separated respectively. Age group 20-35 years was at highest risk of infection Syndromic case management of STDs can be conveniently integrated into the primary health care delivery system in Nigeria.