Primary Health Care Delivery Research Articles

Reconciling primary healthcare delivery with social media: A case study of Cape Coast, Ghana

BackgroundIn bringing healthcare closer to individuals in their natural environment, Ghana rolled out the Community-based Health Planning Services (CHPS) with a corresponding increase in the training and deployment of qualified community health officers (CHOs) to provide primary healthcare at community level. ObjectivesSince primary healthcare thrives on the active engagement/participation of key stakeholders within the community and coupled with the increasing adoption of technologies in health, the study examines how technological platforms like social media are incorporated in healthcare delivery at the community level regarding the trends, institutional framework, opportunities, and challenges. DesignUsing the case study approach, a semi-structured interview is used to engage six community health nurses of four CHPS zones in the Cape Coast Metropolis of Ghana. ResultsA thematic analysis of the data reveals that WhatsApp is highly useful for informing users either on one-on-one basis or as a participatory group platform. However, since there is no policy backing the use of social media for health delivery at this level, the practice tends to be at the discretion of CHOs, thus exposing such initiatives to some ethical concerns. ConclusionsWith no formal policy in existence, the CHPS initiative are missing out on the inherent opportunities provided by social media to deepen primary healthcare at the community level. Accordingly, the study recommends formal policy guidelines, as well as on-the-job training and incorporating social media skills in the curriculum for community health training institutions to respond to the demands and trends of this contemporary era.

Utilization of dental health-care services by accredited social health activist and anganwadi workers in lucknow district: A cross-sectional study

Background: Accredited Social Health Activists (ASHAs) and Anganwadi workers are grassroots-level health activists who are involved in health education and community mobilization and form a bond between the community and the primary health-care delivery system in India. The cross-sectional study was conducted to assess the dental health-care utilization and to estimate the dentition and periodontal status of ASHA and Anganwadi workers. Materials and Methods: The study was conducted at the primary health centers and subcenters of Lucknow District. ASHA and Anganwadi workers presented on the day of the examination were included in the study. The study pro forma was used to record demographic details and dental utilization. Dentition status and periodontal status were used to record dental caries and periodontal status using the World Health Organization Oral Health Assessment Form 2013. Data were analyzed using the SPSS version 21; descriptive statistics, Chi-square test, and regression analysis were used to assess factors related to health-care utilization and P < 0.005 was considered statistically significant. Results: The final study sample comprised 500 health-care workers (220 ASHA and 280 Anganwadi workers). Among the study population, 30% utilized dental services and was found to be statistically significant with age, occupation, and oral findings. However, 56.0% had both dental caries and periodontal diseases followed by dental caries‒32.0%, periodontal disease‒8.0%. There was a significant difference (P < 0.005) in the proportion of dental care utilization and oral diseases among participants. Conclusions: The dental care utilization was found to be short and is not comparative to the diseases among participants.

Development, validity and reliability of instrument to evaluate implementation fidelity of the Family Doctor Concept (FDC) programme in public primary care clinics in Malaysia.

The Family Doctor Concept (FDC) programme was introduced to public primary care clinics in late 2013 as part of the reform agenda in the primary healthcare delivery system. The study aimed to develop a validated and reliable instrument to evaluate the FDC implementation fidelity in primary care clinics. The instrument, which adapted the concept of patient-centred care (PCC), resulted from a series of expert discussions, a literature search, an FDC guideline, and a review of meeting minutes. A 2-step process was conducted with experts to achieve content and face validity. Consequently, the instrument was piloted in 5 public primary care clinics in Selangor involving 8 trained raters. Inter-rater reliability was estimated using intraclass correlation (ICC), while internal consistency was measured using Kuder-Richardson Formula 20 (KR-20). The final instrument comprises 3 sections (instructions, clinic's characteristics and assessment items), with Section 3 containing 15 items divided into four components - population registration, formation of a primary care team, integrated treatment, and monitoring and evaluation. The ICC for total score was excellent, 0.981, while the ICCs of the individual component scores were good to excellent (population registration: 0.937, formation of primary care team: 0.742, integrated treatment: 0.996, and monitoring and evaluation: 0.996). The value of KR-20 was 0.615, which was considered adequate. The instrument developed was found to be valid in terms of face and content validity and reliable in measuring the fidelity of FDC implementation with excellent inter-rater reliability.

The contribution of family physicians to primary health care: Experiences from southwest Nigeria.

Although an emerging speciality in Africa, family medicine contributes significantly to African health systems. Leadership from family physicians can enable the delivery of high-quality primary health care that is accessible, comprehensive, coordinated, continuous and person-centred. This short report chronicles how family physicians from a university teaching hospital in Ibadan, Nigeria, adopted a health post located in a home for persons with mild physical and mental disabilities and changed it into a hub of comprehensive, holistic and person-centred care for residents and staff of the home, as well as individuals and families in the neighbouring communities and its environs. The Department of Family Medicine of the University College Hospital, Ibadan, with the aid of a benefactor, reorganised a modest health facility to include the services of family medicine senior registrars (undergoing training-related rotations) with supervision by consultant family physicians. Family physicians led the primary health care team that provided both facility-based care and community outreach services. This report demonstrates how family physicians can improve the quality of primary health care and outcomes such as health equity in the community served.

Introducing The Lancet Global Health Commission on financing primary health care: putting people at the centre

Introducing The Lancet Global Health Commission on financing primary health care: putting people at the centre

A Mixed Questionnaire Study on Prayer as Complementary and Alternative Medicine in Ghana

Background: Prayer is paramount in the spiritual welfare and development of an individual. Interestingly, prayer is also considered as a form of complementary alternative medicine and is employed in primary healthcare delivery.&#x0D; Aim: The purpose of this study is to investigate the impact of prayer in primary healthcare delivery as a form of complementary healthcare. This study also investigates why patients opt for prayer as an alternative to standard medical care and ultimately to review the scientific aspect of prayer in medicine.&#x0D; Methods: The study incorporates a mixed methods study with integrated data analysis. The respondents in this study were selected practitioners of Naturopathic Medicine with pastoral background, who belong to the Association of Naturopathic Medicine Practitioners in Ghana.&#x0D; Results: Patients and complementary and alternative medicine practitioners alike in Ghana believe that prayer is very important to aid recovery and hence, plays an integral role as complementary medicine in healthcare.&#x0D; Conclusion: This study demonstrates that there is a role of prayer as complementary alternative medicine in primary healthcare delivery. We therefore hold the view that, pastors at the prayer camps should be well educated in basic medical sciences to enable an effective referral pathway to the standard medical centers.

Examining area-level variation in service organisation and delivery across the breadth of primary healthcare. Usefulness of measures constructed from routine data.

Australia has a universal healthcare system, yet organisation and delivery of primary healthcare (PHC) services varies across local areas. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effective PHC systems. Using a suite of measures constructed at the area-level, this study explored their application in assessing area-level variation in PHC organisation and delivery. Routinely collected data from New South Wales, Australia were used to construct 13 small area-level measures of PHC service organisation and delivery that best approximated access (availability, affordability, accommodation) comprehensiveness and coordination. Regression analyses and pairwise Pearson's correlations were used to examine variation by area, and by remoteness and area disadvantage. PHC service delivery varied geographically at the small-area level-within cities and more remote locations. Areas in major cities were more accessible (all measures), while in remote areas, services were more comprehensive and coordinated. In disadvantaged areas of major cities, there were fewer GPs (most disadvantaged quintile 0.9[SD 0.1] vs least 1.0[SD 0.2]), services were more affordable (97.4%[1.6] bulk-billed vs 75.7[11.3]), a greater proportion were after-hours (10.3%[3.0] vs 6.2[2.9]) and for chronic disease care (28%[3.4] vs 17.6[8.0]) but fewer for preventive care (50.7%[3.8] had cervical screening vs 62.5[4.9]). Patterns were similar in regional locations, other than disadvantaged areas had less after-hours care (1.3%[0.7] vs 6.1%[3.9]). Measures were positively correlated, except GP supply and affordability in major cities (-0.41, p < .01). Application of constructed measures revealed inequity in PHC service delivery amenable to policy intervention. Initiatives should consider the maldistribution of GPs not only by remoteness but also by area disadvantage. Avenues for improvement in disadvantaged areas include preventative care across all regions and after-hours care in regional locations.

Patient satisfaction survey: A gateway to quality improvement in primary healthcare in the IAF

Patient satisfaction is an important indicator to assess and improve quality of healthcare services. In Armed Forces Medical Services, studies on patient satisfaction are scant and mainly hospital based. Hence, a study was conducted with an objective to assess patient satisfaction in seven Primary Healthcare Delivery Centers (PHDCs) in one of the operational commands in the Indian Air Force (IAF). Patient Satisfaction Questionnaire Short Form 18 (PSQ-18), a simple tool, was used for the survey. The study was unique in the sense that few centers in the survey were remotely located from tertiary care hospitals and the Medical Officers in these PHDCs were relatively inexperienced. The analysis of the survey clearly brought out distinct differences in certain dimensions of patient satisfaction across the PHDCs. In addition, utility of the Hindi translated version of PSQ-18 was ascertained. Based on the results of the study, few important conclusions were drawn; (a) patient satisfaction could be assessed using simple questionnaire such as PSQ-18, (b) the Hindi translated version of PSQ-18 can also be used as a useful tool depending on the participants’ preference, and (c) the observed dimensions affecting patient satisfaction could be addressed through specific interventions. Similar survey is recommended to be conducted across primary, secondary, and tertiary healthcare establishments in the IAF.

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

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

Research capacity strengthening in health and care delivery through housing for chronic diseases

BackgroundFrom all buildings, houses are where we spent most of our lives. The impact of housing conditions on health was evident during the COVID-19 pandemic. Despite the 2018 Astana Declaration placing integrated delivery of primary health care and public health services across all sectors, a framework that explores health and care in relation to housing remains unexplored. The aim was to determine relevant evidence gaps to building capacity in supportive housing-health care research about chronic diseases and multimorbidity, identify ongoing strains and offer potential solutions.MethodsAn integrative review was conducted through multiple systematic searches in electronic databases. We employed an interdisciplinary approach integrating several research fields -built environment, clinical and human physiology, environmental health, and public health and health care services- around chronic illness and multimorbidity to understand the depth and scope of linkages. Inductive content analysis was used to describe emerging domains from evidence meeting inclusion criteria.ResultsWe defined a multifaceted framework with priority eight building blocks for action: 1) expanding capacity for chronic care model into the primary care setting; 2) scaling up environmental determinants to cover residential spaces; 3) implementing acute methodologies for indoor environment risk assessment; 4) increasing clinical research applicability into built environment studies; 5) recognizing chronic conditions-promoting inflammation physiology; 6) qualifying reliable surrogate disease biomarkers in human monitoring; 7) enforcing technologies for new forms of outpatient care; and 8) renewing evidence-based healthcare design.ConclusionsFuture research needs to prioritise articulating these emerging insights through systematic, translational and multisectoral approaches to strengthen health and care delivery through housing design solutions for people living with chronic morbidity.Key messages Integrating the evidence-based design in future interventions may promote transformative changes in housing and public health programmes engaging primary healthcare services for chronic patients.This eco-biopsychosocial supportive framework informs practice to advance research capacity development in enabling health-conducive environments across various levels of care and health promotion.

Primary care-based interventions to address the financial needs of patients experiencing poverty: a scoping review of the literature

BackgroundIt is broadly accepted that poverty is associated with poor health, and the health impact of poverty has been explored in numerous high-income country settings. There is a large and growing body of evidence of the role that primary care practitioners can play in identifying poverty as a health determinant, and in interventions to address it.Purpose of studyThis study maps the published peer-reviewed and grey literature on primary care setting interventions to address poverty in high-income countries in order to identify key concepts and gaps in the research. This scoping review seeks to map the tools in use to identify and address patients’ economic needs; describe the key types of primary care-based interventions; and examine barriers and facilitators to successful implementation.MethodsUsing a scoping review methodology, we searched five databases, the grey literature and the reference lists of relevant studies to identify studies on interventions to address the economic needs-related social determinants of health that occur in primary health care delivery settings, in high-income countries. Findings were synthesized narratively, and examined using thematic analysis, according to iteratively identified themes.ResultsTwo hundred and fourteen papers were included in the review and fell into two broad categories of description and evaluation: screening tools, and economic needs-specific interventions. Primary care-based interventions that aim to address patients’ financial needs operate at all levels, from passive sociodemographic data collection upon patient registration, through referral to external services, to direct intervention in addressing patients’ income needs.ConclusionTools and processes to identify and address patients’ economic social needs range from those tailored to individual health practices, or addressing one specific dimension of need, to wide-ranging protocols. Primary care-based interventions to address income needs operate at all levels, from passive sociodemographic data collection, through referral to external services, to direct intervention. Measuring success has proven challenging. The decision to undertake this work requires courage on the part of health care providers because it can be difficult, time-consuming and complex. However, it is often appreciated by patients, even when the scope of action available to health care providers is quite narrow.

The impact of COVID-19 on primary health care and antibiotic prescribing in rural China: qualitative study

BackgroundIn China, the primary health care (PHC) system has been designated responsible for control and prevention of COVID-19, but not treatment. Suspected COVID-19 cases presenting to PHC facilities must be transferred to specialist fever clinics. This study aims to understand the impact of COVID-19 on PHC delivery and on antibiotic prescribing at a community level in rural areas of central China.MethodsQualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and analysed thematically.ResultsPHC practitioners reported a major shift in their work away from seeing and treating patients (due to government-mandated referral to specialist Covid clinics) to focus on the key public health roles of tracing, screening and educating in rural areas. The additional work, risk, and financial pressure that PHC practitioners faced, placed considerable strain on them, particularly those working in village clinics. Face to face PHC provision was reduced and there was no substitution with consultations by phone or app, which practitioners attributed to the fact that most of their patients were elderly and not willing or able to switch. Practitioners saw COVID-19 as outside of their area of expertise and very different to the non-COVID-19 respiratory tract infections that they frequently treated pre-pandemic. They reported that antibiotic prescribing was reduced overall because far fewer patients were attending rural PHC facilities, but otherwise their antibiotic prescribing practices remained unchanged.ConclusionsThe COVID-19 pandemic had considerable impact on PHC in rural China. Practitioners took on substantial additional workload as part of epidemic control and fewer patients were seen in PHC. The reduction in patients seen and treated in PHC led to a reduction in antibiotic prescribing, although clinical practice remains unchanged. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and increased public health roles and, in the case of the village clinics, remain financially viable.

The impact of COVID-19 on primary health care delivery in Australia.

To validate the 'safe and effective staffing tool' and explore the impact of COVID-19 on the quality of Australian primary health care (PHC). A national survey was conducted from October to December 2020. The online survey was distributed via social media and professional organisations to PHC nurses. Three-hundred fifty-nine PHC nurses participated. A two-factor solution was found with factors named; 'Perception of quality of care provided' and 'Personal satisfaction with care delivered'. Cronbach's alpha demonstrated good internal consistency for the total scale (α=.915) and each subscale (α=.879/α=.864). Nearly three-quarters of participants (71.3%) were satisfied with the quality of care they delivered. Participants working in general practice, and those with more nursing experience had significantly higher scores in the factor 'perceptions of quality of care provided' and the total 'quality and satisfaction with care'. A lack of time, inadequate supervision and support, and performing non-nursing duties were reported to be impacting care quality. Most participants (80.5%) reported that COVID-19had impacted negatively on the detection and management of non-COVID related health conditions. The 'safe and effective staffing tool' is a valid and reliable measure of perceived quality of care and satisfaction with care delivered. Many PHC nurses perceive that there has been an overall reduction in the quality of care delivered due to COVID-19 and feel that there is a lack of adequate supervision and workplace support. Given the limited baseline data, further research is required to understand the extent that COVID-19 impacts these findings. However, this study demonstrates that strategies need to be implemented to support PHC nurses to provide high-quality care to optimise health outcomes and maintain nurse satisfaction. This is the first attempt to evaluate care quality in Australian PHC. Policymaking requires this evidence to drive changes to better support PHC nurses.

Transformations in the landscape of primary health care during COVID-19: Themes from the European region

The COVID-19 pandemic has dramatically impacted primary health care (PHC) across Europe. Since March 2020, the COVID-19 Health System Response Monitor (HSRM) has documented country-level responses using a structured template distributed to country experts. We extracted all PHC-relevant data from the HSRM and iteratively developed an analysis framework examining the models of PHC delivery employed by PHC providers in response to the pandemic, as well as the government enablers supporting these models. Despite the heterogenous PHC structures and capacities across European countries, we identified three prevalent models of PHC delivery employed: (1) multi-disciplinary primary care teams coordinating with public health to deliver the emergency response and essential services; (2) PHC providers defining and identifying vulnerable populations for medical and social outreach; and (3) PHC providers employing digital solutions for remote triage, consultation, monitoring and prescriptions to avoid unnecessary contact. These were supported by government enablers such as increasing workforce numbers, managing demand through public-facing risk communications, and prioritising pandemic response efforts linked to vulnerable populations and digital solutions. We discuss the importance of PHC systems maintaining and building on these models of PHC delivery to strengthen preparedness for future outbreaks and better respond to the contemporary health challenges.

Naturopathic Medicine and Public Health Management in Ghana; A Mixed Questionnaire Study

Background: Naturopathic medicine is at its embryonic stage of development in Ghana and West Africa in entirety. In jurisdictions where Naturopathic medicine is well regulated, Naturopathic practitioners are well integrated into the primary healthcare delivery team. In Ghana, the case is quite different due to a myriad of issues.&#x0D; Objectives: This study examines the role of Naturopathic medicine in Public Health in Ghana and potential policy direction for adoption of Naturopathic protocols in global pandemic management, the challenges faced by Naturopathic Physicians in primary healthcare delivery, and the challenges of Naturopathic Medical Students on their clerkship at one of the designated government Hospitals. &#x0D; Methods: The study adopted a mixed questionnaires study engaged in integrated data analysis. The respondents in this study were selected Naturopathic Medical Students of the Nyarkotey College of Holistic Medicine, Ghana. &#x0D; Results: Out of a sample size of 28, 100% (28) believed that, there is a role of Naturopathic medicine in public health management. 95% asserted that very little naturopathic remedies have been employed in the fight against Covid-19 in Ghana. There was also a unanimous agreement (100%) that Ghana needs to adopt a National Policy on Naturopathic remedies in Public Health. &#x0D; Conclusion: Naturopathic medicine should be embraced fully into Ghanaian primary healthcare delivery. It is important to look at the best practices which exist in other jurisdictions such as China and India for adoption. It is time for the policy makers to speed up the passage of the Traditional and Alternative Medicine bill.

A Case Study of Complementary Alternative Medicines in Primary Healthcare in Ghana

Background: The embryonic field of complementary alternative medicine in Ghana is gradually taking shape. Alternative medicine in Ghana is an important system of medical practice with legislation currently pending for promulgation.&#x0D; Objectives: To support this embryonic industry for potential role into our primary healthcare and public health system, there is a need for robust health care policy in the area of standardization coupled with strong political willpower and research in Ghana. The aim of this case study is to reflect the role of complementary alternative medicine in primary healthcare in Ghana.&#x0D; Methods: The study incorporates a mixed method engaged in integrated data analysis to investigate the challenges of practitioners of complementary alternative medicines as primary healthcare givers. Additionally, it evaluates the pull factors that drive consumers to complementary alternative remedies from the perspectives of the practitioners and finally, to evaluate the opinions of practitioners on consumers’ push factors from mainstream medicine using Ghana as a case model.&#x0D; Results: This study demonstrates that there is a role of complementary alternative medicine in primary healthcare delivery as well as the public health system. However, there are multifactorial challenges in the sector as respondents outlined lack of standardization, disunity and mistrust between complementary alternative medicine and mainstream medical practice. Some of these opposing forces prevent recognition of these remedies into the national healthcare delivery system. &#x0D; Conclusion: While our findings demonstrate that there is a role of complementary alternative medicines in our public health and primary healthcare in Ghana, we recommend collaboration between complementary alternative and conventional medical practitioners for improvement of quality of life the consumers. We are of the view that, unhealthy competition between the two medical systems should be controlled.

A Seminar Paper on the Review of Five well-known Medicinal Plants Used in Ethiopia

The indigenous knowledge of medicinal plants appeared when humans started and learned how to use the traditional knowledge of medicinal plants. The various literature available shows the significant role of medicinal plants in primary health care delivery in Ethiopia (about 70% of humans and 90% of livestock population) depend on traditional plant medicine. This is similar to many developing countries, particularly with those countries in Sub-saharan Africa. Medicinal plants provide a vital contribution to human and livestock health care. This seminar review was an attempt to present five medicinal plants (citrus lemon, caricapapaya, Moringa stenopetala, Allium sativum, Zingiber officinale).

Driving digital transformation of comprehensive primary health services at scale in India: an enterprise architecture framework

In its commitment towards Sustainable Development Goals, India envisages comprehensive primary health services as a key pillar in achieving universal health coverage. Embedded in siloed vertical programmes, their lack of...

A Comparative Case Study: Does the Organization of Primary Health Care in Brazil and Turkey Contribute to Reducing Disparities in Access to Care?

ABSTRACT Brazil and Turkey are among the few high-middle-income countries that explicitly chose to strengthen their primary health care (PHC) systems as the centerpiece of much broader health system reforms aiming to narrow inequities in access to care. This comparative case study reviews the organization of Brazil and Turkey’s PHC systems to derive lessons that can apply to other countries that may consider reforming the organization of PHC systems as a way to address health inequities. The analysis uses the Flagship Framework to investigate how the organization of PHC delivery in Brazil and Turkey can lead to measurable improvements in access to care. It compares (1) the degree of decentralization in PHC service delivery responsibilities, (2) the use of multi-professional PHC teams, and (3) patient impanelment strategies. The comparative analysis offers three important lessons. First, changes in the organization of PHC systems can contribute to observable improvements in the level and distribution of health outcomes, but organizational strategies do not guarantee eliminating disparities in access. Second, PHC systems can operate in health systems with varying degrees of decentralization, but the level of decentralization may influence implementation. Third, relying on multi-professional PHC teams that serve geographically empaneled populations can improve equitable access to care, but course corrections may be needed to address evolving health demands.

Repercussions of lockdown on primary health care in India during COVID 19.

Primary health care is a comprehensive care with a wide range of essential services for people living in the rural and hard-to-reach areas. However, the primary healthcare delivery system in India is still in its initial stages and lacks human resources. With the COVID-19 pandemic around the corner, there has been a diversion of resources for controlling corona pandemic leading to undermining availability and accessibility of health services. This article highlights a few case scenarios and the multidimensional impact of lockdown on primary healthcare services. The article suggests certain appropriate measures that can be implemented as the lockdown simply cannot stop the transmission with no definite treatment and vaccine. There should be a multipronged strategy for breaking the chain of transmission and for future preparedness in case of such situations and to strengthen our primary healthcare system.