Implementation Of Primary Health Care Research Articles

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

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

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

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

Capacity issues in primary health care implementation: examples from Ghana

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

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

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

PERSIAPAN PELAKSANAAN REAKREDITASI DI 4 PUSKESMAS KOTA YOGYAKARTA

Background: Accreditation is conducted to improve the quality in health service. For continuous quality improvement, we need to re-measure quality standards through re-accreditation. In 2019, several primary health care in Yogyakarta city will face re-accreditation.
 In order to do that, preparation is needed. Preparation for the implementation of primary health care must be planned as well as possible to gain optimal results.
 Objective: To analyze preparation for the implementation of primary health care re-accreditation in Yogyakarta city
 Methods: Descriptive research using a qualitative approach design. There were 18 participants selected by purposive sampling technique. Data collection was carried out by in-depth interview, focus group discussion (FGD) and assessment checklist.
 Results: For Puskesmas Kotagede I, preparation for the implemen tation of primary health care re-accreditation is good but lacking in Man and Do variable. Preparation for the implementation of primary health care re-accreditation are good for both Puskesmas Mergangsan and Gondokusuman I but lack in Do variable. For Puskesmas Tegalrejo, preparation for the implementation of primary health care re-accreditation is good but lacking in Money and Man
 variable.
 Conclusion: Primary health care and the Ministry of Health have been preparing for re-accreditation process well even though several scheduled activities have been postponed due to clashes with other assignments.
 

Supporting the utilization of community-based primary health care implementation research in Ghana.

Ever since the 1990s, implementation research in Ghana has guided the development of policies and practices that are essential to establishing community-based primary health care. In response to evidence emerging from this research, the Community-based Health Planning and Services (CHPS) policy was promulgated in 1999 to scale-up results. However, during the first decade of CHPS operation, national monitoring showed that its pace of coverage expansion was unacceptably slow. In 2010, the Ghana Health Service launched a 5-year plausibility trial of CHPS reform for testing ways to accelerate scale-up. This initiative, known as the Ghana Essential Health Intervention Program (GEHIP), included a knowledge management component for establishing congruence of knowledge generation and flow with the operational system that GEHIP evidence was intended to reform. Four Upper East Region districts served as trial areas, while seven districts were comparison areas. Interventions tested means of developing the upward flow of information based on perspectives of district managers, sub-district supervisors and community-level workers. GEHIP also endeavoured to improve procedures for the downward flow and utilization of policy guidelines. Field exchanges were convened for providing national, regional and district leaders with opportunities for participatory learning about GEHIP implementation innovations. This systems approach facilitated the process of augmenting the communication of evidence with practical field experience. Scientific rigor associated with the production of evidence was thereby integrated into management decision-making processes in ways that institutionalized learning at all levels. The GEHIP knowledge management system functioned as a prototype for guiding the planning of a national knowledge management strategy. A follow-up project transferred its mechanisms from the Upper East Regional Health Administration to the Policy Planning Monitoring and Evaluation Division of the Ghana Health Service in Accra.

Primary health care in the Amazon and its potential impact on health inequities: a scoping review.

Health studies of the Amazon often focus on diseases and infections prevalent in the region, and few studies address health organizations and services. In this sense, this study fills a gap by reviewing the studies aimed at primary healthcare (PHC) implementation in the nine Amazonian countries. This review addresses a need to explore the forms in which PHC is implemented in the Amazon areas outside the urban centers and its potential to reduce health inequities. This study contributes to improvements in the practices of managers and health professionals and research on the topic. Scoping review methodology was applied to peer-reviewed articles. The databases searched were PubMed, Scopus, Lilacs, Embase and Web of Science. Selected studies included peer-reviewed publications, published between January 2000 and November 2019, that focused on PHC or one of its components in the Amazon, and were published in English, Spanish and Portuguese. The study used Arksey and O'Malley's scoping review guidelines, supported by Levac, and included five steps: (i) identification phase, where search queries were applied to the databases followed by the removal of duplicates; (ii) screening phase, where titles and abstracts of articles were screened to exclude irrelevant articles; (iii) eligibility phase, where the full texts of articles were read to assess their relevancy to this study; (iv) data extraction, using a spreadsheet designed to capture relevant information required in this review, using an iterative process; (v) summarizing and classification of each article according to content. The second and third phases were conducted independently by two reviewers. If a disagreement arose between the reviewers, a third reviewer was consulted to help decide whether to include or exclude a study. This review included 25 studies. Of these, 11 presented promising results regarding PHC functioning in the Amazon region, and 14 presented challenges and difficulties in its functioning. Some PHC strategies implemented in the Amazon showed the potential to reduce inequities, mostly when they involved actions that increased access to PHC in the region when they developed a culturally adapted role and engaged community members in the decision-making and in the collaborative construction of health services. Actions that exposed challenges and difficulties were related to ill-prepared healthcare professionals, inadequate service approach and the inability to adapt to cultural issues. The findings reveal information about PHC implementations that have had promising results in the Amazon region and, at the same time, show the challenges and difficulties of the PHC actions. The findings also highlight and synthesize knowledge about the potential that PHC strategies have to affect existing inequities in the Amazon region and gaps in the studies that have been undertaken, or at least published, including a lack of studies of PHC implementation and examination of strategies aimed at health determinants.

The Medical Nemesis of Primary Health Care Implementation: Evidence From Ghana.

Primary Health Care (PHC), based on the Alma Ata declaration, calls for the movement of responsibility, resources, and control away from medical systems and curative measures toward health promotion. However, PHC implementation in practice appears to be heavily influenced by medical systems with its own attendant effects on the attainment of PHC goals. This study therefore examines the extent and effects of medical systems influence on PHC implementation in Ghana. The study uses the thematic framework approach to qualitative data analysis to analyze data collected from PHC managers through interviews. Ethical clearance for the study was obtained from the Noguchi Memorial Institute for Medical Research. Findings suggest that PHC in practice is tied to the apron-strings of medical systems. While this has catalyzed successes in disease control programs and other medicine-based interventions, it has swayed PHC from its intended shift toward health promotion. Community ownership, participation, and empowerment in PHC is therefore lost in the maze of medical systems which reserves power over PHC decision making and implementation to medical professionals while focusing attention on treatment and curative services. Ultimately, PHC has gradually metamorphosed into mini-clinics instead of the revolutionary community-driven promotive services espoused by Alma Ata with concomitant effects on the attainment of Universal Health Coverage. Further, findings show how gradually, the primary in PHC is being used as a descriptor of the first or basic level of hospital-based care instead of a first point of addressing existing health problems using preventive, promotive, and other community driven approaches. Without a reorientation of health systems, significant efforts and resources are channeled toward empowering health workers instead of local communities with significant effects on the long term sustainability of health efforts and the attainment of UHC. The study recommends further studies toward practical means of reducing the influence of medical systems.

Primary Health Care in Northern and Northeastern Brazil: mapping team distribution disparities.

This study analyzes the spatial pattern of implementation of Primary Health Care (PHC) teams in Northern and Northeastern Brazil. This is an ecological study on the rates of Community Health Workers (ACS), Family Health Team (eSF), Oral Health Team (eSB), and Family Health Extended Center (NASF) based on data from the Ministry of Health (MoH). The analysis of the area data identified patterns of spatial dependence of the municipalities for the rates, using Moran indices and scatterplots to visualize critical areas' clusters (95% confidence). Municipalities of the North (n=450) and Northeast (n=1,794) had 132,174 ACS, 18,405 eSF, 13,017 eSB, and 2,205 NASF. The proportion of municipalities with rates within the recommended by the MoH were: ACS (>1.33), 96% in the North and 98.5% in the Northeast; eSF (>2.9/1,000), 54% and 80% in the respective regions; eSB (>2.9/10,000) 28% and 59% in these respective regions. NASF teams were deployed in 70% of the North and 89% of the Northeast. Except for ACS, the North was a critical team area, mainly in Pará, Rondônia, Amazonas, and Amapá. In the Northeast, these areas were smaller and concentrated mainly in western Bahia and eastern Maranhão. The Northeast showed a better composition of teams and a smaller extent of critical areas.

Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces.

Introduction:Team-based care can improve integrated health services by increasing comprehensiveness and continuity of care in primary healthcare (PHC) settings. Collaborative models involving providers from different professions can help to achieve coordinated, high-quality person-centred care. In Canada, there has been variation in both the timing/pace of adoption and approach to interprofessional PHC (IPHC) policy. Provinces are at different stages in the development, implementation, and evaluation of team-based PHC models. This paper describes how different policies, contexts, and innovations across four Canadian provinces (British Columbia, Alberta, Ontario, Quebec) facilitate or limit integrated health services through IPHC teams.Methods:Systematic searches identified 100 policy documents across the four provinces. Analysis was informed by Walt and Gilson’s Policy Triangle (2008) and Suter et al.’s (2009) health system integration principles. Provincial policy case studies were constructed and used to complete a cross-case comparison.Results:Each province implemented variations of an IPHC based model. Five key components were found that influenced IPHC and integrated health services: patient-centred care; team structures; information systems; financial management; and performance measurement.Conclusion:Heterogeneity of the implementation of PHC teams across Canadian provinces provides an opportunity to learn and improve interprofessional care and integrated health services across jurisdictions.

Implementation strategy of primary health care in Ovia communities

Primary health care is the essential health service provided at the grassroot level. Over the years the implementation of Primary Health Care (PHC) programmes in Edo state are bedeviled with associated challenges such as limited community participation, great communication gap that limit evaluation processes of PHC programme and slow pace collaboration among stakeholders. These challenges need to be averted through effective and people oriented strategies to ensure the implementation of primary health care. A descriptive research design with a population of the study comprised 1,024 primary health care stakeholders in Edo state. Multi-stage sampling technique was used to select 180 respondents for the study. The study found that intersectoral collaboration involving partnerships with community health agencies such as village health committees and ward health committees significantly influenced the implementation of PHC. Intersectoral collaboration, community mobilization strategy and community feedback mechanism are effective and efficient strategies for improved implementation of PHC programmes. The study recommended among others that National Primary Health Care Development Agency (NPHCDA) and State Primary Health Care Development Agency (SPHCDA) should strengthen partnership with international health organizations such as WHO, UNICEF, GAVI, UNDP and boost confidence and trust of these international organizations.

Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context.

Since the Alma Ata Declaration of 1978, countries have varied in their progress towards establishing and sustaining comprehensive primary health care (PHC) and realizing its associated vision of ‘Health for All’. International health emergencies such as the coronavirus-19 (COVID-19) pandemic underscore the importance of PHC in underpinning health equity, including via access to routine essential services and emergency responsiveness. This review synthesizes the current state of knowledge about PHC impacts, implementation enablers and barriers, and knowledge gaps across the three main PHC components as conceptualized in the 2018 Astana Framework. A scoping review design was adopted to summarize evidence from a diverse body of literature with a modification to accommodate four discrete phases of searching, screening and eligibility assessment: a database search in PubMed for PHC-related literature reviews and multi-country analyses (Phase 1); a website search for key global PHC synthesis reports (Phase 2); targeted searches for peer-reviewed literature relating to specific components of PHC (Phase 3) and searches for emerging insights relating to PHC in the COVID-19 context (Phase 4). Evidence from 96 included papers were analysed across deductive themes corresponding to the three main components of PHC. Findings affirm that investments in PHC improve equity and access, healthcare performance, accountability of health systems and health outcomes. Key enablers of PHC implementation include equity-informed financing models, health system and governance frameworks that differentiate multi-sectoral PHC from more discrete service-focussed primary care, and governance mechanisms that strengthen linkages between policymakers, civil society, non-governmental organizations, community-based organizations and private sector entities. Although knowledge about, and experience in, PHC implementation continues to grow, critical knowledge gaps are evident, particularly relating to country-level, context-specific governance, financing, workforce, accountability and service coordination mechanisms. An agenda to guide future country-specific PHC research is outlined.

THE ROLE OF POSYANDU CADRES IN EFFORTS TO IMPROVE THE NUTRITIONAL STATUS OF TODDLERS IN SUKA MAKMUR VILLAGE, PATILANGGIO DISTRICT

THE ROLE OF POSYANDU CADRES IN EFFORTS TO IMPROVE THE NUTRITIONAL STATUS OF TODDLERS IN SUKA MAKMUR VILLAGE, PATILANGGIO DISTRICT

Perceived impact of the characteristics of the Indigenous Queensland B.strong brief intervention training program on uptake and implementation.

Brief interventions (BIs) in primary health care (PHC) settings can be effective in addressing behavioural risk factors of chronic conditions. However, the impact of the characteristics of BI training programs on the uptake of the program and implementation of BIs in Indigenous PHC settings is not fully understood. The B.strong Program was an Indigenous health worker BI training program delivered in Queensland from 2017 to 2020. This study examines the impact of the characteristics of the B.strong Program on its uptake and implementation in PHC settings. Semi-structured interviews were conducted in 2019 and 2020 with 20 B.strong Program trainees and four health service managers from eight purposively sampled Queensland PHC services, and one Queensland Department of Health manager, to collect their perceptions of the implementation of the B.strong Program. The Consolidated Framework for Implementation Research guided data collection. Key program characteristics that facilitated both the program uptake and the implementation of BIs were: ensuring the cultural appropriateness of the program from development, to engagement with health services and through to delivery, the applicability of the program to trainees' daily clinical work, program credibility, and its ease of access and availability. Participants preferred face-to-face workshop training for online module training. Relevance to practice, easy access, program credibility and measures taken to ensure cultural appropriateness of the B.strong Program in development, in engagement stages with health services, and in program delivery facilitated program uptake and implementation of BIs. Online BI training may be of limited value compared to face-to-face training in this setting. SO WHAT?: To enhance participation by Indigenous PHC services in health worker BI training programs and implementation of BIs posttraining by health staff, it is important to ensure the cultural appropriateness of the program's characteristics, and its development, engagement and delivery processes.

\u201cThe staff are not motivated anymore\u201d:\xa0Health care worker perspectives on the Integrated Management of Childhood Illness (IMCI)\xa0program in the Philippines

BackgroundStudies focusing on the Integrated Management of Childhood Illness (IMCI) program in the Philippines are limited, and perspectives of frontline health care workers (HCWs) are largely absent in relation to the introduction and current implementation of the program. Here, we describe the operational challenges and opportunities described by HCWs implementing IMCI in five regions of the Philippines. These perspectives can provide insights into how IMCI can be strengthened as the program matures, in the Philippines and beyond.MethodsIn-depth interviews (IDIs) were conducted with HCWs (n = 46) in five provinces (Ilocos Sur, Quezon, National Capital Region, Bohol and Davao), with full transcription and translation as necessary. In parallel, data collectors observed the status (availability and placement) of IMCI-related materials in facilities. All data were coded using NVivo 12 software and arranged along a Social Ecological Model.ResultsHCWs spoke of the benefits of IMCI and discussed how they developed workarounds to ensure that integral components of the program could be delivered in frontline facilities. Five key challenges emerged in relation to IMCI implementation in primary health care (PHC) facilities: 1) insufficient financial resources to fund program activities, 2) inadequate training, mentoring and supervision among and for providers, 3) fragmented leadership and governance, 4) substandard access to IMCI relevant written documents, and 5) professional hierarchies that challenge fidelity to IMCI protocols.ConclusionAlthough the IMCI program was viewed by HCWs as holistic and as providing substantial benefits to the community, more viable implementation processes are needed to bolster acceptability in PHC facilities.

How Barunga Aboriginal community implemented and sustained an anaemia program - A case study evaluation.

Anaemia persists as a public health issue in many Aboriginal communities despite having standard practice guidelines. This case study reveals how Barunga Aboriginal Community in the Northern Territory (NT), Australia, implemented an Anaemia Program (1998-2016) which contributed to low anaemia prevalence in children aged under 5years. This retrospective qualitative case study used purposive sampling to describe the Anaemia Program and factors influencing its implementation. Themes were developed from convergence of three data sources: interviews, program observation and document review. Data were inductively analysed by an Aboriginal and non-Aboriginal researcher and themes were validated by Barunga community health practitioners and compared to practice guidelines and implementation literature. Health practitioners reported that the Anaemia Program contributed to a marked reduction in childhood anaemia prevalence over time. This was supported by available prevalence data. The locally adapted Anaemia Program was unique in the NT with a novel approach to community supplementation for anaemia prevention in addition to anaemia treatment. Supportive implementation influences included: Aboriginal leadership and the use of culturally supportive processes which reinforced the development of trust and strong relationships facilitating community acceptance of the Program. Routine, opportunistic and flexible health care practice, a holistic approach and a stable, skilled and experienced team sustained program implementation. The holistic and successful Barunga Anaemia Program is supported by evidence and guidelines for treating and preventing childhood anaemia. The contextualisation of these guidelines aligned with the literature on effective Aboriginal primary health care implementation. SO WHAT?: This Anaemia Program provides a model for implementation of evidence-informed guidelines in an Aboriginal primary health care setting.

Workshops for approaching suicidal behavior: implementation in Primary Health Care.

to describe the implementation of workshops on the approach of people in psychological distress with suicidal behavior for Primary Health Care workers and managers. this is an action research developed for Primary Health Care professionals in a city in the countryside of São Paulo. Charles Maguerez's Arch methodology was used as a theoretical framework to construct the workshops. through active strategies and the exercise of reflection-action, the workshops enabled participants to raise awareness on the topic, articulation between professionals and managers, and the co-responsibility required to care for users with suicidal behavior assisted in Primary Health Care. the workshops broadened knowledge, facilitating skill development to qualify Primary Health Care professionals in caring for people with suicidal behavior.

Perceived appropriateness of alcohol screening and brief advice programmes in Colombia, Mexico and Peru and barriers to their implementation in primary health care - a cross-sectional survey.

Providing alcohol screening and brief advice (SBA) in primary health care (PHC) can be an effective measure to reduce alcohol consumption. To aid successful implementation in an upper middle-income country context, this study investigates the perceived appropriateness of the programme and the perceived barriers to its implementation in PHC settings in three Latin American countries: Colombia, Mexico and Peru, as part of larger implementation study (SCALA). An online survey based on the Tailored Implementation for Chronic Diseases (TICD) implementation framework was disseminated in the three countries to key stakeholders with experience in the topic and/or setting (both health professionals and other roles, for example regional health administrators and national experts). In total, 55 respondents participated (66% response rate). For responses to both appropriateness and barriers questions, frequencies were computed, and country comparisons were made using Chi square and Kruskal-Wallis non-parametric tests. Alcohol SBA was seen as an appropriate programme to reduce heavy alcohol use in PHC and a range of providers were considered suitable for its delivery, such as general practitioners, nurses, psychologists and social workers. Contextual factors such as patients' normalised perception of their heavy drinking, lack of on-going support for providers, difficulty of accessing referral services and lenient alcohol control laws were the highest rated barriers. Country differences were found for two barriers: Peruvian respondents rated SBA guidelines as less clear than Mexican (Mann-Whitney U = -18.10, P = 0.001), and more strongly indicated lack of available screening instruments than Colombian (Mann-Whitney U = -12.82, P = 0.035) and Mexican respondents (Mann-Whitney U = -13.56, P = 0.018). The study shows the need to address contextual factors for successful implementation of SBA in practice. General congruence between the countries suggests that similar approaches can be used to encourage widespread implementation of SBA in all three studied countries, with minor tailoring based on the few country-specific barriers.

Communities on the move: community participation in health in rural territories of Buenaventura District in Colombia

BackgroundSocial and community participation is a fundamental component of the development of renewed primary healthcare (PHC). With the recognition of health as a right, such participation is a significant part of the design of public policies aimed at this sector. These policies contribute not only to overcoming inequity in the provision of this type of services but also to a reduction in social inequalities as a whole. Through a comparative analysis, this study aimed to explain the conditions through which ethnic-rural territories of the Colombian Pacific coast participate in health to contribute to the generation of policies and programs in territories with similar conditions.MethodsThe work was developed through the use of multiple techniques and strategies for information collection and analysis. These include several semi-structured interviews, multiple observation exercises and analysis based on a set theory, i.e., qualitative comparative analysis (QCA). The latter aims to develop a model that provides a count of the main causal combinations that allow high community participation in health.ResultsKey findings include how the trajectory of social mobilization and existence of a robust community social fabric became two critical conditions for community participation in the context of social exclusion. The presence of variables such as the implementation of PHC, guarantee of social rights, and trust in institutions, is underestimated as sufficient causal conditions for obtaining this result. Therefore, it is essential to recognize the existence, validity, and importance of processes, experiences, and resourcefulness of political natures, which aim at transforming the daily reality of the inhabitants of these communities. These also set a potential space and scenario for managing the communities’ main problems, including health, in the absence of institutionality that guarantees access to their social rights.ConclusionThis study points out the importance of understanding community participation as a political activity, expanding exchange dynamics and dialogs between institutions, rulers, and communities to provide social responses in health and well-being to communities and to understand local realities and their own community dynamics.

Measures to strengthen primary health-care systems in low- and middle-income countries.

Primary health care offers a cost–effective route to achieving universal health coverage (UHC). However, primary health-care systems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primary health-care systems in 20 low- and middle-income countries using a semi-grounded approach. Options for strengthening primary health-care systems were identified by thematic content analysis. We found that: (i) despite the growing burden of noncommunicable disease, many low- and middle-income countries lacked funds for preventive services; (ii) community health workers were often under-resourced, poorly supported and lacked training; (iii) out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and (iv) health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in primary health care was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of primary health care. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. Policy-making should be supported by adequate resources for primary health-care implementation and government spending on primary health care should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of primary health-care management is also needed. Support from primary health-care systems is critical for progress towards UHC in the decade to 2030.