Primary Health Care Service Delivery Research Articles

Integrating Pelvic Floor Muscle Training During Pregnancy in Primary Health Care: A Policy Brief

Women with urinary incontinence (UI) during pregnancy may have a greater of experiencing postpartum UI symptoms than women who do not. Pelvic floor muscle exercises can reduce the symptoms of urinary stress incontinence. This policy brief concisely summarizes research findings and policy recommendations to improve antenatal and postnatal pelvic floor muscle training. However, this policy does not work automatically and must be incorporated in primary health care service design and delivery. This policy brief discusses a clear recommendation based on the best evidence to improve prenatal care services. It argues that the key is high-quality prenatal care that is available, affordable, accessible, and compatible with the needs of pregnant women and health care providers.

Of primary health care reforms and pandemic responses: understanding perspectives of health system actors in Kerala before and during COVID-19

BackgroundIn 2016, the Government of the southern Indian state of Kerala launched the Aardram mission, a set of reforms in the state’s health sector with the support of Local Self Governments (LSG). Primary Health Centres (PHCs) were slated for transformation into Family Health Centres (FHCs), with extended hours of operation as well as improved quality and range of services. With the COVID-19 pandemic emerging soon after their introduction, we studied the outcomes of the transformation from PHC to FHC and how they related to primary healthcare service delivery during COVID-19.MethodsA qualitative study was conducted using In-depth interviews with 80 health system actors (male n = 32, female n = 48) aged between 30–63 years in eight primary care facilities of four districts in Kerala from July to October 2021. Participants included LSG members, medical and public health staff, as well as community leaders. Questions about the need for primary healthcare reforms, their implementation, challenges, achievements, and the impact of COVID-19 on service delivery were asked. Written informed consent was obtained and interview transcripts – transliterated into English—were thematically analysed by a team of four researchers using ATLAS.ti 9 software.ResultsLSG members and health staff felt that the PHC was an institution that guarantees preventive, promotive, and curative care to the poorest section of society and can help in reducing the high cost of care. Post-transformation to FHCs, improved timings, additional human resources, new services, fully functioning laboratories, and well stocked pharmacies were observed and linked to improved service utilization and reduced cost of care. Challenges of geographical access remained, along with concerns about the lack of attention to public health functions, and sustainability in low-revenue LSGs. COVID-19 pandemic restrictions disrupted promotive services, awareness sessions and outreach activities; newly introduced services were stopped, and outpatient numbers were reduced drastically. Essential health delivery and COVID-19 management increased the workload of health workers and LSG members, as the emphasis was placed on managing the COVID-19 pandemic and delivering essential health services.ConclusionMost of the health system actors expressed their belief in and commitment to primary health care reforms and noted positive impacts on the clinical side with remaining challenges of access, outreach, and sustainability. COVID-19 reduced service coverage and utilisation, but motivated greater efforts on the part of both health workers and community representatives. Primary health care is a shared priority now, with a need for greater focus on systems strengthening, collaboration, and primary prevention.

Rural health: strengthening primary health care in Kisumu County, Kenya.

Primary health care (PHC) presents an opportunity to reduce disparities in access and utilization of healthcare services between rural and urban areas in Kenya and beyond. The Government of Kenya has prioritised PHC with an aim of reducing inequity and making essential health services person-centric. This study sought to assess the status of PHC systems prior to the set-up of primary care networks (PCNs) in a rural underserved setting in Kisumu County, Kenya. Primary data were collected using mixed method approaches alongside secondary data extraction from routine health information systems. Emphasis was placed on seeking community voices and feedback through community scorecards and focus groups discussions with community participants. 100% of PHC facilities reported commodity stock outs. 82% reported shortages in health workforce while half (50%) had inadequate infrastructure to deliver PHC. While the setting had 100% of households covered by a trained community health worker within their village, community concerns included lack of drugs, poor roads, and lack of access to safe water. Disparities were evident: some communities had no 24-hour health facility within a 5km radius. This assessment has provided comprehensive data that have informed planning for the delivery of quality and responsive PHC services, with community and stakeholders' involvement. Identified gaps are being addressed multi-sectorally to reduce health disparities as Kisumu County makes strides to wards the achievement of universal health coverage targets.

Capacity and quality of maternal and child health services delivery at the subnational primary healthcare level in relation to intermediate health outputs: a cross-sectional study of 12 low-income and middle-income countries

ObjectivesTo examine the capacity and quality of maternal and child health (MCH) services at the subnational primary healthcare (PHC) level in 12 low-income and middle-income countries (LMICs) and its association...

Perceptions towards integrated care through the narrative of practicing social workers and psychologists in PHC: a cross-case analysis

PurposeIn a collective effort to build a patient-centered and coordinated health care system, social workers and psychologists are being progressively introduced to primary health care (PHC) settings worldwide. The present study aims to explore the current status of integration through the narrative of social workers and psychologists in PHC settings in Kazakhstan.Design/methodology/approachIn this paper purposive snowball sampling was utilized to recruit social workers and psychologists who work, or used to work, in PHC settings since the onset of integration in Nur-Sultan for participation in an in-depth interview. A semistructured interview guide was based on normalization process theory (NPT). Interviews were conducted via video conference, in Russian language, lasted no more than 50 min, and transcribed verbatim. Cross-case analysis of eight cases was performed using NPT constructs.FindingsCross-case analysis included findings from the interviews from five social workers and three psychologists. Four major constructs of implementation process from NPT were reflected in the findings: coherence (believes integration improves patient care, functions within integrated care), cognitive participation (individual changes to role performance, mechanisms of work), collective action (status of support from stakeholders, cooperation within a multidisciplinary team) and reflective monitoring (existing mechanisms for monitoring the integration).Research limitations/implicationsDespite organizational integration, there is a lack of successful clinical integration of social workers and psychologists in PHC settings of Kazakhstan, which is manifested by a lack of understanding of responsibilities and functions of these mental health care specialists. Consensus was reached by all participants that both social workers and psychologists are valuable assets in a multidisciplinary team.Originality/valueThe present study contributes to the current knowledge of integrated PHC service delivery by addressing the status of integrated care in Kazakhstan from interviews with key stakeholders in social work and mental health. Moving forward, improvements are needed to (1) establish the monitoring mechanism to evaluate the status of integration, (2) enhance effective collaboration within multidisciplinary teams in PHC settings and (3) increase awareness among medical workers and community members on mental health issues and the available support offered by social workers and psychologists to promote quality of life in a holistic, integrated manner.

Can higher spending on primary healthcare mitigate the impact of ageing and non-communicable diseases on health expenditure?

IntroductionFinancing healthcare for ageing populations has become an increasingly urgent policy concern. Primary healthcare (PHC) has been viewed as the cornerstone of health systems. While most research has examined the...

Determining staffing needs for improving primary health care service delivery in Kaduna State, Nigeria.

Background: The equitable distribution of a skilled health workforce is critical to health service delivery. Kaduna state has taken significant steps to revamp the primary health care system to ensure access to health care for its populace. However, these investments are yet to yield the desired outcomes due to health workforce shortages and the inequitable distribution of those available. Methods: A Workload Indicator for Staffing Need (WISN) study was conducted at Kaduna state's primary health care level. The study focused on estimating staffing requirements; Nurses/Midwives and Community Health Worker practitioners, Community Health Officers, Community Health Extension Workers, and Junior Community Health Extension Workers in all government-prioritised primary health care facilities. A total of ten focal primary health care facilities in Kaduna North Local Government Area (LGA) were included in the study. Results: Findings from the study revealed a shortage of Nurses/Midwives and Community Health Workers across the study facilities. For the Nurse/Midwife staffing category, nine of the ten PHCs have a WISN ratio < 1, indicating that the number of staff in the Nurse/Midwife category is insufficient to cope with the workload. In two of the ten primary health care facilities, there is an excess in the number of CHWs available; a WISN ratio > 1 was calculated. Conclusion: The WISN study highlights staffing needs in Kaduna State's government-prioritised primary health care facilities. This evidence establishes the basis for applying an evidence-based approach to determining staffing needs across the primary health care sector in the State to guide workforce planning strategies and future investments in the health sector. The World Health Organisation (WHO) WISN tool is useful for estimating staffing needs required to cope with workload pressures, particularly in a resource-constrained environment like Kaduna State.

How did primary health care in Beira experience Cyclone Idai?

Beira, the biggest city of Mozambique's Sofala province, was struck by Cyclone Idai on 14 March 2019, with devastating impacts. The floods along with the cyclone destroyed road infrastructure and health facilities and disrupted primary health care (PHC) service delivery. In addition, destruction of farmland and food stocks resulted in malnutrition; the abundance of water fostered the reproduction of mosquitos, exacerbating the burden of malaria; and problems with water and sanitation led to epidemics of cholera. The exact role and contribution of human-induced climate change is very difficult to quantify, but there is little doubt that climate change is driving more frequent and severe cyclones, such as Idai. Considering the current climatic changes, it is expected that climate hotspots such as Beira will only experience more frequent extreme weather events. In these settings, with high risks but low adaptive capacity, dedicated efforts are required to strengthen PHC with a focus on preparedness for disasters. This should entail community awareness and education, strengthening infrastructure and service provision, as well as collaboration with important stakeholders across other sectors.Contribution: Using a case study approach, this article contributes climate resilient PHC for better preparedness to service continuity.

Adoption of a Digital Patient Health Passport as Part of a Primary Healthcare Service Delivery: Systematic Review.

The utilization of digital personal health records is considered to be appropriate for present-time usage; it is expected to further enhance primary care's quality-of-service delivery. Despite numerous studies conducted on digital personal health records, efforts in a systematic evaluation of the topic have failed to establish the specific benefits gained by patients, health providers, and healthcare systems. This study aimed to conduct a systematic review regarding the impact of digital personal health records in relation to the delivery of primary care. The review methods included five methodological elements that were directed by the review protocol 2020 (PRISMA). Over a time period of 10 years (2011-2021), 2492 articles were retrieved from various established databases, including Scopus, Web of Science, PubMed, EBSCO-Medline, and Google Scholar, and based on reference mining. The Mixed Method Appraisal Tool (MMAT) was used for quality appraisal. A thematic analysis was performed to develop the themes in this study. The thematic analysis performed on 13 articles resulted in seven main themes, which were empowering the patient, helping with communication, improving relationships, improving the quality of care, maintaining health records, sharing records, and saving time. We concluded the study by expanding the seven themes into 26 sub-themes, of which each served as answers to our main research question that prompted this systematic review.

Assessment of Interventions in Primary Health Care for Improved Maternal, New-born and Child Health in Sub-Saharan Africa: A Systematic Review

Primary health care (PHC) holds great potentials to improve maternal, newborn, and child health (MNCH) outcomes. However, there has been limited documentation of its effects on increasing universal access to maternal, newborn, and child health services in sub-Saharan Africa. Also, not adequately known are the most effective interventions to improve the delivery of PHC services in the region. The objective of this study was to conduct a systematic review of empirical evidence of interventions that improved access and quality of PHC services for maternal, newborn, and child health in sub-Saharan Africa. The protocol was registered on Prospero (Registration number CRD42019126029). Using terms related to primary health care and MNCH, we searched African Journals Online (AJOL), PubMed/Medline, Popline, ScienceDirect, Google Scholar, WHO Repository (IRIS), Directory of Open Access Journals (DOAJ), Cochrane Library, and reference lists for studies published in English between 2000 and 2019. Studies were included in the search if they reported interventions, and strategies implemented to improve quality and access to primary health care for maternal, newborn, and child health in sub-Saharan Africa. A total of 25 studies were included in the review. Effective interventions included financial incentives, task-shifting, community-directed engagements, training of providers, mobile health, cost-sharing, and supportive supervision among others. The result of this review contributes useful insight to guide the reformation, and development of new policies and programs for improving access and quality of primary health care delivery in sub-Saharan Africa, particularly to improve maternal and child health in the region. However, strategies to scale and sustain the successes need to be in place.

Love, Hope and Despair of Pregnant Women Living in the Slum of Sylhet City Corporation: A Study

Pregnancy is a joyous but stressful phase in every woman’s life as it takes a ten-month-long journey. Support and caring attitude from family members and others, along with regular ante-natal treatment during pregnancy, is essential for every woman because it will protect the health of the unborn baby and future mother. However, in Bangladesh, patriarchal social structure and cultural components bring unequal treatment for women even when they feel sick. So, this qualitative study was conducted to explore the experiences of pregnant women living in the slum area of Sylhet city corporation, Bangladesh. Data were collected purposively from pregnant women during gestational weeks 36–38 who came for treatment at the Urban Primary Health Care Service Delivery Center of Shimantik (NGO). Ten in-depth interviews were conducted through a semi-structured interview schedule, and then collected data were thematically analysed. Data were presented under four themes: role of husband and family members during pregnancy, challenging circumstances within and outside of the family, the reason for the adverse social concern arising and the strategies employed to deal with the hostile condition. This study recommends that there should be a professional counsellor in every maternity health clinic, especially for pregnant women, with whom they can share their personal grief and sufferings.

Using the quadruple aim to understand the impact of virtual delivery of care within Ontario community health centres: a qualitative study.

The onset of the COVID-19 pandemic and introduction of various restrictions resulted in drastic changes to 'traditional' primary healthcare service delivery modalities. To understand the impact of virtual care on healthcare system performance within the context of Ontario community health centres (CHCs). Thematic analysis of qualitative interviews with 36 providers and 31 patients. Semi-structured phone interviews were conducted in the autumn of 2020. Interviews were recorded, transcribed verbatim, and analysed thematically using the quadruple aim framework. The transition to virtual delivery of services has had both positive and negative impacts on care. Virtual care removed certain barriers to care such as access. However, patients and providers found that phone visits impacted quality of care owing to the inability to read body language and having to rely solely on patient descriptions. Video visits allowed for a similar experience to in-person visits but technical issues constrained this interaction. Depending on the service provided, some providers felt they were not providing the same quality of care. However, providers reported reductions in no-show rates and highlighted the efficiency of virtual appointments. Providers also found they were able to collaborate at a similar level before the pandemic and saw improvements in work-life balance. Overall, patients and providers alike preferred virtual visits with those known to them, and for less complex or transactional aspects of care. The study described positive and negative impacts on patient care, population health, health system costs, and provider experience. These results will be useful for primary care organisations in post-pandemic planning; however, future research is needed for a deeper exploration of the impact on quality of care specifically for more complex health concerns.

OPTIMIZATION OF HEALTHCARE WORKERS AVAILABILITY : INCREASING PRIMARY HEALTH CARE EFFICIENCY IN INDONESIA

Policy has focused on the unequal distribution of health workers, while the potential for improvements in efficiency to address this problem has been neglected. This study aims to measure and compare the level of efficiency in the use of the available health workforce for the delivery of selected primary healthcare services among districts/cities in Indonesia, and to identify factors influencing that efficiency. The Data Envelopment Analysis method with output orientation to measure efficiency and Tobit regression analysis was performed to determine the effect of contextual factors. The average score for the technical efficiency of primary health care service delivery throughout Indonesia was 1.29, indicating the potential to achieve on average 29% higher coverage of the selected primary health services if all were as efficient as the most efficient. The average efficiency score in the Eastern Indonesia region was 1.62 and the average in the Java-Bali region was 1.05, indicating higher potential efficiency gains in the Eastern Indonesia region. Access to health care facilities was a consistently significant factor influencing the efficiency of primary health care in almost all regions. This study has demonstrated the potential for significant gains in coverage of key primary care services through improvements in the efficiency of use of the existing health workforce.

The organisation of primary health care service delivery for non-communicable diseases in Nigeria: A case-study analysis.

As chronic diseases, non-communicable diseases (NCDs) require sustained person-centred and community-based care. Given its direct link to communities and households, Primary Health Care (PHC) is well positioned to achieve such care. In Nigeria, the national government has prioritized PHC system strengthening as a means of achieving national NCD targets. However, strengthening PHC systems for NCDs require re-organization of PHC service delivery, based on contextual understanding of existing facilitators and barriers to PHC service delivery for NCDs. We conducted a mixed method case study to explore NCD service delivery with 13 PHC facilities serving as the cases of interest. The study was conducted in two northern and two southern states in Nigeria-and included qualitative interviews with 25 participants, 13 focus group discussion among 107 participants and direct observation at the 13 PHCs. We found that interprofessional role conflict among healthcare workers, perverse incentives to sustain the functioning of PHC facilities in the face of government under-investment, and the perception of PHC as an inferior health system were major barriers to improved organisation of NCD management. Conversely, the presence of physicians at PHC facilities and involvement of civil society organizations in aiding community linkage were key enablers. These marked differences in performance and capacity between PHC facilities in northern compared to southern states, with those in the south better organised to deliver NCD services. PHC reforms that are tailored to the socio-political and economic variations across Nigeria are needed to improve capacity to address NCDs.

Determining staffing needs for improving primary health care service delivery in Kaduna State, Nigeria.

Background: The equitable distribution of a skilled health workforce is critical to health service delivery, and Kaduna state has taken significant steps to revamp the primary health care system to ensure access to health care for its populace. However, some of these investments are yet to yield the desired outcomes due to workforce shortages and inequitable distribution of those available. Methods: A Workload Indicator for Staffing Need study was conducted at the primary health care level in Kaduna state. The study focused on estimating staffing requirements; Nurse/Midwife and Community Health Worker practitioners; Community Health Officer, Community Health Extension Worker and Junior Community Health Extension Worker, in all government prioritized primary health care facilities. Ten focal primary health care facilities in Kaduna North Local Government Area were included in the study. Results: Findings revealed a shortage of Nurses/Midwives and Community Health Workers across the study facilities. For the Nurse/Midwife staffing category, 9/10 PHCs have a Workload Indicator for Staffing Need ratio < 1; indicating that the number of staff in the Nurse/Midwife category is insufficient to cope with the workload. In two of the ten primary health care facilities, there is an excess in the number of CHWs available; a Workload Indicator for Staffing Need ratio > 1 was calculated. Conclusions: The Workload Indicator for Staffing Need study highlights the staffing needs in government prioritized primary health care facilities in Kaduna state. This evidence establishes the basis for the application of an evidence-based approach to determining staffing needs across the primary health care sector in the State, to guide workforce planning strategies and future investments in the health sector. The World Health Organisation Workload Indicator for Staffing Need tool is useful in estimating staffing needs required to cope with workload pressures, particularly in a resources-constrained environment like Kaduna State.

The effect of health promotion on primary health care services: an analysis of primary health care policy

Health promotion is the best way to prevent mental illness and other illnesses in the community. However, the high rate of corruption and embezzlement of funds has impeded the effectiveness of health promotion in Primary health care system in Nigeria. More so, health promotion is the best way to alleviate diseases and prevent diseases. However, nearly all the health care workers are aware of the benefits of health promotion but to implement it is the problem. The aim: to examine the effect of health promotion on primary health care service through the analysis of Primary Health Care policy. Method: this study was guided by a pragmatic paradigm. The pragmatist paradigm is highly essential to this study because it emphasizes the link between action and truth. It is also ideal for this study as it advocates for mixed methods that are in line with ethnographic research approach to provide the best understanding of a research problem. Furthermore, pragmatic paradigm was adopted for this study and this paradigm encourages the study to combine two research methods (qualitative and quantitative) to achieve quality research findings. In this study a non-experimental, exploratory-descriptive design was used to analyse the quantitative aspect of the national health policies on primary health care service delivery in Nigeria. While ethnographic method analysed the qualitative aspect of the study perfectly. Result: out of three hundred respondents, majority of them revealed that bad leadership is the main reason why health promotion is not effective. While majority of the participants opined that we lack good leaders. The study hereby emphasized more on why the Government is not working on the effectiveness of health promotion in PHC and the findings showed that bad leadership is the main factor that is causing the ineffectiveness of health promotion in PHC and when the respondents were questioned on what to do to ensure a more effective health promotion in the community, majority (34.7 %) of the respondents opined that the community members should be involved actively at every stage while (33.3 %) of the respondents revealed that there is need for active involvement of other essential sectors in formulation and implementation of PHC policy to ensure a permanent change. Conclusion: all things considering, this study shows that poor health promotion in Primary health care is having negative effect on the health of children, adolescents, adults, and old ones. This study here by recommends that the policy makers and the government should eradicate corruption and embezzlement of funds in all sectors especially in primary health care

The performance based budgeting as a catalyst for effective delivery of primary health care

The main aim of this article is to explore how performance-based budgeting has an effect on primary health care service delivery in the Eastern Cape. This article assessed the performance-based budgeting system in the Eastern Cape Department of Health in an attempt to advocate for effective and efficient health service delivery. The Eastern Cape Province is succumbing to insufficient funding at the provincial level and this has a clear-cut reflection on the administration of services within respective departments. The article is premised on a constructivist paradigm that adopts a qualitative approach where document analysis was employed for collecting data. The Eastern Cape Province is succumbing to insufficient funding at the provincial level and this has a clear-cut reflection on the administration of services within respective departments. The article employed the Public Choice Theory and the Concept of New Public Management. Three main findings emerged from the article of the crippled funds in the province, the human resources crisis, poor public finance management, and shortage of health equipment. Data were analyzed using thematic analysis to examine the distinctive themes and sub-themes identified from within the reviewed literature. Recommendations were thus given based on the discussed and derived themes to ensure that there is an appropriate budgeting system to ensure efficient and effective provision of health care services in the Eastern Cape Department of Health.

Nucleic Acid Point-of-Care Testing to Improve Diagnostic Preparedness.

Testing programs for severe acute respiratory syndrome coronavirus 2 have relied on high-throughput polymerase chain reaction laboratory tests and rapid antigen assays to meet diagnostic needs. Both technologies are essential; however, issues of cost, accessibility, manufacturing delays, and performance have limited their use in low-resource settings and contributed to the global inequity in coronavirus disease 2019 testing. Emerging low-cost, multidisease point-of-care nucleic acid tests may address these limitations and strengthen pandemic preparedness, especially within primary healthcare where most cases of disease first present. Widespread deployment of these novel technologies will also help close long-standing test access gaps for other diseases, including tuberculosis, human immunodeficiency virus, cervical cancer, viral hepatitis, and sexually transmitted infections. We propose a more optimized testing framework based on greater use of point-of-care nucleic acid tests together with rapid immunologic assays and high-throughput laboratory molecular tests to improve the diagnosis of priority endemic and epidemic diseases, as well as strengthen the overall delivery of primary healthcare services.

Local Government and Primary Health Care service delivery in South-Western Nigeria 2010–2015

Primary Health Care (PHC) is implemented by the local governments in Nigeria based on the notion that healthcare service delivery is efficient when it is closer to people. With the adoption of analytical research through secondary sources of data, this study assesses the local government performance in PHC service delivery and examines the challenges it faced in the south-western Nigeria states of Lagos, Ogun, and Ondo in the period of 2010–2015. The findings showed various PHC programmes implemented by the local governments of the selected states, which include Maternal and Child Reduction, Investment Case and Eko Free Malaria in Lagos state, Araya and Gbomoro in Ogun state, as well as the Mother and Child Hospitals and Agbebiye in Ondo state. However, findin gs showed similar challenges encountered by the local governments, which include multiplicity of stakeholders in the disbursement of PHC funds, lack of fiscal decentralisation of revenue to the local government, diversion of PHC funds as compared to other projects, and poor community participation in PHC, irregularity of or interference in the local government elections by the state government, exclusion and deviation from the key principles of PHC and lack of continuity in PHC programmes implemented. The general conclusion from the study is that the local government performance in PHC service delivery is weak. In order to enhance the present local government performance in PHC, the study recommends for the application and implementation of local government constitutional role in the management of the PHC service delivery.

Strengths and risks of the Primary Health Network commissioning model.

Objective To explain how the Primary Health Network commissioning model works, and factors likely to affect its success. Methods The study focuses on the delivery of primary healthcare services by one Primary Health Network (PHN) in Australia. The qualitative case study is informed by a desk top review, interviews (n = 49) and observations with key stakeholders involved in commissioning and delivering primary healthcare services in the region. Results The study provides several insights about the PHN model. First, conceptually, the PHN commissioning model is well suited to identifying and meeting local primary healthcare priorities, bringing together a range of stakeholders involved in healthcare provision. Second, although primary healthcare services are difficult to specify and measure, PHN staff use their content knowledge and experience, and relationships with providers and the community, to design services that meet the needs of consumers. Third, the success of this model may be undermined by short funding cycles and short lead-times, a focus on national rather than local priorities, and continual reductions in operational funding. This may result in more procedural forms of contract management, which may mean that changes in service need, provision and quality go unnoticed. Conclusions This study shows that although clever in design, the PHN model may not meet its full potential. Given continual changes to the model, including funding, further independent research should be undertaken to understand how PHNs adjust and whether services continue to meet the needs of the local community.