Provision Of Primary Health Care Services Research Articles

Challenges of Local Government in the Provision of Primary Health Care Services in Ebonyi State. Nigeria

Rural areas in Nigeria including Ebonyi State, suffer from development challenges. One of these challenges is inadequate provision of primary healthcare services to the people. This ugly condition has worsened the case of infant and maternal mortalities in Nigeria and Ebonyi State in particular and this demands urgent attention of the local governments as well as other key development partners in order to address the challenge and improve the standard of living of people at the grassroots. It is based on this that this study investigated the challenges of local government in the provision of primary healthcare services in Ebonyi State. Data were sourced from text books, journals, and internet and library materials. As a qualitative study, content and narrative techniques were adopted to analyze the study. The study revealed that minimum standards set for provision of primary healthcare service delivery have not been met in Ebonyi State; hence, local governments in the study area have not optimally contributed to reduction of infant and maternal mortalities due to certain factors which include: poor healthcare financing, dilapidated primary healthcare infrastructure, shortage of qualified healthcare personnel, corruption in the healthcare sector, and lack of broad-based data bank for beneficiaries of primary healthcare services in the area. The paper therefore recommended proper funding of primary healthcare centres in Ebonyi State in line with the international and national benchmarks. This can be achieved through increased budgetary allocations by granting financial autonomy to local governments; more hospitals and clinics should be provided to increase access to health care facilities; there is also urgent need for massive recruitment of qualified healthcare personnel in the study area to among other things improve the quality of healthcare services available to the people in the localities.

Calculating the Costs of Implementing Integrated Packages of Community Health Services: Methods, Experiences, and Results From 6 sub-Saharan African Countries.

Ensuring access to a package of integrated primary health care services is essential for achieving universal health coverage. In many countries, community health programs are necessary for primary health care service provision, but they are generally underfunded, and countries often lack the necessary evidence on costs and resource requirements. We conducted prospective cost analyses of community health programs in 6 countries in sub-Saharan Africa using the Community Health Planning and Costing Tool. The Community Health Planning and Costing Tool is a spreadsheet-based tool designed to cost key programmatic elements of community health services packages, including training, equipment, incentives, supervision, and management. In each country, stakeholders defined a package of community health services and corresponding standard treatment guidelines to estimate normative costs, which were applied to program scale-up targets. The data were entered into the tool, and cost models were prepared for different geographical and service utilization scenarios. The results were reviewed and validated with the governments, implementing partners, and expert panels. Additional scale-up scenarios were modeled, taking into account probable constraints to increasing community health service provision and potential funding limitations. The services and scope of community health service packages varied by country, depending on contextual factors and determined health priorities. The package costs also varied significantly depending on the size and contents of the service package, the service delivery approach, the remuneration of the community health workers, and the cost of medicines and supplies. Community health programs and service packages are different in every country and change over time as they evolve. They should be routinely costed as an integral part of the planning and budgeting process and to ensure that sufficient resources are allocated for their effective and efficient implementation.

Primary healthcare service delivery for older people with progressive multimorbidity in low- and middle-income countries: a systematic review.

Ensuring primary healthcare (PHC) accessibility to older people with multimorbidity is vital in preventing unnecessary health deterioration. However, older people ≥50y of age in low- and middle-income countries (LMICs) face challenges in effectively accessing and utilizing PHC. A systematic review was conducted adopting the Andersen-Newman theoretical framework for health services utilization to assess evidence on factors that affect access to PHC by older people. This framework predicts that a series of factors (predisposing, enabling and need factors) influence the utilization of health services by people in general. Seven publications were identified and a narrative analytical method revealed limited research in this area. Facilitating factors included family support, closeness to the PHC facility, friendly service providers and improved functional status of the older people. Barriers included long distance and disjointed PHC services, fewer health professionals and a lack of person-centred care. The following needs were identified: increasing the number of health professionals, provision of PHC services under one roof and regular screening services. There is a need for more investment in infrastructure development, coordination of service delivery and capacity building of service providers in LMICs to improve access and utilization of PHC services for older people.

A qualitative exploration of factors that influence the uptake of tuberculosis services by low-skilled migrant workers in Singapore

IntroductionSingapore relies heavily on migrant workers to build its country and harbours a relatively large population of these workers. Importantly, tuberculosis (TB) remains a pernicious threat to the health of these workers and in line with the United Nations High-Level Meeting in 2023, this paper aims to uncover the qualitative discourse facing migrant workers’ uptake of TB services and provide policy recommendations to enable more equitable access to TB services for this population.MethodsIn-depth interviews were carried out with the migrant worker population recruited from a non-governmental organisation in Singapore that serves migrant workers through the provision of primary healthcare services, counselling, and social assistance. Interviews stopped once thematic saturation was achieved and no new themes and subthemes were found.ResultsA total of 29 participants were interviewed, including 16 Bangladeshis and 13 Chinese, aged between 22 and 54 years old, all worked in the construction sector. Four key themes emerged. They are (1) General TB knowledge: Misconceptions are prevalent, where we found that participants were aware of the disease but did not possess a clear understanding of its pathophysiology and associated health effects, (2) Contextual knowledge and perception of associated policies related to TB in Singapore: low awareness among migrant workers as participants’ accounts depicted a lack of information sources in Singapore especially on issues related to healthcare including TB, (3) Attitude to towards TB: Motivation to seek treatment is underpinned by ability to continue working and (4) Stigma: mixed perception of how society views TB patients. The gaps identified in migrant workers’ TB knowledge, their attitude towards the disease and their perception of the availability of TB-related services is despite Singapore’s efforts to curb community spread of TB and its proactive initiatives to reduce the prevalence.ConclusionOur study illuminates the various aspects that policymakers need to home in on to ensure this vulnerable group is sufficiently supported and equitably cared for if they develop active TB during their stay in Singapore as they contribute to the nation’s economy. Leveraging the COVID-19 pandemic as a window of opportunity to improve overall healthcare access for vulnerable groups in Singapore can be a starting point.

Atuação dos médicos na Atenção Primária à Saúde em municípios rurais remotos: onde está o território?

Abstract Resolute and comprehensive health care in remote rural municipalities (RRMs) requires Primary Health Care (PHC) with a strong community dimension anchored in the territory. This paper aims to analyze the performance profile of doctors in PHC, considering their work both in the territory and in PHC units. The perspective of doctors, critical agents in PHC, contributes to understanding whether there is an equitable and comprehensive availability of PHC. A qualitative study was carried out in 27 RRMs, with interviews with 46 Family Health doctors. Content analysis, structuring results in dimensions of arrangements in the performance of doctors in the territories and the organization of activities at the PHC units. Doctors concentrated their activities in the PHC units, primarily in municipal headquarters, with heterogeneous work agreements. Knowledge about the characteristics of the territory and the population was weak, especially those assigned at a considerable distance from municipal headquarters. In the rare work conducted within the territory, an itinerant and/or campaigning model was observed, with the mark of discontinuity. Walk-in patients were prioritized over care actions of follow-up and planning. The findings indicate the need to reinforce interaction with the territory in the provision of PHC services in RRMs.

Doctors' Work in Primary Health Care in remote rural municipalities: where is the territory?

Resolute and comprehensive health care in remote rural municipalities (RRMs) requires Primary Health Care (PHC) with a strong community dimension anchored in the territory. This paper aims to analyze the performance profile of doctors in PHC, considering their work both in the territory and in PHC units. The perspective of doctors, critical agents in PHC, contributes to understanding whether there is an equitable and comprehensive availability of PHC. A qualitative study was carried out in 27 RRMs, with interviews with 46 Family Health doctors. Content analysis, structuring results in dimensions of arrangements in the performance of doctors in the territories and the organization of activities at the PHC units. Doctors concentrated their activities in the PHC units, primarily in municipal headquarters, with heterogeneous work agreements. Knowledge about the characteristics of the territory and the population was weak, especially those assigned at a considerable distance from municipal headquarters. In the rare work conducted within the territory, an itinerant and/or campaigning model was observed, with the mark of discontinuity. Walk-in patients were prioritized over care actions of follow-up and planning. The findings indicate the need to reinforce interaction with the territory in the provision of PHC services in RRMs.

The demand for competence and qualification of medical personnel in the light of the results of empirical studies

The demand for competence and qualification of medical personnel in the light of the results of empirical studies

Efficiency evaluation of the implementation of a New medical organization model providing primary healthcare services in medical organizations of the Sverdlovsk region operating in the compulsory medical insurance system

Nowadays, creation of a new medical organization model providing primary healthcare services (New Model) is broadly associated with the introduction of lean manufacturing technologies. In the setting of modern healthcare development, the challenge of evaluating the efficiency of the medical organization activities remains primary and unresolved, especially in the context of introduction of new methodological approaches. The article describes the experience of creating and evaluating the efficiency of the New Model implementation in medical organizations of the Sverdlovsk region operating in the compulsory medical insurance system.The purpose of the study. To present the results of evaluating the effectiveness of the implementation of the New Model in medical organizations in the Sverdlovsk region.Research materials. The activities of 79 medical organizations involved in the New Model creation and expansion in the period between 2017 and 2019 were analyzed.Research results. The rate of staff involvement in the medical organizations was examined using an express “Questionnaire Q12” method; herewith 1,489 employees were interviewed in 2018, and 3,640 employees in 2019. The level of patient satisfaction with the medical care quality and availability, the number and amounts of fines/deductions/withdrawals for the outpatient care services collected by insurance medical organizations (IMOs), Territorial Fund of Compulsory Medical Insurance of the Sverdlovsk Region (TFCMI SR) were studied.Conclusion. The New Model implementation increases the level of patient satisfaction with the medical care quality and availability, the number of fines/deductions for the outpatient care services collected by IMOs, TFCMI SR has been decreased. A high staff involvement in the medical organization activities has been observed, however certain activities aimed at satisfying the HR needs and staff motivation need to be developed. It is necessary to continue further evaluation of the efficiency of the New Model implementation in terms of medical, social and economic indicators. Crucial in the New Model implementation is the interaction between TFCMI SR, IMOs, and medical organizations in the provision of primary healthcare services aimed at the assessment of the medical care availability and quality, including patient satisfaction.

Supply-side contribution to the lack of PBF impact on unmet need for family planning in Burkina Faso

Abstract Background In 2020, about one in four women in Burkina Faso faced an unmet need for family planning (FP). Between 2013 and 2017, Burkina Faso implemented a performance-based financing (PBF) program to improve primary health care service provision (including FP) at rural health centers. Our prior work revealed that PBF did not lead to a reduction in unmet need for FP, in spite of FP being an explicitly targeted service. Our current study assesses supply-side factors that have likely contributed towards this lack of effect at population level, by examining changes in facility-based indicators relevant to the provision of FP induced by PBF. Methods We used facility-based survey data from 406 PBF and 117 control facilities collected before and after the PBF implementation. To compare changes in FP service provision, we examined changes in a number of relevant indicators including: a. the types of FP methods offered by facilities; b. trainings received by different FP providers; and c. available stocks of modern contraceptives. We relied on a difference-in-differences (DID) regression model to estimate the impact of PBF on these indicators. Results We observed a significant positive impact on the number of staff qualified to provide injectables, implants and IUDs (effect size 0.47, p 0.003) as well as the number of facilities offering IUDs (effect size 0.28, p 0.016) and a significant reduction in the number of facilities experiencing stock-outs of female condoms (effect size -0.09, p 0.007) and implants (effect size -0.03, p 0.042). Conclusions Given the significant positive impacts on the number of qualified staff, facilities providing IUDs and a reduction in stock-outs of female condoms and implants attributable to the PBF intervention without showing signs of negative effects on the indicators measured supply-side factors might not have been the main reason for the lack of effect of the PBF program on unmet need for FP. Key messages • Supply-side factors might not have been the main reason for the lack of effect of the PBF program on unmet need for FP. • Further research is needed to explore other potential underlying reasons.

Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations

Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations

Predicting Areas with High Concentration of the Long-Term Uninsured and Their Association with Emergency Department Usage by Uninsured Patients in South Carolina.

Background: To predict areas with a high concentration of long-term uninsured (LTU) and Emergency Department (ED) usage by uninsured patients in South Carolina. Methods: American Community Survey data was used to predict the concentration of LTU at the ZIP Code Tabulation Area (ZCTA) level. In a multivariate regression model, the LTU concentration was then modeled to predict ED visits by uninsured patients. ED data came from the restricted South Carolina Patient Encounter data with patients’ billing zip codes. A simulation was conducted to predict changes in the ED visit numbers and rates by uninsured patients if the LTU concentration was reduced to a lower level. Results: Overall, there was a positive relationship between ED visit rates by the uninsured patients and areas with higher concentrations of LTU. Our simulation model predicted that if the LTU concentration for each ZCTA was reduced to the lowest quintile, the ED visit rates by the uninsured would decrease significantly. The greatest reduction in the number of ED visits by the uninsured over a two-year period was for the following primary diagnoses: abdominal pain (15,751 visits), cellulitis and abscess (11,260 visits) and diseases for the teeth and supporting structures (10,525 visits). Conclusions: The provision of primary healthcare services to the LTU could help cut back inappropriate uses of ED resources and healthcare costs.

Knowledge, Attitude and Behavior of Families Applying to A Training and Research Hospital Pediatric Clinic About Childhood Vaccinations

ABSTRACT Aim: Our study aimed to determine factors affecting the level of knowledge of families about pediatric vaccination and their attitudes and behaviors towards vaccination. Methods: This study with a descriptive, cross-sectional design included 595 families. The families have completed a 31-items questionnaire. Each correct answer for knowledge questions was rated as 1 point while each incorrect answer or unanswered question was rated as 0 points. The total score was calculated for each participant and compared with demographic data. Results: Mean children’s age was 3.9±0.1 years and 48.2% (n=287) were girls. 77.1% (n=459) participants were mothers. Of the families included, 99% reported that they got their children vaccinated regularly and 85.9% (n=511) reported that they got their children vaccinated in Family Health Centers. The families reported that they were mostly informed by healthcare providers. Based on multivariate regression analysis, it was found that there was a significant correlation between the level of knowledge of participants and child's age, total income level, maternal education level, maternal employment status, presence of chronic disease. Conclusion: Provision of primary healthcare services and in-service training of healthcare providers to maintain continuity of healthcare services are highly important in improving the level of knowledge, attitudes, and behaviors of families. Keywords: family, vaccines, knowledge, attitude, behavior

Urban rural differentials in spatial distribution of pregnant women having received Tetanus Toxoid injection by district in Punjab: Results from Pakistan Social and Living Standards Measurements Survey 2014-15.

Dear Madam, Tetanus is a potentially fatal infection caused by Clostridium tetani bacteria, and during childbirth it can infect wounds and results in maternal death.1,2 Tetanus Toxoid (TT) vaccination is a simple, effective and freely available preventive measure available in public sector health facilities in Pakistan for pregnant women that can protect pregnant women and their newborns. Globally, TT vaccination is a standard preventive tool in the arsenal of primary health care service providers. In this study, district level TT vaccination coverage in pregnant women during their last pregnancy, in the Punjab province was mapped using Geographic information Systems to highlight its spatial distribution disaggregated by urban, rural residencystatus and the differences between the two types of dwellers.
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FRONTLINE HEALTH PROVIDER'S PERSPECTIVE IN REDUCING CHILD DEATHS DUE TO MALNUTRITION IN A TRIBAL DISTRICT OF MAHARASHTRA: A QUALITATIVE STUDY

Background: Malnutrition is a complex problem with double burden of undernutrition and overweight. India is no exception to it but there is a higher level of malnutrition in tribal blocks and to curb this situation,various activities have been undertaken but the slow pace of decline in malnutrition is a concern.The role of frontline health workers is crucial in strengthening primary health care.They serve as the bridge between the formal government health-care system and the community.The present study helps to seek the perception of primary health care service providers and challenges faced by them in reducing child deaths due to malnutrition. Method: A descriptive cross sectional qualitative study was conducted during August 2019 - February 2020 in three talukas of a tribal district. Focus group discussions (FGD) for each service providers Auxiliary Nurse midwife (ANM), Anganwadi worker (AWW) and Accredited Social Health activist (ASHA) were conducted. All the FGDs were audio recorded and transcripts were prepared,a thematic analysis framework was used for doing the analysis. Results: Most of the service providers were aware regarding their roles and responsibilities in implementation of schemes/ services related to malnutrition. The important factors influencing their performance were superstitions, more reliance on health seeking from unqualified health care providers and faith healers, poor road connectivity, network issues,lack of refresher training,overburdening with work,poor incentives. Conclusion: Specific training programs to tackle malnutrition along with frequent refresher training of the service providers,better infrastructure and human resources will help in achieving the desired results in future in dealing with child malnutrition.

The Impact of COVID-19 on the Performance of Primary Health Care Service Providers in a Capitation Payment System: A Case Study from Poland.

In Poland, as in many other countries, the use of capitation payment schemes in primary health care is popular. Despite this popularity, the subject literature discusses its role in decreasing the quality of primary medical services. This problem is particularly important during COVID-19, when medical entities provide telehealth services to patients. The objective of the study is to examine the effects of COVID-19 pandemic on the performance of the primary health care providers in Poland under a capitation payment scheme. In this study the authors use data from interviews with personnel of medical entities and financial and administrative reports of primary health care providers in order to identify how this crisis situation impacts the performance of primary health care entities, under capitation payment system. The performance indicators include both the financial and quality measures. Selected to the case study primary health care service providers significantly improved their profitability due to considerable costs savings and reduction of services provided to patients in a time of COVID-19 pandemic. Capitation payment system proved to be inefficient, in the studied pandemic period, in terms of the services provided by primary health care service providers to patients and the funds paid to them, in exchange, by the government entities.

What makes primary healthcare facilities functional, and increases the utilization? Learnings from 12 case studies.

Background:The last few decades have witnessed a number of innovative approaches and initiatives to deliver primary healthcare (PHC) services in different parts of India. The lessons from these initiatives can be useful as India aims to strengthen the PHC system through Health and Wellness Centers (HWCs) component under Ayushman Bharat Program, launched in early 2018.Materials and Methods:Comparative case study method was adopted to systematically document a few identified initiatives/models delivering the PHC services in India. Desk review was followed by field visits and key informant interviews. Twelve PHC case studies from 14 Indian states, with a focus on equity and “potentially replicable designs” were included from the government as well as the “not-for-profit” sector. The cases studies comprised of initiatives/models having the provision of PHC services, whether exclusively or as part of broader hospital services. The data was collected from May 2016 to March 2017.Results:The “political will” for government facilities and “leadership and motivation” for “not-for-profit” facilities adjudged to contribute towards improved functioning. A comprehensive package of services, functional ‘continuity of care’ across levels, efforts to meet one or more type of quality standards and limited “intention to availability” gap (or assured provision of promised services) were considered to be associated with increased utilization. A total of 10 lessons and learnings derived from the analysis of these case studies have been summarised.Conclusions:The case studies in this article highlights the components which makes PHC facilities functional and have potential for increased utilization. The article underscores the need for institutional mechanisms for health system research and innovation hubs at both national and state level in India, for the rapid scale of comprehensive primary healthcare. Lessons can be applied to other low- and middle-income countries intending to deliver comprehensive PHC services to advance towards universal health coverage.

Availability of mental health services at the primary care level in northern part of Nigeria: Service providers' and users' perspectives

Background/Objectives: Community-based mental health services (MHSs) should target 70% of the rural population, the end users of primary health-care (PHC) services. In this study, the views of the service users and providers were explored to determine the level of MHSs available at their PHC care centers in three selected states in northern part of Nigeria. Materials and Methods: Concurrent quantitative and qualitative data (using mixed-methods research) were collected from a sample of 249 participants through a survey questionnaire and focus group discussions. The sets of data were analyzed using SPSS 23.0 and thematic clustering; these were triangulated to determine the availability of the MHSs. Results: PHC service providers and users reported that PHC centers lacked any formal MHSs, and only a few personal efforts by service providers were mentioned. The service users could not attest to even these unofficial services. Conclusion: Primary MHSs remain conspicuously absent at community level in the study areas. Both service providers and users attest to the near-complete scarcity despite their willingness to provide and use the services, respectively, if and when formal arrangements can be made. Recommendations: Stakeholders' attention is once again drawn to a neglected component of the PHC to promote mental health and prevent community mental health problems characteristic of many communities.

Current Status of Mental Health Services at the Primary Healthcare Level in Northern Nigeria.

Mental health services at the primary healthcare level remain critical in most developing countries, especially in resource-poor and crisis-stricken communities. This study explored the erstwhile mental health services, with particular reference to their availability, at the 47 primary healthcare centres in three selected states in northern Nigeria, with a view to drawing for action. Qualitative data were collected from a purposive sample of 13 participants through in-depth interviews. Additional data were also collected from observations during the visits (a checklist based on minimum standards for primary healthcare services) and clinic records at the centres. The data were analysed using content analysis and thematic clustering to indicate the status of the mental health services at the primary healthcare centres. Despite having the mental health units on the service delivery charts of the primary healthcare centres studied, none was providing any formal mental health services. There were only few but uncoordinated services in some centres essentially provided by individual primary healthcare service providers and a non-governmental organization found in one of the 47 primary healthcare centres in one of the three states investigated. In conclusion, mental health services at all primary healthcare centres in all the Local Government Areas in all the states visited are at best scarce, poorly and haphazardly rendered in a few places or completely absent in most centres. There is an urgent need to stimulate the primary healthcare system and other levels of government and their partners, to initiate or activate policies in favour of community-based mental health services to make these important services available at the community (primary healthcare) level for the promotion of mental health and treatment of mental illnesses.

Quality of care for non-communicable diseases in the Republic of Moldova: a survey across primary health care facilities and pharmacies

BackgroundThe Republic of Moldova is faced with a high prevalence of non-communicable diseases (NCDs) related to lifestyle and health behavioural factors. Within the frame of the decentralisation reform, the primary health care system has been tasked to play an important role in the provision of preventative and curative NCD health services. There is however limited evidence available on the actual coverage and quality of care provided. Our paper aims to provide an updated overview of the coverage and quality of service provision in rural and urban regions of Moldova.MethodsWe designed a facility-based survey to measure aspects of coverage and quality of care of NCD services across 20 districts of the Republic of Moldova. This study presents descriptive data on the structural, procedural and clinical aspects of primary healthcare delivery at health centre and family doctor office level. Adjacent private pharmacies were also assessed for the availability of essential NCD medicine.ResultsOrganised under the WHO Health Systems Framework, our findings highlight that service provision and information were generally the strongest among the six health systems building blocks, with more weaknesses found in the area of the health workforce, medical products, financing, and leadership/governance. Urban facilities generally fared better across all indicators.ConclusionsThe gaps in service provision identified by this study require broad health system improvements to ensure NCD related policies and strategies are embedded in primary health care service provision. This likely calls for stronger coordination and collaboration between the public and private sectors and the different levels of government working towards ensuring universal health coverage in Moldova.

GASTOS E INFRAESTRUTURA BÁSICA DE SAÚDE EM MUNICÍPIOS DO CENTRO-OESTE DO BRASIL

Trata-se de estudo exploratório, que trata de tipologia de infraestrutura e gastos na atenção básica (AB) nos municípios da região Centro-Oeste do Brasil. Para obtenção dos resultados foi realizada análise de correspondência e regressão linear múltipla entre tipologia e gastos com saúde. Para a tipologia utilizou-se dados do Programa Nacional para Melhoria do Acesso e Qualidade da Atenção Básica (PMAQ-AB). Os resultados evidenciam que municípios que alocam mais recursos per capita possuem de maneira geral melhor infraestrutura. Os gastos totais evidenciam relação positiva, que pode ser explicada pelo ganho de escala na AB, devido à predominância dos gastos em saúde nos municípios neste tipo de atenção. Porém, foi evidenciada influência negativa da despesa federal com AB na tipologia, reforçando a hipótese de que quanto maior o grau de dependência de recursos transferidos por outras esferas para financiamento das políticas municipais, menor a eficiência econômica na provisão de serviços de AB. Despesas com pessoal evidenciam relação positiva com infraestrutura. Uma possível causa pode ser o número de médicos e profissionais na AB, que além de melhores resultados na saúde, está associado com menores custos totais dos serviços, como consequência de melhores cuidados preventivos e menores taxas de hospitalização.