Primary Health Care Workforce Research Articles

Activities of the oral health teams in primary health care: a time-motion study

BackgroundEfficient planning of the oral health workforce in Primary Health Care (PHC) is paramount to ensure equitable community access to services. This requires a meticulous examination of the population’s needs, strategic distribution of oral health professionals, and effective human resource management. In this context, the average time spent on care to meet the needs of users/families/communities is the central variable in healthcare professional workforce planning methods. However, many time measures are solely based on professional judgment or experience.ObjectiveCalculate the average time parameters for the activities carried out by the oral health team in primary health care.MethodThis is a descriptive observational study using the time-motion method carried out in five Primary Health Care Units in the city of São Paulo, SP, Brazil. Direct and continuous observation of oral health team members occurred for 40 h spread over five days of a typical work week.ResultsA total of 696.05 h of observation were conducted with 12 Dentists, three Oral Health Assistants, and five Oral Health Technicians. The Dentists’ main activity was consultation with an average duration of 24.39 min, which took up 42.36% of their working time, followed by documentation with 12.15%. Oral Health Assistants spent 31.57% of their time on infection control, while Oral Health Technicians spent 22.37% on documentation.ConclusionThe study establishes time standards for the activities performed by the dental care team and provides support for the application of workforce planning methods that allow for review and optimization of the work process and public policies.

Examining the Use and Application of the WHO Integrated People-Centred Health Services Framework in Research Globally - a Systematic Scoping Review.

The World Health Organisation (WHO) accepted the Integrated People-centred Health Services (IPCHS) framework in 2016 as an essential component for achieving universal health coverage in fragmented health systems. We aimed to examine the empirical applications of the WHO IPCHS framework to guide its use in strengthening health-service research. Academic databases and the IPCHS website were searched for relevant articles published between 2016 and July 2023. Two reviewers independently screened and extracted data on the study design, setting, IPCHS framework components, and facilitators and barriers to implementing the IPCHS strategies. Descriptive and content analyses were conducted. Six studies were identified using the IPCHS framework. Studies have examined a combination of the five IPCHS strategies. All studies reported building strong primary care-based systems and coordinating care for individuals. Continued relationships and trust, co-production of health programmes, diversity of health care team, and technology were major facilitators, while low health literacy, lack of primary setting capacity and healthcare workforce were principal barriers to IPCHS implementation. This scoping review offers an overview of IPCHS strategies employed in healthcare research. Generally, the IPCHS framework remains underutilised in primary research. These results offer guidance for future research to support effective healthcare delivery.

Barriers and strategies for primary health care workforce development: synthesis of evidence

BackgroundHaving a sufficient and well-functioning health workforce is crucial for reducing the burden of disease and premature death. Health workforce development, focusing on availability, recruitment, retention, and education, is inseparable from acceptability, motivation, burnout, role and responsibility, and performance. Each aspect of workforce development may face several challenges, requiring specific strategies. However, there was little evidence on barriers and strategies towards comprehensive health workforce development. Therefore, this review explored barriers and strategies for health workforce development at the primary health care level around the world.MethodsA scoping review of reviews was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews. The article search was performed in Google Scholar, PubMed, Web of Science, and EMBASE. We used EndNote x9 for managing the collected articles, screening processes, and citation purpose. The scoping review included any kind of review articles on the application of health workforce development concepts, such as availability, recruitment, retention, role and responsibility, education and training, motivation, and burnout, with primary health care and published in English anywhere in the world. Based on the concepts above, barriers and strategies for health workforce development were identified. The findings were synthesized qualitatively based on the building blocks of the health system framework. The analysis involved specific activities such as familiarization, construction of the thematic framework, indexing, charting, and interpretation. The results were presented in texts, tables, and figures.ResultsThe search strategies yielded 7,276 papers were found. Of which, 69 were included in the scoping review. The most frequently cited barriers were financial challenges and issues related to health care delivery, such as workloads. Barriers affecting healthcare providers directly, including lack of training and ineffective teamwork, were also prominent. Other health system and governance barriers include lack of support, unclear responsibility, and inequity. Another notable barrier was the shortage of health care technology, which pertains to both health care supplies and information technology. The most common cited effective strategies were ongoing support and supervision, engaging with communities, establishing appropriate primary care settings, financial incentives, fostering teamwork, and promoting autonomous health care practice.ConclusionsEffective leadership/governance, a robust health financing system, integration of health information and technology, such as mobile health and ensuring a consistent supply of adequate resources are also vital components of primary health care workforce development. The findings highlight the importance of continuous professional development, which includes training new cadres, implementing effective recruitment and retention mechanisms, optimising the skill mix, and promoting workplace wellness. These elements are essential in fostering a well-trained and resilient primary health care workforce.

Attitudes towards career choice and general practice: a cross-sectional survey of medical students and residents in Tyrol, Austria

BackgroundThe global primary healthcare workforce is declining, leading to a shortage of general practitioners. Although various educational models aim to increase interest in general practice, effective interventions are limited. The reasons for this low appeal among medical graduates remain unclear.MethodsThis cross-sectional study surveyed medical students’ and residents’ attitudes towards general practice in Tyrol, Austria. The online questionnaire addressed professional values, general practice-related issues, personal professional intentions, and demographics. Data analysis employed chi-square tests and multivariate logistic regression to explore predictors of interest in general practice.ResultsThe study included 528 students and 103 residents. Key values identified were stable positions, assured income, and work-family reconciliation. General practice was recognised for long-term patient relationships and patient contact, with students attributing more positive work-environmental characteristics and higher reputation to it than residents. Few participants (students: 3.2%, residents: 11.7%) had opted for general practice; about half were considering it as career option. Reasons not to choose general practice were preferences for other specialties, intrinsic characteristics of general practice, workload, insufficient time for the patients, financial pressures, low reputation, and perceived mediocre training quality. Predictors of interest in general practice included perception of independent decision-making, importance of work-family balance (students), better practical experiences in general practice during medical school (students and residents), younger age, and perceiving general practice as offering a promising future (residents). Both groups felt underprepared by medical school and/or general practice training for general practice roles. The attractiveness of specialist medicine over general practice was related to clearer content boundaries, better career opportunities, and higher incomes.ConclusionsAccording to these results, measures to improve attractiveness of general practice should focus on (i) high-quality undergraduate education including practical experiences, and (ii) on ensuring professional autonomy, work-family reconciliation, and job stability. Efforts to encourage more graduates to pursue this essential healthcare sector are crucial for strengthening primary healthcare and public health services.Trial registrationThe study has not been registered as it did not include a direct medical intervention on human participants.

Challenges and opportunities in strengthening primary mental healthcare for older people in India: a qualitative stakeholder analysis

BackgroundPrimary mental healthcare (PMHC) allows for complex mental health issues in old age to be addressed. India has sought to improve PMHC through legislation, strategies and programmes. This study analyses the challenges and opportunities involved in strengthening PMHC for older persons in India from the perspectives of key stakeholders.MethodsSemistructured interviews were conducted with 14 stakeholders selected from the PMHC system in India and analysed using thematic analysis. First, the analysis was organizationally structured in accordance with the six WHO mental health system domains: (1) policy and legislative framework, (2) mental health services, (3) mental health in primary care, (4) human resources, (5) public information and links to other sectors, and (6) monitoring and research. Second, for each building block, challenges and opportunities were derived using inductive coding.ResultsThis study highlights the numerous challenges that may be encountered when attempting to strengthen age-inclusive PMHC. Among these challenges are poor public governance, a lack of awareness and knowledge among policy-makers and other stakeholders, and existing policies that make unrealistic promises to weak primary healthcare (PHC) structures with an excessive focus on medicalizing mental health problems. Thus, the mental health system often fails to reach vulnerable older people through PHC. Established approaches to comprehensive, family- and community-oriented PHC support attempts to strengthen intersectoral approaches to PMHC that emphasize mental health promotion in old age. Targeting the PHC workforce through age-inclusive mental health education is considered particularly necessary. Experts further argue that adequate monitoring structures and public spending for mental health must be improved.ConclusionsIn this study, we aim to elaborate on the mental healthcare developments that may serve to achieve equity in access to mental healthcare in India. Coordinated and collaborative efforts by public and private stakeholders involved in the care of older persons, both with and without lived mental health experiences, as well as their families and communities, are necessary to bring the vision of those policies for PMHC to fruition. The findings presented in this study can also inform future research, policies and practice in other low- and middle-income countries.

Description of the methodology for developing and validating the WHO’s family planning and comprehensive abortion care competencies for the primary health care workforce

A qualified health workforce is essential to receiving effective, timely, affordable, equitable and respectful family planning and comprehensive abortion care. However, in many countries, health workers lack the competencies required to deliver quality family planning and comprehensive abortion care services. Competency-based education and learning aims to train and assess competencies. The theory-supported approach focuses on outcomes, emphasizes the learner’s ability to perform, promotes learner-centeredness and links the health needs of the population to the competencies required of health workers. In 2011, the World Health Organization published a guidance document, Sexual and reproductive health - Core competencies in primary care, defining the competencies that primary care providers need to safely deliver sexual and reproductive health services at the community level and included family planning and comprehensive abortion care.In this article, we describe the methodology and process undertaken in 2020, by the World Health Organization to produce the family planning and comprehensive abortion care competencies guidance, filling gaps identified in the previous guidance document. The World Health Organization’s Family Planning and Comprehensive Abortion Care toolkit for the primary health care workforce was published in 2022 and defines the key competencies for health workers in primary health care providing quality family planning and comprehensive abortion care services, as well as support for developing programmes and curricula for education and lifelong learning. The Toolkit is useful for practitioners, managers/supervisors and employers, educators, regulatory bodies, and policymakers. It is an important advance toward strengthening family planning and comprehensive abortion care services in primary health care.

Family doctors as healthcare coordinators. Matrix of family doctors' competences for unlocking health workforce potential - the case of Poland

The article presents the results of the research on the competences of family doctors in the Polish healthcare system. According to the 2017 bill on primary health care (PHC) introducing integrated care to PHC, family physicians are obliged to coordinate the care delivered to their populations and to manage the PHC teams. First contracts on integrated care with the National Health Fund have been concluded in 2022. 
 The regulation evoked the necessity of redefining the role of family physicians in the healthcare system. Before that they were habitually deprived of chances to manage the care they provide. The author claims that their role should be perceived as managerial. It is crucial for patients and decision makers to understand family physicians' role in the system and properly manage the PHC workforce, especially when new professions and functions are being introduced to PHC. The regulation is not clear enough in regard to the definition of healthcare coordinator and leaves space to terminological inconsistency and, as a consequence, inadequate use of health workforce potential. The observations that led to designing the research were shared and consulted with the PHC community (focus group consisted of family doctors and PHC facilities’ staff members from lubuskie voivodeship). The research has been shared within academia (results of each stage of the research have been published and peer reviewed).
 The author has developed the matrix of family doctors’ competences to show the scope of competences they demonstrate. It is an ordered aggregation of competences classified according to the roles performed by family doctors in the healthcare system. It includes the indication of classified sources of formal requirements of those competences (in brief: sources of competences). One of the six roles presented in the matrix is a healthcare coordinator. Comparative text analyses have been performed to assess the relation between the range of family physicians’ and healthcare coordinators’ competences. 
 The results show that family physicians have a full set of competences, including managerial, to coordinate the care, which means that they are predisposed to play the role of healthcare coordinator. The author proposes a precise competence-based description of the role of family doctor as a healthcare coordinator. The author further suggests introducing a new function of healthcare coordinator’s assistant. 
 Since one of the sources of competences included in the matrix are WHO’s recommendations on competence clusters for coordinated care the results of this research may be found particularly interesting by international audiences. Especially when the shift towards integration of care is common for most of the healthcare systems and many of them are in preliminary stages of introducing the changes when comparing practice is of great value. 
 The research will be followed by qualitative study of family physicians’ experience in playing the role of healthcare coordinator. The aim of this study is to develop a framework for competence training for family physicians delivering coordinated care.

What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria

IntroductionThe SARS-CoV-2 (COVID-19) pandemic overwhelmed some primary health care (PHC) systems, while others adapted and recovered. In Nigeria, large, within-state variations existed in the ability to maintain PHC service volumes....

WONCA Europe 2023 Recommendations: Updated Definition of General Practice/Family Medicine Specialty, General Practitiner’s Competencies, Qualification Requirements for Academic Posts and Shortage of Primary Care Workforce Statement

Wonca Europe, the European branch of World Organization of Family Doctors, annualy holds a powerful international event – a conference for family doctors in Europe and the world, as well as a number of events on the eve. The objective: to analyze and highlight the news, documents and events of Wonca Europe 2023. Materials and methods. Own participation, observation and experience, analysis of documents and materials of Wonca Europe, materials of the Council meeting, analysis of information of Wonca and Wonca Europe websites, interviews of Wonca Europe members and conference participants. Results. 2,040 participants representing 75 countries from Europe and beyond took part in the Wonca Europe 2023 conference. At the Council meeting of Wonca Europe 2023, among delegates from 30 European countries participated with the right to vote were the president of the Ukrainian Association of Family Medicine, vice-rector, cor-member of NAMNU, Prof. O. K. Tolstanov and Prof. Tkachenko V. I. During the Council meeting the following important documents were approved: updated definition of medical and scientific specialty «General practice/family medicine» Wonca Europe (2023), characteristics of the discipline «general practice/family medicine», basic competencies of a general practitioner / family doctor, European qualification requirements for academic positions in general practice/family medicine in universities and academic departments. The program of the annual Wonca Europe conference included 9 keynote lectures, a number of workshops, many sessions with presentations of scientific research by family doctors, presentation of clinical cases from practice, short messages and 324 poster presentations. The WONCA Europe 2023 Statement in Shortage of European Primary Health Care Workforce became an important document with the aim of further presenting it to politicians and implementing it in European countries at the national level. Conclusions. The experience gained, founding documents and work experience will provide an impetus for further development, support and improvement of family medicine in Ukraine.

Exploring the Challenges for Universal Health Coverage: A Call to Africa by AfroPHC.

The primary health care (PHC) system in Africa faces many challenges AND opportunities. To date, human resources for health in PHC are grossly insufficient in number, often inefficiently and inequitably distributed, lacking adequate training for delivering fully responsive and comprehensive frontline care and are treated inequitably within the health system. There has been a lack of solidarity among key role players in healthcare to create adequate PHC funding in Africa. Resources do not appropriately or adequately reach the frontline PHC service platform due to outdated service delivery and payment models. Patients experience PHC as numbers in a queue, with poor comprehensiveness, continuity, and coordination. Health workers are also treated like numbers in a bureaucracy that fragments and undermines training and service for integrated care around patient and population needs. However, opportunities abound with global PHC milestones, increasing political will for investment in PHC, and proven mechanisms for achieving a stronger workforce such as community health workers, clinical task-sharing, and the integration of family doctors into PHC. The African Forum for PHC (AfroPHC) has a vision for PHC and UHC that is team-based with skills mix appropriate to Africa, including family doctors, family nurse practitioners, clinical officers, community health workers and others that are empowered to take care of an empaneled population in high-quality people centred PHC. AfroPHC is making a call on stakeholders to develop and implement a regional forward-looking plan to 1) build robust PHC systems, 2) train, recruit and maintain a sufficient frontline PHC workforce, and 3) support PHC with appropriate financing. This can all come together easily in a nationally defined PHC contract using risk-adjusted blended capitation payment to decentralised PHC teams empanelled to enrolled populations, coordinated by district health services and easily administered at national or sub-national level for empowered public and private providers.

Development, delivery, and evaluation of a training program for the early identification of autism: Monitoring of Social Attention, Interaction, and Communication.

Early identification of Autistic children is an important precursor to diagnosis, and access to supports and services. Here we describe the training of the maternal and child health (MCH) workforce in the state of Victoria, Australia in the early identification of infants and toddlers with a high likelihood of autism. In 2019, 1,428 MCH nurses completed early autism training held at venues across the state, with an additional 82 nurses completing online-only training. A training needs analysis enabled the research team to determine the workforce's current skill and knowledge levels, and to identify knowledge gaps, training needs and workplace barriers. The professional development program, known as Monitoring of Social Attention, Interaction, and Communication (MoSAIC), comprised: online pre-workshop modules; a face-to-face instructor-led workshop, which included the use of the Social Attention and Communication-Revised (SACS-R) tool; and online post-workshop modules, which included a recording of a face-to-face workshop with all accompanying resources. This was the first time that the MCH workforce received this training package. Attendees were asked to complete a training satisfaction survey immediately following the face-to-face instructor-led workshop and a follow-up survey regarding their autism knowledge and SACS-R implementation 4-6 weeks after the workshop. Over 90% (n = 325) of MCH nurses who completed the training satisfaction survey agreed or strongly agreed with statements that the training was clear and of high quality. Most nurses also reported that the training was well-presented and that they would recommend it to a colleague. In the 6 months following the training, a total of 82,581 SACS-R assessments were conducted by the MCH workforce, reflecting that MCH nurses had successfully integrated SACS-R assessments into their work practice after receiving the early autism identification training. This study demonstrated that training on the early identification of autism can be successfully designed, customized, and delivered to a large primary healthcare workforce for universal developmental surveillance of autism.

A snapshot of Australian primary health care nursing workforce characteristics and reasons they work in these settings: A longitudinal retrospective study.

This article aimed to provide a snapshot of demographics and professional characteristics of nursing and midwifery workforce in Australian primary health care (PHC) settings during 2015-2019 and factors that influenced their decisions to work in PHC. Longitudinal retrospective survey. Longitudinal data that were collected from a descriptive workforce survey were retrieved retrospectively. After collation and cleaning, data from 7066 participants were analysed using descriptive and inferential statistics in SPSS version 27.0. The majority of the participants were female, aged between 45 and 64 years old and working in general practice. There was a small yet steady increase in the number of participants in the 25-34 age group and a downward trend in the percentage of postgraduate study completion among participants. While factors perceived most/least important to their decision to work in PHC were consistent during 2015-2019, these factors differed among different age groups and postgraduate qualification holders. This study's findings are both novel and supported by previous research. It is necessary to tailor recruitment and retention strategies to nurses/midwives' age groups and qualifications to attract and retain highly skilled and qualified nursing and midwifery workforce in PHC settings.

Optimizing the primary health care workforce to achieve timely healthcare that meets the population’s needs: Romania’s human resource in primary care

optimizing the primary health care workforce to achieve timely healthcare that meets the population’s needs: Romania’s human resource in primary care

Rural health workforce response to Australia's recent natural disasters and emergencies, with a focus COVID-19.

Australia has recently been heavily impacted by natural disasters and emergencies including drought, bushfire, floods and COVID-19. The New South Wales Rural Doctors Network (RDN) and partners developed and implemented strategies to support the primary health care response during this challenging time. Strategies included the establishment of an inter-sectoral working group of 35 government and non-government agencies, a stakeholder survey, a rapid literature review, and broad consultation aimed at understanding the impacts of natural disasters and emergencies on primary health care services and workforce in rural NSW. Several key initiatives were established, including the RDN COVID-19 Workforce Response Register and #RuralHealthTogether, a website to support the wellbeing of rural health practitioners. Other strategies included financial support for practices, technology enabled service support and a Natural Disaster and Emergency Learnings Report. The cooperation and coordination of 35 government and non-government agencies led to development of infrastructure to support the crisis response to COVID-19 and other natural disasters and emergencies in an integrated way. Benefits included consistency of messaging, coordination of support locally and regionally, sharing of resources and collation of localised data to inform coordination and planning. Stronger primary healthcare engagement in emergency response pre-planning is required to ensure maximum benefit and use of established resources and infrastructure. This case study shows the value and applicability of an integrated approach to support primary healthcare services and workforce when responding to natural disasters and emergencies.

Undergraduate Medical Education Reform in Viet Nam for a Primary Health Care Workforce.

Strong primary health care (PHC) systems require a robust PHC workforce. Traditionally, medical education takes place in academic medical centres that favour subspecialty care rather than PHC settings. This may undervalue primary care as a career and contribute to a shortage of PHC workers. However, designing undergraduate medical education curricula that incorporate early experiences in clinical care delivery at PHC sites remains a challenge, including in many low- and middle-income countries (LMICs). This paper describes how a collaboration between Harvard Medical School and five medical schools in Vietnam, and in-country collaborations among the Vietnamese medical schools, facilitated curricular innovation and co-creation of coursework relevant to PHC through the development of a Practice of Medicine (POM) course. The collaboration implemented a technical assistance strategy consisting of in-person workshops, focused virtual consultations, on-site 'office hours', site visits and observations to each of the five medical universities, and immersion trips to support the creation and implementation of the POM course. A pilot program was started at a single site and then scaled nationally using local customisation, experience, and expertise utilising a train-the-trainers approach. As a result, five new POM courses have been developed by five Vietnamese institutions. Fifty Vietnamese faculty received training to lead the POM course development, and 228 community-based preceptors have been trained to teach students at PHC sites. A total of 52 new PHC and community-based clinical training sites have been added, and 3,615 students have completed or are currently going through a POM course. This experience can serve as a model for future academic collaborations to support the development of a robust PHC workforce for the 21st century.

Oral Health Literacy In Young Migrant/Refugee Mothers From Developing Countries

Abstract Background and problems In the last decade, migration has increased due to climatic, economic, and social factors. Oral health is an integral part of overall health, but primary health packets for migrants/refugees often neglect oral health education and care in the care delivery system. The present article aims to present a realistic approach to integrating oral health into existing structures for young migrant/refugee mothers on a community level in Switzerland. Importance As a young child's oral health is closely related to mother's oral health status and oral health knowledge level, it would be critical that migrant/refugee mothers have access to timely oral health education and care through the primary health care system. Solution We propose an integrated oral health care model for migrant/refugee mothers that maximizes the existing primary health care system. Using existing maternal oral health resources, a training module is developed for the primary care care workforce that serve migrant/refugee mothers. This training module includes oral health needs and status assessment and delivering preventive oral health services in primary care settings. The module includes drawings and images to describe the dangers of poor oral hygiene during pregnancy related to the health of mothers and babies and how to keep the mouth healthy with low-cariogenic diet practice and home oral hygiene care. Primary health care workforce in selected migrant health centers, like nurses, medical aides, and community health care workers, is trained by this module and evaluated by a set of self-assessed questionnaires before and after the training for knowledge improvement, attainment, and clinical practice changes. Migrant mothers participate in questionnaires on oral health hygiene practice and access to dental care during pregnancy and for their young children. The questionnaires are validated by the affiliated university-hospital clinical research center.

Decentralisation and community stakeholders’ engagement for better mental health services development in the conflict-affected regions of Ukraine

Purpose The purpose of this paper is to explore how conflict-affected communities in Ukraine (the Lugansk region) can develop sustainable mental health services in decentralised settings. The main interest focuses on community stakeholders’ perception of their problems and solutions that communities can create to achieve better mental health coverage. Design/methodology/approach A series of roundtables (RTs) (4 RTs, 62 participants overall), accompanied by interactive brainstorming techniques, were conducted with communities’ representatives/stakeholders from the East of Ukraine (Lugansk region, a government-controlled area) during the year 2021. Participants (health, mental health, social care workers and administration representatives) were provided with the opportunity to discuss mental health services’ development challenges and create affordable solutions for their communities. Results of discussions were submitted to qualitative analysis and offered for review by participants. Findings Decentralisation in Ukraine led to allocating funds alongside responsibilities for developing the services to communities. Most of the communities appear not to be ready to acknowledge the role of mental health services, entirely relying on the existing weak psychiatric hospital-based system. Awareness-raising interactive capacity-building activities for the community leaders and decision-makers effectively promote community-based mental health services development. Five clusters of challenges were identified: leadership, coordination and collaboration problems; infrastructure, physical accessibility and financial problems; mental health and primary health-care workforce shortage and lack of competencies; low awareness of mental health and available services and high stigma; war, crises and pandemic-related problems. Communities stakeholders foresaw seven domains of action: increasing the role of communities and service users in the initiatives of governmental bodies; establishing in the communities local coordination/working groups dedicated to mental health service development; developing the community-based spaces (hubs) for integrated services provision; embedding the mental health services in the existing services (social, administrative and health care); mental health advocacy and lobbying led by local leaders and service users; increasing capacity of communities in financial management, fundraising; developing services by combining efforts and budgets of neighbouring communities. Research limitations/implications The study has potential limitations. Participants of the roundtables were mostly appointed by local authorities, so some of them didn`t have a motivation for mental health services development. Service users were involved only from the facilitators` side, not from the side of communities; therefore, it was impossible to include their view of problems and solutions. Obtained data were limited to the opinion of local professionals, administration workers and other local stakeholders. The human rights aspect was not clearly articulated in the tasks of the roundtables. Originality/value To the best of the authors’ knowledge, the paper is original in terms of its topic (connecting decentralisation and local stakeholders’ engagement for understanding the challenges of mental health services development) and research strategy (engagement of Ukrainian communities, qualitative analysis of the discussion results and applying the best practices and international recommendations to the local context).

Primary health care in China: A decade of development after the 2009 health care reform

AbstractOver 40 years ago, primary health care (PHC) was defined in the Alma‐Ata Declaration as a critical component of the health care system to address the basic health demand of the people. In China, the Government attaches great importance to health care at the primary level. After the launch of the historical Reform of the Medical and Health Care System in 2009, the PHC system in China has witnessed major progress and breakthroughs, especially in its steadily increased capacity, continuously improved accessibility, and betterment in equality. In this review, we summarized published literatures and official policies, synthesized data from the electronic registration information system of the National Health Commission, national statistical reports, and yearbooks in health care. The review is intended to describe the systematic development of PHC in China in the last decade. The main results include: the solid national policy foundation, increasing number of PHC institutions and workforce, better training of PHC professionals, major achievements in primary health indicators, government financial support to PHC institutions, improved PHC budgeting and insurance coverage, and the advancement of supporting technologies. Challenges and prospects are also discussed.

Rural primary care workforce views on trauma-informed care for parents experiencing complex trauma: Adescriptive study.

An important service system for rural parents experiencing complex trauma is primary health care. To investigate workforce knowledge, attitudes and practices, and barriers and enablers to trauma-informed care in rural primary health care. This study used a descriptive, cross-sectional design. It involved an on-line survey conducted in 2021 in rural Victoria, Australia. Participants were the primary health care workforce. The main outcome measures were study-developed and included, a 21-item Knowledge, Attitudes and Practices tool, a 16-item Barriers and Enablers to Trauma-Informed Care Implementation tool, and three open-ended questions. The 63 respondents were from community health (n=40, 63%) and child and family services (n=23, 37%). Many (n=43, 78%) reported undertaking trauma-informed care training at some point in their career; with 32% (n=20) during higher education. Respondents self-rated their knowledge, attitudes and practices positively. Perceived enablers were mainly positioned within the service (e.g. workforce motivation and organisational supports) and perceived barriers were largely external structural factors (e.g. availability of universal referral pathways, therapeutic-specific services). Open-ended comments were grouped into four themes: (1) Recognition and understanding; (2) Access factors; (3) Multidisciplinary and collaborative approaches; and (4) Strengths-based and outcome-focused approaches. Primary health care is an important driver of population health and well-being and critical in rural contexts. Our findings suggest this sector needs a rural trauma-informed care implementation strategy to address structural barriers. This also requires policy and system development. Long-term investment in the rural workforce and primary care service settings is essential to integrate trauma-informed care.

Operational challenges in the pre-intervention phase of a mental health trial in rural India: reflections from SMART Mental Health

BackgroundAvailability of mental health services in low- and middle-income countries is largely concentrated in tertiary care with limited resources and scarcity of trained professionals at the primary care level. SMART Mental Health is a strategy that combines a community anti-stigma campaign with a primary health care workforce strengthening initiative, using electronic decision support with the goal of better identifying and supporting people with common mental disorders in India.MethodsWe describe the challenges faced and lessons learnt during the pre-intervention phase of SMART Mental Health cluster Randomised Controlled Trial. Pre-intervention phase includes preliminary activities for setting-up the trial and research activities prior to delivery of the intervention. Field notes from project site visit, project team meetings and detailed follow-up discussions with members of the project team were used to document operational challenges and strategies adopted to overcome them. The socio-ecological model was used as the analytical framework to organise the findings.ResultsKey challenges included delays in government approvals, addressing community health worker needs, and building trust in the community. These were addressed through continuous communication, leveraging support of relevant stakeholders, and addressing concerns of community health workers and community. Issues related to use of digital platform for data collection were addressed by a dedicated technical support team. The COVID-19 pandemic and political unrest led to significant and unexpected challenges requiring important adaptations to successfully implement the project.ConclusionSetting up of this trial has posed challenges at a combination of community, health system and broader socio-political levels. Successful mitigating strategies to overcome these challenges must be innovative, timely and flexibly delivered according to local context. Systematic ongoing documentation of field-level challenges and subsequent adaptations can help optimise implementation processes and support high quality trials.Trial registration: The trial is registered with Clinical Trials Registry India (CTRI/2018/08/015355). Registered on 16th August 2018. http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=23254&EncHid=&userName=CTRI/2018/08/015355