Principles Of Primary Health Care Research Articles

Ethics in Primary Health Care: Responsibilities in Patient Care. Bibliographic review

Medical ethics is essential at the first level of care, where doctors must guarantee the autonomy of patients and equity in terms of health care, according to the World Health Organization (WHO), the International Code of Medical Ethics of the World Medical Association (AMM) and the Ministry of Public Health of Ecuador mention that ethical principles must be implemented and guaranteed in the Primary Health Care physician, the objective of this review is to describe the ethical and moral principles that form part of the doctor in Primary Health Care through reviews of updated bibliographies. It was described that the ethical and moral principles of Primary Health Care are benevolence, justice, wisdom and solidarity and within the main bases on which ethics is focused is the doctor-patient relationship that allows clarifying the correct action on health problems.

Enhancing Primary Health Care through Interprofessional education: Insights from a Training Workshop.

Strengthening primary care services with a focus on comprehensive Primary Health Care principles necessitates collaborative work practices within interprofessional teams. In Italy, the Local Health District of Florence embodies a comprehensive Primary Health Care -inspired model of primary care, prominently featuring the House of Community concept. This work presents findings and insights from a multidisciplinary, interprofessional education activity tailored for healthcare professionals, researchers, and students actively participating in the primary care reorganization. The activity was structured using a four-phase learning model (imaginative, analytical, common sense, and dynamic), aligning with four distinct activities (brainstorming, lecture, case study, and group project). Key themes that emerged encompassed the significance of nurturing relationships among team members, the aspiration for an inclusive work environment, the vital role of community engagement and collaboration across various services, disciplines, and sectors beyond healthcare. These themes highlight the essential attributes of successful primary care practices built on the principles of comprehensive comprehensive Primary Health Care. Throughout the innovation process of primary care services, interprofessional education training events emerged as indispensable components for bolstering implementation and ensuring sustainability. This study underscores the crucial role of interprofessional education in bridging the gap between theoretical constructs and practical application, emphasizing that comprehensive Primary Healthcare principles find tangible manifestation in real-world scenarios.

Thinking and Enacting the Patient Medical Home Under Pandemic Conditions: A Qualitative Study From Primary Care in Alberta, Canada.

The COVID-19 (C19) pandemic shocked primary care systems around the world. Those systems responded by supporting patients in the community, and acute care facilities in crisis. In Canada, the Patient Medical Home (PMH) is a widely adopted care model that aims to operationalize the tenets and principles of Primary Health Care (PHC) as developed since the Alma-Ata Declaration. This paper describes how personnel working in and with Primary Care Networks (PCNs) in Alberta, Canada deployed the PMH model and its underlying PHC principles to frame and respond to the C19 shock. Using purposive and snowball sampling techniques, we interviewed 57 participants who worked in public health and primary care, including community-based family physicians. We used interpretive description to analyze the interviews. PCN staff and physicians described how the PMH model was foundational to normal operations, and how C19 responses were framed by the patient-centric, team-delivered, and continuous care principles the model shares with PHC. Specifically, participants described ensuring access to care, addressing the social determinants of health, being patient centered, and redeploying and expanding PHC teams to accomplish these goals. Delivering PHC through the PMH allowed physicians and allied health staff to deliver patient-centered, team-based, holistic bio-medical services to Albertans. In tailoring services to meet the specific social and health needs of the populations served by each PCN, healthcare providers were able to ensure relevant support remained available and accessible.

The Effective Coverage of Maternal and Child Primary Health-Care-Services and its Relationship with Health-Expenditures: An Analysis at Sub-National-Level in Iran

Introduction: The primary health care (PHC) approach is widely acknowledged as a fundamental element in achieving universal health coverage (UHC) goals. Consequently, numerous countries have undertaken efforts to restructure their health systems based on PHC principles. This study aims to evaluate geographic disparities in essential maternal and child indicators provided at the PHC level, focusing on both crude and effective coverage. Additionally, it seeks to explore the association between effective coverage and health expenditures within the national and sub-national contexts of Iran.
 Methods: This research employed a secondary analysis approach to investigate the spatial distribution of maternal and child health (MCH) indicators in Iran's provinces, utilizing the latest available data from the 2010 Demographic Health Survey (DHS). To provide a comprehensive understanding of MCH indicators, the study calculated composite indicators, crude, and effective coverage. The provinces' situations were compared using the median cut-off method. Additionally, the study examined the association between coverage indicators and total health expenditure per-capita.
 Results: At the national level, the crude and the effective composite coverage were 89.56% and 77.22%, respectively. Also, the medians of composite crude and effective service coverage in the provinces were 90.25% and 77.62%, respectively. There was no significant difference between urban and rural areas.
 Conclusion: This study has revealed a notable difference between the crude and effective service coverage of the selected MCH indicators. While the coverage of maternal services was generally higher than that of child services, there were significant geographic disparities in the coverage of key indicators of MCH services across provinces. Despite the provision of free services in rural areas, their coverage was not higher than that of urban areas. These findings suggest that PHC services in Iran are still far from achieving the desired coverage and UHC goals. Policymakers and stakeholders need to focus on addressing the gaps in effective coverage and geographic disparities to improve access to essential maternal and child health services and achieve UHC in Iran.

Are remote health clinics primary health care focused? Validation of the Primary Health Care Engagement (PHCE) Scale for the Australian remote primary health care setting.

To test and validate a measure of primary health care (PHC) engagement in the Australian remote health context. PHC principles include quality improvement, community participation and orientation of health care, patient-centred continuity of care, accessibility, and interdisciplinary collaboration. Measuring the alignment of services with the principles of PHC provides a method of evaluating the quality of care in community settings. A two-stage design of initial content and face validity evaluation by a panel of experts and then pilot-testing the instrument via survey methods was conducted. Twelve experts from clinical, education, management and research roles within the remote health setting evaluated each item in the original instrument. Panel members evaluated the representativeness and clarity of each item for face and content validity. Qualitative responses were also collected and included suggestions for changes to item wording. The modified tool was pilot-tested with 47 remote area nurses. Internal consistency reliability of the Australian Primary Health Care Engagement scale was evaluated using Cronbach's alpha. Construct validity of the Australian scale was evaluated using exploratory factor analysis and principal component analysis. Modifications to suit the Australian context were made to 8 of the 28 original items. This modified instrument was pilot-tested with 47 complete responses. Overall, the scale showed high internal consistency reliability. The subscale constructs 'Quality improvement', 'Accessibility-availability' and 'population orientation' showed low levels of internal consistency reliability. However, the mean inter-item correlation was 0.31, 0.26 and 0.31, respectively, which are in the recommended range of 0.15 to 0.50 and indicate that the items are correlated and are measuring the same construct. The Australian PHCE scale is recommended as a tool for the evaluation of health services. Further testing on a larger sample may provide clarity over some items which may be open to interpretation.

Gap Analysis of Providing Primary Health Care in Comprehensive Rural Health Centers of Iran

Background: The lack of primary health care (PHC) assessment will lead to the lack of knowledge of the final client's needs and to deviation from the mission of the health system. This study was conducted to compare the understanding and experience of PHC providers and recipients regarding the principles of PHC in Iran.
 Methods: This cross-sectional descriptive-analytical study was conducted on Comprehensive Rural Health Centers (CRHCs) in 2022. The research population consisted of health service providers and recipients in rural areas. A Primary Care Assessment Tool (PCAT) was used. 410 child/ adolescent and 402 adult PCAT were completed by stratified cluster sampling method and 413 service providers were randomly selected. This questionnaire had 6 core domains and 3 ancillary domains. After collection and entering the Excel; data were analyzed by inferential statistics tests including Independent T-test and one-way ANOVA, by SPSS26 and STATA16 at the significant level of P>0.05.
 Results: Except for the Cultural Competence and Services Available domains, in the rest of the domains, there was not the same understanding between the service provider and recipient regarding PHC services. Also. child/adolescent PHC recipients had the same understanding as adult PHC recipients in the domains of Cultural Competence, Family Centeredness, Information System, Ongoing Care, and Access. But a significant difference was between the two groups in other domains, Primary Care Score, and Primary Care Expanded scores (P >0.05).
 Conclusions: For the common understanding between all three compared groups, cultural competence was the strongest component, and coordination-referral system, services provided, and community orientation were the weakest components. To fill this gap, increasing the health literacy of service recipients, real needs assessment, and providing services based on the needs of the community, reforming the processes of the referral system, and the commitment of the government to implement the processes seem necessary.

More than meets the eye: a critical discourse analysis of a Swedish health system reform

BackgroundIn line with international trends acknowledging the importance of Primary Health Care (PHC) for improving population health and reducing health inequalities, the Swedish health system is undergoing a restructuring towards the coordinated development of a modern, equitable, accessible, and effective system, with PHC principles and functions at its core. Since discursive analyses of documents underpinning PHC reforms are scarce in Sweden and beyond, the aim of this study was to explore how the reorientation towards good quality and local health care has been represented in official government reports.MethodsBased on a policy-as-discourse analysis, four Swedish Government Official Reports underpinning the good quality and local health care reform were interrogated following four questions of Bacchi’s “What’s the Problem Represented to be?” (WPR) approach. By applying the first WPR question, concrete proposals guiding the reorientation were identified, analyzed and thematized into candidate problem representations. These problem representations were then analyzed in relation to previous empirical and conceptual research considering WPR questions two and three, which resulted in the development of three problem representations. Potential silences that the problem representations might produce were then identified by applying WPR question four.ResultsThe three problem representations connected the Swedish health system “problem” to a narrow mission, a siloed structure, and a front-line service disconnected, especially from the needs and preferences of individual patients. By representing the problem along these lines, the analysis also illustrated how the policy reorientation towards good quality and local health care risk silencing important PHC aspects such as health promotion, equitable access, and human resources.ConclusionThe results from this study indicate that as discursively framed within concrete proposals, government official reports in Sweden represent the health system problem in particular ways and with these problem representations overlooking several aspects that are central to a health system characterized by PHC principles and functions. In the continued reorientation towards good quality and local health care, these silences might need to be acknowledged.

Organisation des soins palliatifs intégrés en Belgique

In the Declaration of Astana (2018), the World Health Organization underlines the emergency of strengthening our health systems and the relevance of the primary health care (PHC) model to achieve this, including regarding palliative care. In the light of the principles of PHC, this article presents and questions the current organization of palliative care in Belgium: do they meet their main criteria, which are comprehensiveness, accessibility, acceptability, permanence and continuity of care? As palliative support is provided at all levels of the health care pyramid, the base – the first line – supports a large part of it. This organization encourages practices where local health professionals – the general practitioner and the family nurse – are the main actors in the support. Specialists in the palliative sector only intervene to help front-line professionals in difficulty or to enable them to accompany particularly complex situations. The decompartmentalization of health specialties and the meeting of palliative care with PHC brings here a gain in quality and meaning. However, this perspective on our care model also reveals certain shortcomings – mostly financial – and certain inadequate practices that jeopardize an organization that is nevertheless sustainable, up to the challenges of today and tomorrow.

Equity in Health and the New Normal: The Philippine Universal Health Care Law

The Philippine Universal Health Care (UHC) Law, consistent with the WHO’s Primary Health Care (PHC) Declaration (1978, 2008 and 2018) strives to achieve Equity in Health and Health for all Filipinos by ensuring universal access to health care within a New Normal that ensures inclusive growth. While the series of PHC declarations address gross health inequities among nations; our UHC Law addresses health inequities within our nation. Fifty per cent of Filipinos, who die, continue to die without health professional attendance. Our health outcomes are improving but lag behind those of our ASEAN neighbors. We continue to face what the Department of Health (DOH) describes as the triple burden of disease. Our health inequities persist within a socio-economic context of non-inclusive growth. To address these inequities in health, we need to work for a new normal that would ensure inclusive growth. In health, we need to implement the UHC law based on the philosophy and principles of PHC. There have been initial advances in the implementation of UHC. To accelerate it further, the UHC SG recommended the prioritization of the establishment of an interoperable, real time national health information system to guide governance, human resource for health (HRH) production, deployment and distribution, the provision of medicines and technology, and health financing. In addition to health systems reform, we need to shock and awe the Filipino people with a comprehensive primary care benefit package that can be actually utilized by the poor, generate popular support for UHC, and have significant impact on decreasing Out-of-Pocket health expenditures. To achieve Health for All Filipinos and Equity in Health, we need to ensure universal access to quality health care (UHC) within a new normal that leads to inclusive growth.

Successes and challenges of primary health care in Australia: A scoping review and comparative analysis.

Australia has achieved universal health insurance for its population since 1975 - a major step forward for increasing access to primary care (PC). Nevertheless, there are reports of several multi-layered challenges, including inequity, that persist. This analysis aims to undertake a scoping review of the success, explanatory factors, and challenges of Primary Health Care (PHC) in Australia guided by the World Health Organization (WHO)-defined key characteristics of good PC. We searched PubMed, Embase, Scopus and Web of Science using key terms related to PHC principles, attributes, system functioning and health care delivery modalities. We also used key PC terminologies used to assess key characteristics of good PC developed by WHO and key terms and attributes from Australia's health care landscape. We then integrated our search terms with the PHC Search Filters developed by Brown, L., et al. (2014). We restricted the search from 2013 to 2021. Two authors independently assessed study eligibility and performed a quality check on the extracted data. We presented findings according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified 112 articles on primary health care (PHC), represented from all Australian states and territories. Overall, Australian PHC has achieved comprehensiveness, access and coverage, quality of care, patient / person centeredness and service coordination indicators with exemplary evidence-base practice/knowledge translation and clinical decision-making practices at the PC settings. Yet, we identified complex and multilayered barriers including geographic and socio-economic berries and inequality, staff dissatisfaction/turn over, low adoption of person-centred care, inadequate sectoral collaboration, and inadequate infrastructure in rural and remote primary care units. Primary health care in Australia, which has evolved through major reforms, has been adapting to the complex health care needs of the socio-culturally diversified nation, and has achieved many of the PC attributes, including service diversity, accessibility, acceptability, and quality of care. Yet, there are persistent gaps in service delivery to socio-economically disadvantaged populations, including indigenous people, culturally and linguistically diverse (CALD) populations, and rural- and remote-residents. These challenges could be mitigated through system-wide and targeted policy-level intervention to further improve service delivery through effective and functional local health service coordination, sectoral integration, and improving health care providers' cultural competence.

Barriers to community participation in primary health care of district health: a qualitative study

IntroductionCommunity participation is one of the principles of primary health care (PHC). However, it has not been adequately institutionalized due to numerous barriers. Therefore, the present study is conducted to identify barriers to community participation in primary health care in the district health network from the perspectives of stakeholders.MethodsThis qualitative case study was conducted in 2021 in Divandareh city, Iran. A total of 23 specialists and experts experienced in community participation, including nine health experts, six community health workers, four community members, and four health directors in primary health care programs, were selected using the purposive sampling method until complete saturation. Data was collected using semi-structured interviews and analyzed simultaneously using qualitative content analysis.ResultsAfter data analysis, 44 codes, 14 sub-themes, and five themes were identified as barriers to community participation in primary health care in the district health network. The themes included community trust in the healthcare system, the status of community participation programs, the community and system’s perception of participation programs, health system management approaches, and cultural barriers and institutional obstacles.ConclusionBased on the results of this study most important barriers to community participation relate to community trust, the organizational structure, community and the health profession’s perception regarding the participatory programs. It seems necessary to take measures to remove barriers in order to realize community participation in primary healthcare system.

Community-orientated primary health care: Exploring the interface between community health worker programmes, the health system and communities in South Africa.

Due to insufficient number of health workers and the evidence of the benefits of community health workers (CHWs), CHWs are being deployed to provide health care services to under-served communities. In this article, we explore to what extent the South African CHW programmes introduced between 2009 and 2011 are attuned to community needs, integrated into the healthcare system and community structures, and also implemented in accordance with community-orientated primary health care principles. Using a case study approach, we studied CHW teams in seven primary healthcare facilities located in semi-urban and rural areas of Gauteng and Mpumalanga provinces, South Africa. We collected data using in-depth interviews involving facility managers, CHW supervisors, community representatives and key informants, and focus groups and observations of CHWs. The implementation of community-orientated health interventions remains complex. In the different sites, there were efforts to integrate the views of stakeholders (e.g., political leaders) into the implementation of the CHW programmes. However, many residents were more concerned about access to housing than health services. The CHWs services' were found to be generally comprehensive, however inefficient training, supervision and mentorship limited their effectiveness. The multidisciplinary approach to care, as introduced by some sites, helped enhance the knowledge and skills of some of the CHWs on complex health topics. The roll out of community orientated primary health care services is crucial in a resource-constrained setting like South Africa. However, significant socio-economic issues disrupt community involvement and the effective provision of services. Governments need to provide sufficient funds for training, supervision, supplies and remuneration to help overcome these barriers.

One goal: Health for all; Post-COVID public health initiatives.

WHO's theme on its 75th year, "Health for All", is both appropriate and meaningful on account of the unfinished agenda of primary health care (PHC), the Sustainable Development Goals, and the aftermath of the COVID-19 pandemic. The Kerala experience of the pandemic amply demonstrated that the application of these PHC principles helped to address diverse aspects of physical, mental, and social dimensions. The need for 'internalization' of One Health principles and operational strategies cannot be over-emphasized.

Self-reported continuity and coordination of antenatal care and its association with obstetric near miss in Uasin Gishu county, Kenya.

Continuity and coordination of care are core principles of high-quality primary health care. Optimising continuity and coordination improves maternal satisfaction. However, their association with morbidity and mortality outcomes is unclear. The obstetric near-miss approach can be used to investigate whether continuity and coordination influences the occurrence of a severe maternal outcome. To compare self-reported continuity and coordination of care between obstetric near-miss survivors and those without near miss during pregnancy, delivery and postpartum. Uasin Gishu county, Rift Valley region, Kenya. A cross-sectional survey targeting 340 postnatal mothers. Continuity of care index (COCI) and modified continuity of care index (MCCI) were used to estimate longitudinal continuity. The Likert scale was administered to measure perceived continuity and coordination of care. Mann-Whitney U test and binomial logistic regression were used for hypothesis testing. COCI and MCCI were lower among near-miss survivors (COCI = 0.80, p = 0.0026), (MCCI = 0.62, p = 0.034). Near-miss survivors scored lower on items assessing coordination between a higher-level provider and usual antenatal clinic (mean = 3.6, p = 0.006) and general coordination of care during pregnancy (mean = 3.9, p = 0.019). Presence of a non-life-threatening morbidity in pregnancy was associated with occurrence of near miss (aOR = 4.34, p = 0.001). Near-miss survivors scored lower on longitudinal continuity and coordination of care across levels. Further research should focus on strengthening coordination, determining the optimal level of longitudinal continuity and improving systems for early identification and management of morbidities in pregnancy.Contribution: The results of this study show that while longitudinal and relational COC is important during the antenatal period, the presence of a non-life-threatening condition in pregnancy remains the most important predictor of the occurrence of a near miss.

OLDER ADULT’S PERCEPTION OF PRIMARY HEALTH CARE REFORM IN A LOW-MIDDLE-INCOME COUNTRY (LMIC): IMPACT ON GERIATRIC CARE

Abstract Health reforms are intended to provide equitable and beneficial care across population groups, it also transforms service delivery. We sought to identify current or potential implementation gaps that divert improvement efforts in service delivery, and practices that prevent holistic approaches in caring for older adults, especially in developing nations. This study examined a major health reform initiative in a LMIC aimed at integrating defragmented health organizations under one management, it also looked at extent to which reform agendas align with primary health care (PHC) principles. Using purposeful random sampling design, this quantitative study obtained participants’ views of care received in 12 sites and 2 states in Nigeria. A total of 218 participants aged 50 years and older in both rural and urban areas. Partial correlations were carried out after accounting for other variables of interest. Findings show there was no significant differences in attributes of primary care received by geography, gender or by state. Although Ondo state scored higher than Federal Capital Territory in previous performance evaluations (66% and 43% in 2015), respondents from both states received only two out of the seven primary care attributes recommended by the World Health Organization. First contact (access to care) and Care continuity, p <.01 and p, 0.5, (d = 0.202 and 0.179) were significant. Overall, our findings suggest that performance improvement at management level dominated reform efforts over service delivery. It is unclear how this aligns with providing older adults with the health care that they need.

Strengthening rural surgery in the Philippines: Essential in achieving universal health care.

The Lancet Commission on Global Surgery (LCoGS) launched Global Surgery 2030 to address the surgical services inequities with a bias toward low-income and middle-income countries like the Philippines. The same inequity is observed particularly when it comes to the urban-rural divide. With more than half of the population living in rural areas, access to surgery becomes a major challenge that further impedes the much-needed health of an economically productive workforce. The Universal Health Care [UHC] Act (RA 11332) of 2019 ensures that all Filipinos have access to quality, cost-effective, promotive, preventive, curative, rehabilitative, and palliative health services without causing a financial burden. Recognizing the provision of essential surgery, in the context of primary healthcare is important. It should be accessible, continuous, comprehensive, and coordinated at the time of need - parallel to the principle of primary health care. Driven by this concept and experiences, the authors conceptualized and presented the Philippine Rural Surgery model for future development and implementation. This is envisioned to provide essential surgery among local rural primary health care settings that is universal, accessible, cost-effective and safe. As this is still new in the Philippines, we proposed tenets and recommendations based on WHO Health System Strengthening building blocks to guide stakeholders in creating formal plans towards institutionalization under the principles of UHC. Such access to surgical service in the context of a unique socio-demography of the Philippines would be essential in attaining the parameters and provisions set by the UHC Act.

Multi-Jurisdictional Evaluation of Sentinel City Virtual Simulation for Community Health Nursing Clinical Education

Although positive learning outcomes have been documented for nursing students who participate in virtual simulation for community health nursing clinical education (Chircop & Cobbett, 2020), it is unknown whether learning outcomes of students using the same virtual simulation program are comparable across jurisdictions. Nine schools of nursing across Canada (Nova Scotia, Ontario, British Columbia) implemented and evaluated Sentinel City a virtual simulation program to complement the traditional community clinical, or as an alternative learning experience. A descriptive survey was used to carry out an evaluation of the use of Sentinel City and student learning outcomes. Quantitative data provided demographic statistics to describe the sample, compare student learning outcomes and perceptions of their learning experience and the qualitative data from open-ended questions provided detailed responses on the use of Sentinel City and its future recommendation. Data were analyzed using ANOVA (Welch statistic) to identify any significant differences among students from each jurisdiction in relation to their perception of the use of Sentinel City in meeting their course learning outcomes. Qualitative data from open-ended responses were analyzed using the six-step process outlined by Braun and Clarke (2006). The use of Sentinel City for community clinical learning in various Canadian jurisdictions positively contributed to achieving desired student learning outcomes. There are, however, significant differences among jurisdictions. Most of the students “agreed” that Sentinel City helped them achieve course learning outcomes. In all jurisdictions, most of the students indicated that they were “confident” and “very confident” in their knowledge about the community health nursing process, understanding of a population/community health assessment, understanding how to plan a population health intervention, and in their ability to integrate the five principles of primary health care into practice. Regarding their ability to apply a population health perspective (upstream thinking), most of the students were “confident” and “very confident”. Almost all students (93.62%) were confident and “very confident” in their ability to recognize health inequities indicating the highest level of confidence (Mean 4.38, SD 0.71). As educators, we found several advantages with the use of SC, including the ability to create controlled and standardized clinical learning experiences which contributes to fairness and quality of community clinical education. We recommend a robust orientation and professional development program for clinical instructors in community health nursing that is consistent with the new International Nursing Association for Clinical Simulation and Learning (2021) standards. The required expertise in community health nursing together with solid

Indicator-activities to apply primary health care principles in national or large-scale community health worker programs in low-and middle-income countries: a Delphi exercise

IntroductionPrimary Health Care (PHC) gained considerable momentum in the past four decades and led to improved health outcomes across a wide variety of settings. In low-and middle-income countries (LMICs), national or large-scale Community Health Worker Programs (CHWPs) are considered as vehicles to incorporate PHC principles into healthcare provision and are an essential aspect of the PHC approach to achieve health for all and sustainable development goals. The success of CHWPs is rooted in the application of PHC principles. However, there is evidence that shows patchy implementation of PHC principles across national CHWPs in LMICs. This may reflect the lack of information on what activities would illustrate the application of these principles in CHWPs. This study aimed to identify a set of core/indicator-activities that reflect the application of PHC principles by CHWPs in LMICs.MethodsA two-round modified Delphi study was undertaken with participants who have extensive experience in planning, implementation and evaluation of CHWPs. Survey design and analysis was guided by the four PHC principles namely Universal Health Coverage, Community Participation, Intersectoral Coordination and Appropriateness. Responses were collected using a secure online survey program (survey monkey). In round one, participants were asked to list ‘core activities’ that would reflect the application of each PHC principle and its sub-attributes and challenges to apply these principles in CHWPs. In round two, participants were asked to select whether they agree or disagree with each of the activities and challenges. Consensus was set a priori at 70% agreement of participants for each question.ResultsSeventeen participants from 15 countries participated in the study. Consensus was reached on 59 activities reflecting the application of PHC principles by CHWPs. Based on participants’ responses, a set of 29 indicator-activities for the four PHC principles was developed with examples for each indicator-activity.ConclusionThese indicator-activities may provide guidance on how PHC principles can be implemented in CHWPs. They can be used in the development and evaluation of CHWPs, particularly in their application of PHC principles. Future research may focus on testing the utility of indicator-activities on CHWPs in LMICs.

Assessment of Community Services Coverage at Primary Healthcare Facilities in Rural Population of Sharg-Elnil Locality - Khartoum State from 2018 to 2020.

Background: Sudan health system is based on the district health system approach, which emphasizes the principles of primary health care (PHC). Nevertheless, the decentralization of the public sector resulted in more deterioration of the PHC system particularly in rural and peripheral areas due to lack of financial resources and managerial capacities.
 Objectives: The study aimed to assess the community services coverage at primary Healthcare Facilities in Rural Population of Sharg-Elnil Locality - Khartoum State from 2018 to 2020.
 Materials and methods: A number of (37) Health facilities was selected in addition to (333) households. All selected mothers/care takers of children aged 12–23 months; all working Primary Healthcare sites and all health worker who are the first responsible of Health sites in the study area were included in the study. The study was conducted by using questionnaires, checklists, observation and Interview with structure close ended questionnaire. Data was computed and analyzed using SPSS program version 25.0. Descriptive and inferential statistic was used.
 Results: The study showed that 55.6% of the participants stated that their areas distance less than 2 km. The majority of the participants 72.4% were obtained their health services by going to the hospital or rural health center. More than two thirds of the participants 66.7% stated that there was transportation mean for health center. The majority of participants 69.7% stated that their families or household having ability to pay the cost of transportation. Only 46.2% of the participants stated that there was health insurance for families. Approximately 96% of the participants had vaccination card explained the vaccination that taken the children less than 2 years. Also 98.5% their child completes the routine vaccination until the date of visit. The majority 93.4% of the participants their child under five obtained any vaccines including that taken in vaccination campaigns or national days for vaccination or during child health days. The majority of the participants 69.1% indicate that their children under 5 previously taken BCG vaccines. More than half of the participants 50.8% stated that their children under 5 infected with diarrhea disease the last 2 weeks. Also 58.3% had children under 5 infected with fever during the last 2 weeks. Less than 50% (45.6%) of the participants their family having bed nets for mosquito control. Only 26.1% of the participants had one sleep under nets last night. The majority of the participants 88% had periodic follow-up during the pregnancy. The most reasons for not follow-up during pregnancy were because the health center is faraway 23.7%, economic barriers 6.3% and family barriers 3%. The participants stated that the tetanus doses coverage was 94%. The most doses of tetanus taken by the participants were five doses 36.3%. Also 56.5% of the participants sated that they were gave any medical care during the first last 6 weeks after last delivery (postnatal). More than 63% of the participants were used contraceptive. The most reasons of not used contraceptive were fear from side effects 24.3%, due to refuse of husband 2.7%, due to culture believes 3.3%, not able to by 2.4% and because of not aware 2.4%. There was association education level of father and periodic follow-up during the pregnancy, p=.000. There was association education level of mother and use of contraceptive, p=.000. There was association between occupation of mother and use of contraceptive, p=.000. there was highly association between children under 5 infected with fever during the last 2 weeks and having any bed nets for mosquito control, p=.002.
 Conclusion: The results show that coverage of the services provided were moderate which need to be strengthening and provision of resources for rural communities.

Assessment of Community Services Coverage at Primary Healthcare Facilities in Rural Population of Sharg-Elnil Locality - Khartoum State from 2018 to 2020.

Background: Sudan health system is based on the district health system approach, which emphasizes the principles of primary health care (PHC). Nevertheless, the decentralization of the public sector resulted in more deterioration of the PHC system particularly in rural and peripheral areas due to lack of financial resources and managerial capacities.
 Objectives: The study aimed to assess the community services coverage at primary Healthcare Facilities in Rural Population of Sharg-Elnil Locality - Khartoum State from 2018 to 2020.
 Materials and methods: A number of (37) Health facilities was selected in addition to (333) households. All selected mothers/care takers of children aged 12–23 months; all working Primary Healthcare sites and all health worker who are the first responsible of Health sites in the study area were included in the study. The study was conducted by using questionnaires, checklists, observation and Interview with structure close ended questionnaire. Data was computed and analyzed using SPSS program version 25.0. Descriptive and inferential statistic was used.
 Results: The study showed that 55.6% of the participants stated that their areas distance less than 2 km. The majority of the participants 72.4% were obtained their health services by going to the hospital or rural health center. More than two thirds of the participants 66.7% stated that there was transportation mean for health center. The majority of participants 69.7% stated that their families or household having ability to pay the cost of transportation. Only 46.2% of the participants stated that there was health insurance for families. Approximately 96% of the participants had vaccination card explained the vaccination that taken the children less than 2 years. Also 98.5% their child completes the routine vaccination until the date of visit. The majority 93.4% of the participants their child under five obtained any vaccines including that taken in vaccination campaigns or national days for vaccination or during child health days. The majority of the participants 69.1% indicate that their children under 5 previously taken BCG vaccines. More than half of the participants 50.8% stated that their children under 5 infected with diarrhea disease the last 2 weeks. Also 58.3% had children under 5 infected with fever during the last 2 weeks. Less than 50% (45.6%) of the participants their family having bed nets for mosquito control. Only 26.1% of the participants had one sleep under nets last night. The majority of the participants 88% had periodic follow-up during the pregnancy. The most reasons for not follow-up during pregnancy were because the health center is faraway 23.7%, economic barriers 6.3% and family barriers 3%. The participants stated that the tetanus doses coverage was 94%. The most doses of tetanus taken by the participants were five doses 36.3%. Also 56.5% of the participants sated that they were gave any medical care during the first last 6 weeks after last delivery (postnatal). More than 63% of the participants were used contraceptive. The most reasons of not used contraceptive were fear from side effects 24.3%, due to refuse of husband 2.7%, due to culture believes 3.3%, not able to by 2.4% and because of not aware 2.4%. There was association education level of father and periodic follow-up during the pregnancy, p=.000. There was association education level of mother and use of contraceptive, p=.000. There was association between occupation of mother and use of contraceptive, p=.000. there was highly association between children under 5 infected with fever during the last 2 weeks and having any bed nets for mosquito control, p=.002.
 Conclusion: The results show that coverage of the services provided were moderate which need to be strengthening and provision of resources for rural communities.