Private Primary Health Care Facilities Research Articles

Impact of COVID-19 on essential healthcare services at the primary healthcare level in Armenia: a qualitative study

BackgroundThe COVID-19 pandemic has presented significant global healthcare challenges, particularly impacting the continuity of essential health services in low- and middle-income countries. This study investigates the impact of the COVID-19 pandemic on the utilization and provision of essential health services in Armenia.MethodsWe employed a conventional qualitative study design, conducting semi-structured in-depth interviews (n = 17) within public and private primary healthcare (PHC) facilities in Armenia in 2021. Our study participants encompassed physicians providing specialty services in PHC facilities (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular visitors to PHC facilities (e.g. adults with chronic diseases, parents of children), and policymakers. Thematic analysis was conducted, yielding five emergent categories: mobilization and organization of PHC services during COVID-19; PHC visits during COVID-19; worsening of chronic conditions due to the decline in PHC visits; problems with routine childhood vaccinations; and patient-provider communication challenges.ResultsThe number of in-person visits to PHC facilities declined due to adaptations in service delivery, imposed lockdown measures, and the public’s fear of visiting healthcare facilities. Maternal and child health services continued with no major disruptions. PHC providers deliberately limited the number of maternal and child visits to essential antenatal care, newborn screenings, and routine childhood immunizations. Still, children experienced some delays in vaccination administration. The pandemic resulted in a notable reduction in follow-up visits and monitoring of patients with chronic conditions, thereby exacerbating their chronic conditions. Phone calls were the primary method of patient-provider communication during the pandemic.ConclusionsThe COVID-19 pandemic has had a profound impact on the delivery and utilization of essential healthcare services at PHC facilities, especially for those with chronic conditions who needed continuous care. Unified national-level guidance and technical capacity are needed to direct the provision of essential services at the PHC level, promote effective health communication, and implement digital platforms for the uninterrupted provision of essential care during public health emergencies.

Lessons on chronic care organisation during the COVID-19 pandemic in Cambodia, Slovenia, and Belgium. COVID as a magnifying glass on primary health care.

Introduction: Primary health care (PHC) systems worldwide have been challenged by the COVID-19 pandemic. Some patients couldn’t access care or services were not available.
 Background: Fuelled by different health systems, the impact on NCD care has been different in the three countries under research: Cambodia (a developing health system in a middle-income country), Slovenia (a centrally-steered health system in a high-income country), and Belgium (a publicly-funded privatised health system in a high-income country). As crises can uncover both the strengths and weaknesses of a PHC system, we can use them as an opportunity to pinpoint weak and strong areas and translate this knowledge into recommendations to strengthen the PHC system. This study aims to answer two research questions: ‘How has COVID-19 influenced NCD care within PHC?’ and ‘Under which circumstances does a crisis lead to health system strengthening in which types of countries?’.
 Methods: Interviews were conducted with 58 key stakeholders including policy makers or influencers, patient and provider representatives, researchers and primary care providers. These interviews were supplemented with document reviews. A qualitative thematic analysis was performed and results were discussed with the international research team. This study is part of the SCUBY project, funded by the EU Horizon 2020 programme.
 Results: COVID-19 had different impacts on key organizations in the three countries. In Belgium, general practitioners got overburdened with COVID-19 testing and accompanying administration, highlighting the chronic lack of auxiliary staff such as nurses or assistants. In Cambodia, some private PHC facilities, serving the majority of the patients with NCDS were closed by the owners to prevent transmission. This led to the increased burden of NCD on the public sector which has a duty to maintain essential services in the crisis circumstance. However, it pointed to the importance of strengthening the public sector for NCD care to cope with future crises. In Slovenia, the high COVID-19 burden in nursing homes revealed vulnerabilities in the long-term care system, such as lack of staff and fragmented service provision.
 
 In relation to health system strengthening opportunities, the current crisis also provides a unique chance to move forward in the three countries. In Cambodia, the successful vaccination campaign renewed trust in the public health sector, whereas in Slovenia new investments in the health care sector were announced. In Belgium, the Minister of Health planned to reform the financing system and to strengthen primary care.
 Conclusions: The COVID pandemic caused disruption of care in all three countries. However, it also creates important chances to accelerate the scale-up of high-quality care for all patients with NCDs. When taking the time to analyse how COVID-19 impacted the health care system we can boost it faster than before.

Cluster and Buffer Analysis of the Distribution of Healthcare Facilities in Plateau State

Nigeria faces significant challenges in providing access to healthcare services for its population. An important aspect of Nigerian health policy that requires timely evaluation, is accessibility to Primary Health Care (PHC) facilities (and, indeed, other healthcare facilities) especially in rural areas. Thus, the need to investigate their distribution and spatial influence. This study employed the technology of Remote Sensing and GIS in generating relevant scientific data on the spatial distribution of healthcare facility in Plateau State. Coordinates of various health facilities were recorded using handheld GPS while various attribute information were also obtained and recorded. The results thus acquired were tabulated and segmented by local government. The type of facility (primary, secondary and tertiary) and, ownership (government or private) was tabulated and prepared for further analysis. There are 1237 health facilities spread across the state. Government PHC facilities; 615, private PHC facilities; 542, government secondary and private secondary healthcare facilities; 31 and 44 respectively and 5 tertiary healthcare facilities were documented and their spatial distribution and relationship represented graphically. Buffer distances of 0.5, 1 and 2 Kilometers and 1, 2, 3, 5 and 10 Kilometers were used for buffer analysis of the spatial relationship between facilities and settlements. This showed a reasonable coverage especially around the location of settlements within the state. Urban centers present clustering of facilities due to density of population in these areas. The cluster analysis reveals similar Nearest Neighbor Ratios for all the types of facilities with private secondary healthcare having the least with 0.606858. This is a direct consequence of the clustering of private secondary facilities around the Jos-Bukuru metropolis in the northern end of the state. Other types of facility are not too far from this ratio with government primary presenting 0.701219, private primary 0.837056 and 0.661641 for government secondary facilities. The northern senatorial district shows much of this clustering with the peak in and around the Jos-Bukuru metropolis. This can be attributed to the important role of Jos as the administrative center of the state and a major urban area. The z-scores for both government (-14.174948) and private primary healthcare facilities (-15.069804) indicates significant clustering. The z-score for government secondary (-1.735602) in correlation with its relatively high Nearest Neighbour Ratio points towards the near-equitable distribution of these facilities.

Space Based Application For The Inventory, Distribution And Analysis Of Healthcare Facilities In Nasarawa State, Nigeria

The study aimed at carrying out the inventory, distribution and analysis of healthcare facilities in Nasarawa state using remote sensing and geographic information system (GIS) techniques. Field mapping was conducted and coordinates with attributes of these healthcare facilities were recorded. GIS analysis using multiple ring buffer and cluster extension of the spatial analysis tool in ArcGIS 10.8 version was used. Result revealed a total of 1,119 healthcare facilities distributed across the state. Out of which 807 are government primary healthcare, while 227 are private primary and 24 government secondary whereas 60 are private secondary and one tertiary healthcare facility. Result also revealed significant disparities in the distribution of government tertiary healthcare facilities across the local government areas with only having such facility in the whole of Nasarawa State. This indicates limited access to specialized healthcare services. The general trend of health facilities in Nasarawa state is towards clustering because these facilities are intended to reside close to settlements and thus will present some degree of clustering though the level may differ between different types of facilities. The buffer analysis in secondary healthcare showed a wide number of settlements by local government that need more present of secondary healthcare facility in Nasarawa state showing good accessibility of health care facility to the settlement within 1 km and 10 km radius. The government own primary healthcare facilities record a z-score of -17.52725 and 0.677488 nearest neighbour ratio suggesting a very strong trend towards clustering, and from the analysis, there is a less than 1% chance of randomness or dispersion. This indicates that there is a lot needs to be done to ensure a more dispersed and competitive distribution of these facilities. The private primary healthcare facilities have a z-score of -18.527370 and nearest neighbour ratio of 0.357209, which shows very significant clustering alongside an identical 1% probability of random distribution. This clearly indicates that there is need for strategic planning and resource allocation to the health sector to ensure an equitable, dispersed and competitive distribution of these facilities. The findings from this study have implications for the actualization of the United Nations’ health-related Sustainable Development Goal (SDG-3) and also to achieve the Universal health coverage.

How socioeconomic status affected the access to health facilities and malaria diagnosis in children under five years: findings from 19 sub-Saharan African countries

BackgroundPrompt and appropriate clinical management of malaria is critical for reducing the continued high burden of malaria among children under five years in sub-Saharan countries. However, more remains to be known about how a patient’s socioeconomic status (SES) would affect the access to diagnosis of malaria.MethodsIn this cross-sectional study using the Demographic and Health Survey and Malaria Indicators Survey, we pooled the data of 38,567 febrile under-five children in 2016–2018 from 19 sub-Saharan countries. Multivariable logistic regression was used to assess the associations between SES and two binary outcomes: the visit to a health facility and a blood test for fever. Stratified analyses were further conducted by the type of health facilities (public hospitals/public primary healthcare facilities/private hospitals/private primary healthcare facilities) for the latter outcome.ResultsFifty-eight percent of the febrile children were taken to health facilities, among whom only 55% took blood tests. Compared to children from households in the highest wealth quintile, children in the lowest quintile were less likely to be taken to medical facilities [adjusted odds ratio (aOR) = 0.775, 95% confidence interval (CI): 0.675–0.889]. Parents with more than secondary education were more likely to seek care (aOR = 1.830, 95% CI: 1.561–2.145) and to have blood tests (aOR = 1.729, 95% CI: 1.436–2.082) for their febrile children than parents without formal education. The probabilities of receiving blood tests at public hospitals and public primary healthcare facilities stayed relatively high across parental education levels and wealth quintiles, while these probabilities remained the lowest at private primary healthcare facilities, ranging from 0.100 (95% CI: 0.074–0.127) to 0.139 (95% CI: 0.083–0.194) across parental education levels and from 0.104 (95% CI: 0.078–0.130) to 0.125 (95% CI: 0.090–0.160) across wealth quintiles.ConclusionsSignificant socioeconomic disparities existed both in the access to health facilities and laboratory diagnosis of malaria in children in sub-Saharan African countries. These disparities were particularly evident in the private sector. Universal health coverage needs to be further strengthened to make formal healthcare in general and the laboratory diagnosis of malaria more accessible and affordable.Graphical abstract

The capacity of primary healthcare facilities in Bangladesh to prevent and control non-communicable diseases

BackgroundThe rapid rise of non-communicable diseases (NCDs) has become a significant public health concern in Bangladesh. This study assesses the readiness of primary healthcare facilities to manage the following NCDs: diabetes mellitus (DM), cervical cancer, chronic respiratory diseases (CRIs), and cardiovascular diseases (CVDs).MethodsA cross-sectional survey was conducted between May 2021 and October 2021 among 126 public and private primary healthcare facilities (nine Upazila health complexes (UHCs), 36 union-level facilities (ULFs), 53 community clinics (CCs), and 28 private hospitals/clinics). The NCD-specific service readiness was assessed using the World Health Organization’s (WHO) Service Availability and Readiness Assessment (SARA) reference manual. The facilities’ readiness was assessed using the following four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. The mean readiness index (RI) score for each domain was calculated. Facilities with RI scores of above 70% were considered ‘ready’ to manage NCDs.ResultsThe general services availability ranged between 47% for CCs and 83% for UHCs and the guidelines and staff accessibility were the highest for DM in the UHCs (72%); however, cervical cancer services were unavailable in the ULFs and CCs. The availability of basic equipment was the highest for cervical cancer (100%) in the UHCs and the lowest for DM (24%) in the ULFs. The essential medicine for CRI was 100% in both UHCs and ULFs compared to 25% in private facilities. The diagnostic capacity for CVD and essential medicine for cervical cancer was unavailable at all levels of public and private healthcare facilities. The overall mean RI for each of the four NCDs was below the cut-off value of 70%, with the highest (65%) for CRI in UHCs but unavailable for cervical cancer in CCs.ConclusionAll levels of primary healthcare facilities are currently not ready to manage NCDs. The notable deficits were the shortage of trained staff and guidelines, diagnostic facilities, and essential medicine. This study recommends increasing service availability to address the rising burden of NCDs at primary healthcare levels in Bangladesh.

Impact of COVID-19 on the essential healthcare services at primary healthcare level

Abstract Background The COVID-19 pandemic triggered numerous challenges for the healthcare systems worldwide, particularly affecting the continuity of essential health services in low- and middle-income countries. We explored the effects of the COVID-19 pandemic on the utilization and delivery of essential health services in Armenia. Methods We applied a conventional qualitative study design using semi-structured in-depth interviews (n = 17) in public and private primary healthcare (PHC) facilities in Armenia (2021). Participants included physicians providing primary health services (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular PHC facility patients (e.g. adults with chronic diseases, parents of children), and policymakers. Iterative thematic analysis was done based on inductively emerged 3 main themes: patient-provider communications, maternal and child health services, and management of chronic diseases. Results Overall, visits to the PHC facilities were decreased due to fear to contract COVID-19 coupled with lack of information, misinformation and panic. There was a lack of digital platforms for ensuring continuous patient-provider communication and phone calls were the main way of communication. PHC providers intentionally limited the number of maternal and child visits to only essential antenatal visits, newborn screenings and routine child immunizations. Still, the latter has suffered resulting in delayed and decreased vaccinations. The pandemic remarkably decreased the number of follow-up visits and monitoring of patients with chronic conditions resulting in more critical and severe conditions. Conclusions The COVID-19 pandemic affected the provision and utilization of essential health services at PHC facilities by changing people’s health-seeking behavior. Unified national-level guidance for PHC facilities is needed to direct the provision of essential services, effective health communication and usage of digital platforms. Key messages • Though provider encounters should be limited during outbreaks, continuous provision of essential services is critical in the prevention of morbidity, complications and worsened disease severity. • Efforts are needed to develop effective health and risk communication strategies and enhance appropriate usage of digital platforms to promote adequate health-seeking behavior among the public.

Evaluating the Impact of the COVID-19 Pandemic on Accessing HIV Services in South Africa: A Systematic Review.

Progress has been made towards controlling the Human Immunodeficiency Virus (HIV) epidemic in South Africa. However, the emergence of coronavirus disease 2019 (COVID-19) has disrupted access to health care. This systematic review aims to evaluate the impact of the pandemic on accessing HIV services at a primary health care (PHC) level in South Africa. HIV services that have been significantly impacted are highlighted, and recommendations for future public health emergencies are made. Three databases were searched in January 2022. The studies included were those that reported on HIV services at a PHC level in South Africa. From the searches, 203 papers were identified, of which 34 full texts were screened. Eleven studies met the inclusion criteria and were included in this review. Overall, decreases in HIV testing, positive HIV tests, and initiation of antiretroviral therapy (ART) were reported. Resilience of ART provision was reported, meaning that adherence to treatment was sustained throughout the pandemic. The findings showed that HIV services at private PHC facilities were unaffected, however, an overall decrease in HIV services at public PHC facilities was reported, excluding antenatal care which showed resilience.

Compliance of Private Primary Health Care Facilities Towards Requirements of Labelling of Dispensed Medicine in Sarawak.

Compliance towards the requirements of labelling of dispensed medicine (LDM) among private primary health care facilities ensures appropriate use of medicines. This study aimed to examine the rate of compliance towards the requirements of LDM among retail pharmacies (RPs) and private medical clinics (PMCs). A cross-sectional study was conducted from April 2019 to January 2020 across all inspected premises in Sarawak. Publics who attended RPs and PMCs and have medicines dispensed have their medicine labels examined for compliance with the requirements of LDM upon exiting the premises. Their verbal consents were obtained and the compliance score was recorded into self- -developed data collection forms. The compliance rate was the percentage of requirements on the examined medicine labels that fulfill the requirements under Regulation 12 of Poisons Regulations 1952. A total of 414 LDM were examined, with 135 from RPs and 279 from PMCs. The full compliance towards the requirements of LDM among RPs and PMCs were 23.7% and 41.6%, respectively. The median compliance score of PMCs (0.83) was significantly higher (P<0.001) than RPs (0.67). The requirements of LDM with the lowest compliance were name of medicine (53.1%), followed by name of patient (31.9%) and date of dispensing (25.6%). The full compliance rate on the requirements of LDM among RPs and PMCs were low. More stringent enforcement and public education on their rights for fully compliant medicine labels could improve the compliance.

Initiating a district-based public\u2013private mix to overcome tuberculosis missing cases in Indonesia: readiness to engage

BackgroundDistrict-based public–private mix (DPPM) is a variant of a relatively new PPM strategy of addressing missing cases in the tuberculosis (TB) care cascade in Indonesia. We aimed to determine the readiness of various stakeholders to engage in implementing the DPPM strategy.MethodsThe research design was sequential exploratory mixed methods. A qualitative study in the first stage was carried out through in-depth interviews, FGD and study documents. Data were analyzed through coding, categorizing, pattern matching and theorizing. The second stage was a survey conducted using instruments built in the first stage. Data were analyzed using Rasch modeling and logistic regression.ResultsDistrict TB case detection rate (CDR) has improved from 35% (2018) to 104% (2019). The contribution of private hospitals has increased considerably. However, there were almost none from the private primary healthcare facilities. The substantive theory generated indicates that awareness and concern of the TB problem, TB program comprehension and involvement, and institutional support are behind the readiness of facilities to engage the TB program (the readiness to engage). The measurement results indicate the significant correlation of all dimensions on readiness to engage. Concern of the TB problem and institutional support are variables that influence readiness to engage (p < 0.05).ConclusionsEngaging private and public facility stakeholders is a challenge for local government. Intervention is through a personalized approach, encourages institutional support of health facilities for the TB program and system approach.

Patient perspectives on interpersonal aspects of healthcare and patient-centeredness at primary health facilities: A mixed methods study in rural Eastern Uganda.

Patient-centered care (PCC) is an approach to involve patients in health care delivery, to contribute to quality of care, and to strengthen health systems responsiveness. This article aims to highlight patient perspectives by showcasing their perceptions of their experience of PCC at primary health facilities in two districts in Uganda. A mixed methods cross-sectional study was conducted in three public and two private primary health care facilities in rural eastern Uganda. In total, 300 patient exit survey questionnaires, 31 semi-structured Interviews (SSIs), 5 Focus Group Discussions (FGDs) and 5 feedback meetings were conducted. Data analysis was guided by a conceptual framework focusing on (1) understanding patients' health needs, preferences and expectations, (2) describing patients perceptions of their care experience according to five distinct PCC dimensions, and (3) reporting patient reported outcomes and their recommendations on how to improve quality of care. Patient expectations were shaped by their access to the facility, costs incurred and perceived quality of care. Patients using public facilities reported doing so because of their proximity (78.3% in public PHCs versus 23.3% in private PHCs) and because of the free services availed. On the other hand, patients attending private facilities did so because of their perception of better quality of care (84.2% in private PHCs versus 21.7% in public PHCs). Patients expectations of quality care were expressed as the availability of medication, shorter waiting times, flexible facility opening hours and courteous health workers. Analysis of the 300 responses from patients interviewed on their perception of the care they received, pointed to higher normalized scores for two out of the five PCC dimensions considered: namely, exploration of the patient's health and illness experience, and the quality of the relationship between patient and health worker (range 62.1-78.4 out of 100). The qualitative analysis indicated that patients felt that communication with health workers was enhanced where there was trust and in case of positive past experiences. Patients however felt uncomfortable discussing psychological or family matters with health workers and found it difficult to make decisions when they did not fully understand the care provided. In terms of outcomes, our findings suggest that patient enablement was more sensitive than patient satisfaction in measuring the effect of interpersonal patient experience on patient reported outcomes. Our findings show that Ugandan patients have some understanding of PCC related concepts and express a demand for it. The results offer a starting point for small scale PCC interventions. However, we need to be cognizant of the challenges PCC implementation faces in resource constrained settings. Patients' expectations in terms of quality health care are still largely driven by biomedical and technical aspects. In addition, patients are largely unaware of their right to participate in the evaluation of health care. To mitigate these challenges, targeted health education focusing on patients' responsibilities and patient's rights are essential. Last but not least, all stakeholders must be involved in developing and validating methods to measure PCC.

Comparison of Lassa fever prevention practices between public and private primary health care facilities in Jos, Plateau state, Nigeria

Background: Lassa fever is endemic in Nigeria and health care workers are at a high risk of contracting and transmitting the infection. This study compares Lassa fever prevention practices among health care providers in public and private Primary Health Care facilities in Jos.Methods: The study used a comparative cross-sectional design to study health care workers in 29 Primary Health Care facilities selected using a two-stage sampling technique. All health care workers who attended to patients were interviewed using a semistructured interviewer-administered questionnaire. Data were analysed using Statistical Package for Social Sciences version 23 and a p-value of ≤ 0.5 was considered statistically significant.Results: Majority of the respondents had neither received on-the-job training on Lassa fever prevention (91.9%) nor Universal Standard Precautions (88.7%). Private Primary Health Care facilities had better supplies and equipment for Lassa fever prevention compared to their public counterparts. Majority (65.8%) of respondents had poor Lassa fever prevention practices and this was worse in the private (75.4%) than the public (55.6%) facilities. No facility met all the requirements for Lassa fever prevention. Training had a statistically significant association with good practice among public Primary Health Care facilities. Conclusion: Noncompliance with Lassa fever prevention practice is still common in Primary Health Care facilities. This is worse in private facilities. Continuous training and improved supplies of materials and equipment are necessary for effective Lassa fever prevention among these health care providers.

Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis.

This is the protocol for a review and there is no abstract. The objectives are as follows: The review has the following two objectives. To identify, appraise and synthesise qualitative research evidence on healthcare workers’ perceptions and experiences regarding their use of mHealth technologies to provide and support the delivery of primary healthcare services. To identify hypotheses, for subsequent consideration and assessment in effectiveness reviews, about why some technologies are more effective than others.

Analysis of Primary Health-Care Resource Preparedness for Implementation of Maternal HIV Screening in Indonesia's Urban Areas

The Indonesian goverment's minimum service standard (MSS) indicator stipulates that 100% of pregnant women in the country must undergo HIV checks. in 2017, however only 7% of pregnant women underwent such checks. The same condition applies to Depok City, where in 2016 only 3.6% of pregnant women were screened. Because 86.6% antenatal examinations are done within primary-care facilities, this study has to analyzed the preparedness of primary health-care resources in the implementation of HIV screening for pregnant women. The research used qualitative method with in-depth interview, FGD and document review. The Study found that human resource workers trained in HIV programs were not available at every Public Health Center (PHC) and private primary health-care (PPHC) had no such workers were trained on HIV. Roughly half (17 of 35) of PHCs Primary health care capable of HIV screening for maternal. No PPHC facilities especially inpendent midwife practice had such capabilities The number of reagents was found to be inadequate at the PHCs, and no reagents at all were found at prprivate care facilities. Counselling media was found to be lacking at both types of primary care facilities. Conclusion the implementation of HIV screening in primary health care facilities is not yet ready according to the MSS. Regulations that require PPHC facilities to be capable of HIV screening and government support for the availability of resources (especially training and reagents) are require for the achievement of the MSS.

ASSESSMENT OF PRESCRIBING INDICATORS IN PUBLIC AND PRIVATE PRIMARY HEALTH CARE FACILITIES IN JAVA, INDONESIA

Prescribing indicator is an easy core indicator to evaluate drug utilization as stated in WHO guideline. Rational prescribing pattern is important to improve rational use of drugs whereas irrational prescribing pattern can lead to irrational drug use. This study aimed to assess the prescribing pattern in public and private primary healthcare facilities which were included in the National Health Insurance Program in Indonesia. This study has been conducted using the cross sectional research design, quantitative and retrospective method in four provinces in Java island (West Java, Banten, DIY and Central Java provinces) from May to July 2014. The method of retrospective data collection were collected 757 prescriptions from 26 PHCs and 900 prescriptions from 30 clinics or General Practitioners (GPs). All data in the prescribing form were analyzed manually using Microsoft Excel 2007. The average number of item in public and private facilities was 3.31 and 3.06 respectively. The percentage of generic prescribing was 93.3% and 62.0%, the percentage of drugs in accordance with the 2013 national formulary was 89.0% and 64.5%, the percentage of antibiotic per total number of encounter was 42.8% and 39.4%, while the percentage of injection per total encounter was only 0.7% and 2.2%. Paracetamol and dexamethasone were the most frequently prescribed drugs while for antibiotic group were amoxicillin, ciprofloxacin, cotrimoxazole and cefadroxil.The average number of items per encounter and antibiotic were not met the WHO standard(≤3 for average number and less than 30% for antibiotic percentage). Suitable interventions are needed to improve the prescribing practices in Indonesia.

Comparative assessment of private and public health care providers' Knowledge on malaria treatment in bassa local government area of plateau state

Background: Health-care workers have a major role to play in ensuring that malaria treatment is carried out in accordance to treatment guidelines, to ensure the quality of patient care. Having the requisite knowledge of the ailment and its management is a necessity in achieving optimal treatment outcomes. Objectives: The purpose of this study was to assess and compare health-care workers' knowledge on malaria and its treatment across public and private primary health-care facilities of Bassa Local Government Area, Nigeria. Materials and Methods: Two hundred pretested semi-structured questionnaires were administered to health-care workers across selected public and private facilities; and the generated data were analyzed using Statistical Package for Social Sciences software version 20. Results: A total of 184 health-care workers (92% of the study population of 200) participated in the study. The majority of the health-care workers (65.8%) were from the public sector, while 34.2% were from private health facilities. Most of the respondents were Junior Community Health Extension Workers (23.4%) and Community Health Extension Workers (22.8%). The other health workers included in the study were nurses and laboratory and pharmacy technicians involved in the management of malaria. The respondents had a good knowledge of the cause, symptoms, and diagnosis of malaria across the facilities, based on their item scores; however, their knowledge on anti-malarial drugs was poor. Workers with >10 years in practice had significantly better knowledge (45.3%) than those with lesser experience (28.4%) (P = 0.018). Those in private practice had marginally better knowledge (44.4%) than those in public sectors (38.8%). Conclusion: The respondents had good knowledge of the etiology, symptoms, and diagnosis of uncomplicated malaria across the facilities, but knowledge of the recommended antimalarials and symptoms of complicated malaria was poor. The outcomes will be useful in educating health-care professionals in the facilities, with an emphasis on the recommended drugs for malaria.

PHP26 - Assessment of Prescribing Indicators in Public and Private Primary Health Care Facilities in Indonesia

The assessment of prescribing indicators is beneficial to understand prescribing rationality and drug utilization. Drug utilization has to be monitored regularly and prescribing indicator is one easy core indicator to evaluate it as stated in WHO guideline. This study aimed to assess the prescribing pattern in public and private primary health care facilities which were included in the National Health Insurance Program in Indonesia. A retrospective, quantitative, and cross-sectional survey designed to describe the prescribing practices at primary health care facilities in 4 provinces in Java Island, Indonesia. The study was conducted in May-June 2014. This study collected 757 prescriptions from 26 PHCs and 900 prescriptions from 30 clinic or General Practitioners (GPs). All data in the prescribing form were analyzed manually using Microsoft Excel 2007. The average number of item in public and private facilities was 3.31 and 3.06 respectively. The percentage of generic prescribing was 93.3% and 62,0% while the percentage of drugs in accordance with the 2013 national formulary was 89.0% and 64.5% in public and private facilities. The percentage of antibiotic per total number of encounter was 42.8% and 39.4% while the percentage of injection per total encounter was only 0.7% and 2.2% in public and private facilities. Paracetamol and dexamethasone were the most frequent drugs prescribed while for antibiotic group were amoxicillin, ciprofloxacin, cotrimoxazole and cefadroxil. Based on the finding, it showed that the prescribing pattern for average number of items per encounter and antibiotic were not met the WHO standard. It inferred the necessity to develop suitable intervention to improve the prescribing practices in Indonesia.

Assessment of four common underfive children illnesses Routine Health Management Information System data for decision making at Ilemela Municipal Council, Northwest Tanzania: A case series analysis

BackgroundIn 2012, The Tanzania Ministry Of Health introduced the revised Routine Health Management Information System (RHMIS) modules and registers, and introduced the open source software for data collection at the district council level. Despite a series of data collection tools revisions, the quality of data collated from both public and private primary health care facilities has not been investigated. MethodsA case series study design was conducted on underfive children outpatient registers and monthly reports on malaria, acute respiratory infections, acute diarrhoea and pneumonia from 10 randomly selected health facilities. The data was entered into excel software and exported to stata version 11 for analysis. The data was analyzed for completeness, timely report submission and reporting accuracy. ResultsThe Study found that 62% of the expected data was complete. Around 40% of the facilities submitted reports on time. Private health facilities submitted monthly reports late compared to the public facilities (p-value=0.039). There was 26% over-reporting of diagnosis. Health centres tended to over-report more diagnoses by 11 times higher than the dispensaries. In addition, private owned health facilities tended to over-report more diagnoses by 6 times higher than public owned health facilities. ConclusionThe RHMIS data collected through out patients department (OPD) registers on four common underfive children's illnesses at ilemela municipality were of unsatisfactory quality in light of allocation of resource allocations in the comprehensive council health plan.

A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana.

Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and ‘no malaria drug’ on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support of rational drug use.

Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa

Patients with community-acquired urinary tract infections (UTIs) frequently present to healthcare facilities in South Africa (SA). To provide information on UTI aetiology and antimicrobial susceptibility of pathogens. We recruited women with UTI-related symptoms, who tested positive for ≥2 urine dipstick criteria (proteinuria, blood, leucocytes or nitrites) at 1 public and 5 private primary healthcare facilities in 2011. Demographic and clinical data were recorded and mid-stream urine (MSU) specimens were cultured. UTI pathogens were Gram-stained and identified to species level. Etest-based antimicrobial susceptibility testing was performed for amoxicillin/clavulanic acid, cefixime, cefuroxime, ciprofloxacin, fosfomycin, levofloxacin, nitrofurantoin, norfloxacin and trimethoprim/sulphamethoxazole. Of the 460 women recruited, 425 MSU samples were processed and 204 UTI pathogens were identified in 201 samples. Most pathogens were Gram-negative bacilli (GNB) (182; 89.2%) and 22 (10.8%) were Gram-positive cocci (GPC). Escherichia coli was the most frequent GNB (160; 79.6%), while Enterococcus faecalis was the predominant GPC (8; 4.0%). The UTI pathogens had similar susceptibility profiles for fosfomycin (95.5%; 95% confidence interval (CI) 92.6 - 98.4), the 3 fluoroquinolones (94.1%; 95% CI 90.8 - 97.4), nitrofurantoin (91.7%; 95% CI 87.8 - 95.6), cefuroxime (90.1%; 95% CI 86.0 - 94.3) and cefixime (88.2%; 95% CI 83.7 - 92.6). UTI pathogens were less susceptible to amoxicillin/clavulanic acid (82.8%; 95% CI 77.5 - 88.0) when compared with fluoroquinolones and fosfomycin. Trimethoprim/ sulphamethoxazole was the least efficacious antimicrobial agent (44.3% susceptible; 95% CI 37.4 - 51.2). This study provides relevant data for the empirical treatment of community-acquired UTIs in SA.