Programmatic Area Research Articles

Effects of pay for performance in primary care in an under-registration scenario.

To propose a method for detecting and analyzing under-registration and highlight its potential financial effect in view of the implementation of the Previne Brasil Program. An ecological study was carried out to analyze cytopathological exams in programmatic area 3.1 in the municipality of Rio de Janeiro. The data was collected from the Departamento de Informática do Sistema Único de Saúde (DATASUS - Department of Informatics of the Unified Health System) database, including information on reports from outsourced cytopathology laboratories and those available in the Sistema de Informação em Saúde para a Atenção Básica (SISAB - Health Information System for Primary Care) and the Sistema de Informação do Câncer do Colo do Útero (SISCOLO - Cervical Cancer Information System) of DATASUS/Ministry of Health. The estimated under-registrations per health unit totaled 108,511 exams in the last two years in the programmatic area 3.1 area, which corresponds to an estimated total of R$ 435,129.00 that would have been foregone if the Previne Brasil Program had been in place during the period studied. The article's main contribution lies in the presentation of empirical evidence of the potential effects of under-registration on Primary Health Care financing. In addition, there are two other significant findings - firstly, it highlights weaknesses in the process of recording health information inherent to vulnerable regions; secondly, it indicates a vicious circle potentially fueled by sudden changes in Primary Health Care funding conditions, in addition to potential consequences for other levels of care.

Prevalence of latent tuberculosis infection and incidence of tuberculin conversion among school contacts older than 5 years in the City of Buenos Aires.

Introduction. Tuberculosis continues to be a common problem in settings of socioeconomic vulnerability. Our primary objective was to establish the prevalence of latent infection and tuberculin conversion among school contacts of tuberculosis cases. Population and methods. In a programmatic area in the south of the City of Buenos Aires, the prevalence of latent infection and tuberculin conversion was assessed in 691 children and adolescents using the tuberculin skin test. The association between loss to follow-up by the health care team and the demographic, school, and baseline care characteristics was studied, and the level of adherence when isoniazid chemoprophylaxis was indicated was described. Results. According to established definitions, the prevalence of latent infection was between 3.4% (95% confidence interval [CI]: 2.3-5.2) and 11.6% (95% CI: 9.3-14.4) in the 610 contacts with at least one skin test. The incidence of tuberculin conversion was between 0.3% and 6.8% in the 294 assessed participants. Age older than 18 years, a higher prevalence of unmet basic needs in the school district, attending the afternoon school shift, negative sputum smear results in the index case, and absence of baseline skin test were associated with contact lost to follow-up. Conclusions. The incidence of tuberculin conversion among school contacts was low. Adherence to isoniazid treatment remains limited. Factors associated with loss of contact tracing were identified, which may guide strategies necessary to improve this process.

Registration with Primary Health Care and COVID-19 mortality: cohort of diabetics from five administrative health regions in the city of Rio de Janeiro, Brazil, 2020-2021.

The present study carried out an analysis of survival according to the status of registration with Primary Health Care (PHC) and of factors associated with death from COVID-19, in cases residing in Programmatic Area 3.1 (PA3.1) with a diagnosis of diabetes (in the notification form or in the electronic medical record), of the Municipality of Rio de Janeiro (RJ), Brazil, in 2020-2021. A probabilistic linkage of databases was performed based on information on cases notified as COVID-19 and data from the electronic medical records of people living with diabetes. A survival analysis was carried out, using the Cox regression model stratified by age group and adjusted for confounding variables. Individuals registered with the PHC of PA3.1 had almost twice the risk of death from COVID-19 (adjusted hazard ratio [HRadj]=1.91) when compared to those unregistered. This association was stronger in individuals aged 18 to 59 years registered with the PHC (HRadj=2.82) than in individuals aged 60 years or over (HRadj=1.56). Surveillance strategies for identifying and adequately monitoring higher-risk groups, among individuals living with diabetes, within the scope of Primary Health Care, can contribute to reducing mortality from COVID-19.

How are global health policies transferred to sub-Saharan Africa countries? A systematic critical review of literature

BackgroundMost sub-Saharan Africa countries adopt global health policies. However, mechanisms with which policy transfers occur have largely been studied amongst developed countries and much less in low- and middle- income countries. The current review sought to contribute to literature in this area by exploring how health policy agendas have been transferred from global to national level in sub-Saharan Africa. This is particularly important in the Sustainable Development Goals (SDGs) era as there are many policy prepositions by global actors to be transferred to national level for example the World Health Organization (WHO) policy principles of health financing reforms that advance Universal Health Coverage (UHC).MethodsWe conducted a critical review of literature following Arksey and O’Malley framework for conducting reviews. We searched EBSCOhost, ProQuest, PubMed, Scopus, Web of Science and Google scholar for articles. We combined the concepts and synonyms of “policy transfer” with those of “sub-Saharan Africa” using Boolean operators in searching databases. Data were analyzed thematically, and results presented narratively.ResultsNine articles satisfied our eligibility criteria. The predominant policy transfer mechanism in the health sector in sub-Saharan Africa is voluntarism. There are cases of coercion, however, even in the face of coercion, there is usually some level of negotiation. Agency, context and nature of the issue are key influencers in policy transfers. The transfer is likely to be smooth if it is mainly technical and changes are within the confines of a given disease programmatic area. Policies with potential implications on bureaucratic and political status quo are more challenging to transfer.ConclusionPolicy transfer, irrespective of the mechanism, requires local alignment and appreciation of context by the principal agents, availability of financial resources, a coordination platform and good working relations amongst stakeholders. Potential effects of the policy on the bureaucratic structure and political status are also important during the policy transfer process.

Data cleaning process for HIV-indicator data extracted from DHIS2 national reporting system: a case study of Kenya

BackgroundThe District Health Information Software-2 (DHIS2) is widely used by countries for national-level aggregate reporting of health-data. To best leverage DHIS2 data for decision-making, countries need to ensure that data within their systems are of the highest quality. Comprehensive, systematic, and transparent data cleaning approaches form a core component of preparing DHIS2 data for analyses. Unfortunately, there is paucity of exhaustive and systematic descriptions of data cleaning processes employed on DHIS2-based data. The aim of this study was to report on methods and results of a systematic and replicable data cleaning approach applied on HIV-data gathered within DHIS2 from 2011 to 2018 in Kenya, for secondary analyses.MethodsSix programmatic area reports containing HIV-indicators were extracted from DHIS2 for all care facilities in all counties in Kenya from 2011 to 2018. Data variables extracted included reporting rate, reporting timeliness, and HIV-indicator data elements per facility per year. 93,179 facility-records from 11,446 health facilities were extracted from year 2011 to 2018. Van den Broeck et al.’s framework, involving repeated cycles of a three-phase process (data screening, data diagnosis and data treatment), was employed semi-automatically within a generic five-step data-cleaning sequence, which was developed and applied in cleaning the extracted data. Various quality issues were identified, and Friedman analysis of variance conducted to examine differences in distribution of records with selected issues across eight years.ResultsFacility-records with no data accounted for 50.23% and were removed. Of the remaining, 0.03% had over 100% in reporting rates. Of facility-records with reporting data, 0.66% and 0.46% were retained for voluntary medical male circumcision and blood safety programmatic area reports respectively, given that few facilities submitted data or offered these services. Distribution of facility-records with selected quality issues varied significantly by programmatic area (p < 0.001). The final clean dataset obtained was suitable to be used for subsequent secondary analyses.ConclusionsComprehensive, systematic, and transparent reporting of cleaning-process is important for validity of the research studies as well as data utilization. The semi-automatic procedures used resulted in improved data quality for use in secondary analyses, which could not be secured by automated procedures solemnly.

Responding to aid volatility: government spending on district health care in Zambia 2006–2017

ABSTRACT Background: A corruption event in 2009 led to changes in how donors supported the Zambian health system. Donor funding was withdrawn from the district basket mechanism, originally designed to pool donor and government financing for primary care. The withdrawal of these funds from the pooled financing mechanism raised questions from Government and donors regarding the impact on primary care financing during this period of aid volatility. Objectives: To examine the budgets and actual expenditure allocated from central Government to the district level, for health, in Zambia from 2006 to 2017 and determine trends in funding for primary care. Methods: Financial data were extracted from Government documents and adjusted for inflation. Budget and expenditure for the district level over the period 2006 to 2017 were disaggregated by programmatic area for analysis. Results: Despite the withdrawal of donor funding from the district basket after 2009, funding for primary care allocated to the district level more than doubled from 2006 to 2017. However, human resources accounted for this increase. The operational grant, on the other hand, declined. Conclusion: The increase in the budget allocated to primary care could be an example of ‘reverse fungibility’, whereby Government accounted for the gap left by donors. However, the decline in the operational grant demonstrates that this period of aid volatility continued to have an impact on how primary care was planned and financed, with less flexible budget lines most affected during this period. Going forward, Government and donors must consider how funding is allocated to ensure that primary care is resilient to aid volatility; and that the principles of aid effectiveness are prioritised to continue to provide primary health care and progress towards achieving health for all.

Exploring the Social Capital of Cooperative Extension Agents in Mississippi

The Cooperative Extension System has a high turnover rate. Studies indicate a need to improve collaboration and communication efforts between agents to improve their retention. This exploratory study used a social capital lens to investigate agents’ collegial relationships and access to information. Cross-sectional data were collected from a nonrandomized sample of Extension agents from Mississippi State University (MSU) Extension. Results showed agents’ engagement in professional associations depended on their programmatic responsibilities. Few agents were active members of associations that were not linked to their specific program area. Findings pointed to a low level of bridging capital and a higher level of bonding capital since agents had strong ties with colleagues in their own programmatic area. Agents mostly socialized with others in their own program area at statewide events, and most did not seek information from a district or regional director. This may adversely impact information sharing due to an overdependence on homogenous networks. This study suggested the social capital of MSU Extension agents could be more fully developed. Agents may benefit from opportunities to engage in national-level and heterogenous professional organizations to build bridging capital.

Public Health as Social Justice? A Qualitative Study of Public Health Policy-Makers’ Perspectives

Social justice is often described as the ‘foundation of public health.’ Yet, outside of the theoretical literature the polysemous nature of the concept is rarely acknowledged. To complement recent contributions to normative theory specifically motivated by questions of social justice in public health, this study explores public health policy-makers’ perspectives on the meaning and role of social justice in their practice. This study involved twenty qualitative, semi-structured interviews with public health policy-makers recruited from two programmatic areas of public health [chronic disease prevention (CDP) and public health emergency preparedness and response (PHEPR)] within public health organizations in Canada. Participants’ perspectives appeared to be influenced by the perceived goals belonging to the programmatic area of public health in which they practiced. Those involved in PHEPR indicated that justice-based considerations are viewed as a ‘constraint’ on the aims of this area of practice, which are to minimize overall morbidity and mortality, whereas those involved in CDP indicated that justice-based considerations are ‘part and parcel’ of their work, which seeks primarily to address the unique health needs of (and thus, disparities between) population groups. The aims and activities of different programmatic areas of public health may influence the way in which social justice is perceived in practice. More ought to be done (in theory and in practice) to interrogate how the unique contributions that individual programmatic areas of public health can and should cohere in order to realize the broader aim that public health has as an institution to promote social justice.

A organização do rastreamento do câncer do colo uterino por uma equipe de Saúde da Família no Rio de Janeiro, Brasil

Introdução: O rastreamento organizado do câncer do colo do útero ainda é um desafio a ser vencido em todo o Brasil. Objetivo: Descrever a intervenção de uma equipe de Saúde da Família para a melhoria da qualidade das ações de rastreamento desta condição. Métodos: A intervenção foi estruturada a partir das recomendações nacionais para o rastreamento do câncer do colo do útero e das evidências disponíveis na literatura para aumento da participação popular em programas de rastreamento. Funcionalidades do sistema de prontuário eletrônico local foram fundamentais para a viabilização da proposta. A partir da reorientação de práticas assistenciais e administrativas, foi estabelecido e mantido por 15 meses um programa organizado de rastreamento do câncer do colo do útero nesta equipe de Saúde da Família. Resultados: No mês anterior ao início da intervenção, as equipes da unidade de saúde e da área programática apresentavam uma cobertura média de 10% da população alvo rastreada. Ao final de 15 meses, a equipe-intervenção atingiu uma cobertura de 44%, em contraste com a média de 22% das demais equipes da unidade, e 25% da área programática. Conclusões: Quando uma equipe de Saúde da Família empreende esforços para a organização do rastreamento do câncer do colo do útero, bons resultados podem ser alcançados no aumento da cobertura populacional. Esperamos que outras equipes possam se beneficiar da divulgação desta experiência e tomem para si a responsabilidade de organizar o rastreamento do câncer do colo do útero, impactando positivamente sobre a saúde de suas comunidades.

Assessing Public Issues Knowledge and Needs of Extension Agents in Florida

It has been argued that to remain relevant in today's society, Extension must expand its role to provide public issues education. We conducted a web-based survey to determine whether Extension agents in Florida were prepared to deal with contentious issues. Survey respondents identified issues affecting their clientele, levels of frequency with which they addressed the issues, and self-perceived levels of knowledge related to the issues. Results were analyzed by agent type (i.e., programmatic area). Results revealed that the issues of immigration, crop diseases, and food security held particular potential for improvement.

Advisors, Faculty, and Librarians: Collaborating for Student Success

ABSTRACTLibrarians have continuously struggled with developing quality relationships with faculty and advisors to support students online. In 2014, Rasmussen College introduced a one-stop student support model of service that makes a student's advisor their primary point of contact for library resources, academic support, financial aid, course scheduling, and advising conversations. Support services were aligned centrally across all Rasmussen campuses, designating a librarian to assist students by programmatic area, instead of by campus. Librarians developed partnerships and resources to support advisors and faculty in their interactions with students needing academic assistance. Rasmussen College made a concentrated effort to significantly increase its library and learning electronic resources to contribute to student success. As a result of these efforts, we have improved connectivity with faculty and advisors and have seen increased usage of library resources.

Tradeoffs in resource allocation at state health agencies.

Priority setting is at the core of resource allocation. In recent years, priority setting in public health has occurred in the context of a difficult authorizing environment, one in which politicians have shown increasing interest in reducing the footprint of government, even during times of increased demand for social services. In this context of austerity, tradeoffs abound. These tradeoffs may occur not only within a single programmatic area in public health (e.g., cutting an infant mortality program vs a "Children With Special Health Care Needs" program) but also at a broader, more abstract level (e.g., favoring programs that are relatively more efficient for one population vs less efficient for programs serving a population in greater need of services). This project was undertaken to provide more insight into tradeoffs within state health agencies with regard to what types of tradeoffs exist and how often they occur. To characterize these tradeoffs, we engaged in a mixed-methods project where we first conducted 45 semistructured interviews with public health leaders across 6 state health agencies. Tradeoffs were elicited through open-ended questions and probes and qualitatively coded and analyzed. Next, we conducted a national survey across all state health agencies, receiving 207 responses (66% response rate). Survey respondents were asked to rate how frequently they encountered particular tradeoffs and how difficult they were to resolve. The most frequently encountered tradeoffs were "insufficient funding for a program versus no funding for a program" (84% rating as frequently/very frequently encountered) and prioritizing "current versus future need" (80% rating as frequently/very frequently). More than 50% of respondents said that they encountered 7 of the 11 tradeoffs frequently or very frequently and found 10 of the 11 difficult or very difficult to resolve. Forty-two percent of respondents rated "services for younger groups versus services for older groups" as difficult/very difficult to resolve.

The national policy of primary care in municipal centers of health from programmatic area 1.0

Objetivo: Discutir a política nacional de atenção básica do Sistema Único de Saúde junto aos profissionais de saúde de três centros municipais de saúde. Método: Qualitativo, descritivo-reflexivo e pesquisa-ação. A população foi os profissionais de saúde que atendem mulheres e crianças. Foram selecionados todos os profissionais dos centros municipais de saúde da área programática 1.0. Para coleta de dados foram realizados três seminários que foram gravados, transcritos e lavrados com atas. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Escola de Enfermagem Anna Nery sob protocolo 37/08. Resultados: Os dados foram submetidos à análise temática, seguida da construção de quatro categorias. Conclusão: Os sujeitos acreditam que a maior dificuldade de realizar os princípios da atenção básica é por falta de recursos humanos para realizar ações educativas no âmbito coletivo já que no individual é realizado. Descritores: Políticas públicas, atenção básica à saúde, capacitação profissional, enfermagem.

English

ObjectiveData collection and management by local health departments (LHDs) is a complex endeavor, complicated by system level and organizational factors. The purpose of this study was to describe the processes and use of information systems (IS) utilized for data collection, management, and sharing by LHD employees.MethodsWe interviewed a purposive sample of 12 staff working in the key public health practice areas of communicable disease control, immunizations, and vital records from three LHDs in different states. Our interview questions addressed job descriptions, daily activities, and the use and perceptions of both data and IS in support of their work. A content analytic approach was used to derive themes and categories common across programmatic areas.ResultsLocal public health involves the use of mix of state-supplied and locally implemented IS supported by paper records. Additionally, each LHD in this study used at least one shadow system to maintain a duplicate set of information. Experiences with IS functionality and the extent to which it supported work varied by programmatic area, but inefficiencies, challenges in generating reports, limited data accessibility, and workarounds were commonly reported.ConclusionsCurrent approaches to data management and sharing do not always support efficient public health practice or allow data to be used for organizational and community decision making. Many of the challenges to effective and efficient public health work were not solely technological. These findings suggest the need for interorganizational collaboration, increasing organizational capacity, workflow redesign, and end user training.

Assessment of Workforce Capacity for Local Health Departments in Nebraska

This study assessed the workforce capacity of Nebraska Local Health Departments (LHDs) from the perspective of public health programmatic areas. DESIGN AND OUTCOMES MEASURES: We conducted a mail survey of 21 LHD directors in Nebraska and collected the information on LHD workforce capacity, training, and competency by public health programmatic areas (eg, environmental health, mental health). An FTE shortage index score for each public health programmatic area was calculated to estimate an LHD's current shortage in that area. Spearman correlation analysis was conducted to examine the relationships between LHD capacity, manpower shortage, and staff training and competency. Our results indicated that a significant proportion of the 18 responding LHDs in Nebraska did not have staff to cover the areas of mental health (66.7%), sexually transmitted diseases (44.4%), occupational safety and injury (38.9%), oral health (27.8%), and health disparities (22.2%). The results also suggest that Nebraska's LHDs experienced the greatest workforce shortages in environmental health (mean shortage index = 0.45), followed by chronic diseases (0.44), health disparities (0.41), and sexually transmitted diseases (0.41). The identified shortage areas should be a high priority for federal and state policy makers to address through developing appropriate strategies and providing adequate funding for LHD workforce development in Nebraska. Using the public health programmatic area approach to collect workforce data may help fill some gaps in the current efforts of LHD workforce enumeration. Future research is needed to examine the validity and reliability of the workforce measures based on public health programmatic areas.

Association Between Body Mass Index and Suicidal Thoughts and Attempts Among US Adolescents

Association Between Body Mass Index and Suicidal Thoughts and Attempts Among US Adolescents

Impact of the 2008–2010 Economic Recession on Local Health Departments

We measured the impact of the 2008-2010 economic recession on local health departments (LHDs) across the United States. Between 2008 and 2010, we conducted 3 Web-based, cross-sectional surveys of a nationally representative sample of LHDs to assess cuts to budgets, workforce, and programs. By early 2010, more than half of the LHDs (53%) were experiencing cuts to their core funding. In excess of 23 000 LHDs jobs were lost in 2008-2009. All programmatic areas were affected by cuts, and more than half of the LHDs had to reduce or eliminate at least 1 programmatic area. The capacity of LHDs to provide core public health services was undermined by the economic recession.

Quality of life assessment of patients with schizophrenic spectrum disorders from Psychosocial Care Centers

OBJECTIVE: Assessing the quality of life and the clinical and social-demographic factors associated in schizophrenic spectrum patients (ICD-10 F20-F29) attending CAPS at the programmatic area 3.0. METHODS: A cross-sectional study was carried out in a sample of schizophrenic spectrum patients who have been enrolled in 2008 in CAPS in programmatic area (AP) 3 at Rio de Janeiro city, using MINIPLUS to assess schizophrenia spectrum disorder and use of psychoactive substances, Positive and Negative Symptoms Scale (PANSS) to assess psychiatric symptoms and Quality of Life Scale (QLS-BR) to assess the quality of life. RESULTS: Seventy nine patients were included, of whom 74 (93.7%) presented some impairment in quality of life. The most frequently affected area was occupational performance. Variables that showed a significant association with severe impairment of quality of life were: marital status, race, occupation, who patients lived with, homelessness, having children, previous psychiatric hospitalization, negative symptoms and symptoms designated as not applicable (being characterized by a lack of typical positive and negative symptoms). CONCLUSION: The knowledge of these factors should be crucial to implement health policies and psychosocial rehabilitation programs focused on improving the quality of life of these patients.

Systems of geographical information in health, uses and projection in the programmatic area V, County De Jujuy, Argentina

With the incorporation of Hospital Ntra. Sra de El Carmen as Unit Sentry of Lesions arose the necessity to relate the lesions of transport with a certain space, introducing the...

Infecciones respiratorias agudas en niños: costo para las familias y utilización de servicios

This editorial comments on a recently published work about estimated cost for families related to hospitalisation of childrenwith acute lower respiratory infection (ALRI) according to complexity and location of hospital. lt also explores family reasonsfor attending hospitals outside their programmatic area, even at risk of higher cost. lt also refers to the shortage of local coslrelated information and its importance in relation to sanitary and social issues. The catastroph¡c characteristics of an episodeof acute lower respiratory infection related hospitalisation for the families ¡n the study, 80% of which were of low socioeconomic background, are exemplified by the fact that 20-40% of total family income were spent during a single episode, thisaffecting in a higher degree those families with lowest socioeconomic situation.&nbsp; Another aspects discussed here are related to spontaneous demand orientation outside provided local sanitary network.These networks usually rely on political and territorial considerations rather than functionality issues. The author states theneed of this type of economic analysis for planning and developing adequacy of health services offer in relation to population needs.