Primary Health Care Workforce Research Articles

Beyond the pipeline: a critique of the discourse surrounding the development of an Indigenous primary healthcare workforce in Australia.

A central strategy in addressing health disparities experienced by Indigenous people has been based on a concern with workforce improvement. In this paper, the Indigenous Australian healthcare workforce literature since 1977 is reviewed and its scope of concern, as being often limited to questions of 'supply', is critiqued. The pipeline metaphor, whether used explicitly or implied, regularly focuses attention on closing the gap on Indigenous representation within the health workforce. The exception though is the discourse concerning Indigenous Health Workers (IHWs), where questions concerning the legitimacy of the role continue to abound within a workforce hierarchy where community knowledge, though shown to be crucial to culturally safe health service provision, is trumped by the other health professions whose knowledges and legitimacy are not in question. This contrast exemplifies the need to examine the working of power not just 'supply'. The pipeline metaphor is disrupted with concerns about a range of other 'gaps' - gaps in the recognition of Indigenous knowledges, in organisational structures, in governance and in self-awareness by the health professions of their whiteness. As the health system continues to measure workforce development in terms of pipeline capacity, our study questions what happens beyond the pipeline.

Transforming Nursing Education and Practice: a Review on the Innovation Strategy towards Sustainable Primary Healthcare Workforce

Nurses embody largest group of healthcare providers and the initial access of patient contact in many settings. They convey primary care in small and large hospital practices in clinics, schools and workplace. They function independent and collaborative practices often taking lead clinical, management, accountability roles in innovative means in rural areas, where modern technology-assisted care delivery is little. The researcher-utilized reviews using content analysis to address aim of identifying barriers and innovation strategies that nurses have helped implement in health services to transform primary healthcare. Search strategy is based on combining terms including, health innovation, practice, innovation strategy, and primary healthcare policy, yielded 84 results. Due to diverse potential findings, the review utilized degrees of criteria selection. Multi-staging strategy was developed to identify relevant review literatures. ProQuest and Ebscohost serve as databases during retrieval. Results revealed barriers to transforming PHC practice include frequent staff turnover, scope-of-practice limitation, fragmentation of care and lack of support from key stakeholders. Literatures unveiled that these be resolved by allowing nurses practice fully their training, expanding opportunities for nurses to lead collaborative efforts and implementing nurse residency program. Additionally, transition programs should typically include periods of orientation, preceptorship from key stakeholders to promote innovative culture in workplace.

Digital possibilities in the prevention and early detection of oral cancer in the WHO South-East Asia Region.

Cancers of the lip and oral cavity are the most common cancers among men in the World Health Organization (WHO) South-East Asia Region. Most cancers of the oral cavity are attributable to tobacco smoking, smokeless tobacco use and areca-nut product use, alone or in combination, and excessive consumption of alcohol. These risk factors are highly prevalent in parts of the region. This paper outlines an integrated framework for oral cancer prevention, which includes a strengthened primary health-care workforce, enhanced community engagement and a positive policy environment. Operationalizing this framework could be greatly facilitated by the application of digital technologies. Robust evidence exists for the effectiveness of using appropriately trained primary health-care workers to screen for oral cancer by oral visual examination; this can be combined with counselling for riskbehaviour modification as part of an overall strategy on noncommunicable diseases. This needs to be supported by greater overall community engagement, for example to tackle low levels of awareness of the harmful effects of smokeless tobacco and areca-nut products. A strong policy environment that supports and promotes these efforts is essential, along with the enforcement of the measures required by the WHO Framework Convention on Tobacco Control. Despite the burden of disease, oral cancer has been a neglected area of public health. This paper considers how the positively disruptive effects of digital technology may enable much-needed acceleration in prevention and control efforts.

Primary Health Care Matters.

Primary Health Care Matters.

Determination of Quality Assurance for Maternal and Child Health Services in Baghdad City

Objective: To determine the quality assurance for maternal and child health care services in Baghdad City.Methodology: A descriptive study is conducted throughout the period of November 28th 2008 to October 10th2009. A simple random sample of (349) is selected through the use of probability sampling approach. The studysample was divided into four groups which include (220) consumers, (35) medical staff, (72) nursing staff and (22)organization structure (primary health care centers). Data were collected through the use of assessment tools. It wascomprised of four questionnaires and overall items included in these questionnaires are (116) items. The studyincluded assessment of organization structure. Data were collected through the utilization of constructedquestionnaire and the interview technique as a mean of data collection. Data analysis was performed through the useof descriptive statistical data analysis approach graphical presentation by bar-chart, frequencies, percentages andmean of scores and inferential statistical data analysis approach which is presented as chi-square procedure.Result: The findings and conclusion of the study indicate that there is overload of target population on primaryhealth care centers, poor designed building, statistical program and data reporting system was poor, decrease corefinancial support and inadequacy of funding for primary health care centers, there is increased demand anddecreased supply of primary health care workforce and poor health education for consumers in primary health- carecenters.

Delivery of primary health care in Malawi.

Malawi is a landlocked country with a population of 17 million. The delivery of the health care system is based on primary health care (PHC). The PHC structures are acceptable; however, the system is marked by maldistribution of resources, fragmentation of services and shortage of staff. This hampers the function of the set, well-meaning PHC frameworks. Family medicine offers training and retention of the PHC and rural workforce, harnessing clinical governance and capacity building. Family medicine’s role extends to involve advocacy for the PHC to improve its performance.

An assessment of job satisfaction among primary health care workers in Rivers State, Nigeria

Background: Primary Health Care (PHC) is considered to be a more appropriate approach to health, and the health system, improving access to health services, as well as disease prevention. The availability and efficiency of PHC is a key determinant of the overall health and wellbeing of a people, and a useful yardstick for assessment of a nation's health system. Hence, PHC workforce are at the vanguard of essential health service delivery through direct contact with grassroots community members, within and without the health facilities, for provision of preventive, treatment, referral and follow-up health services. Poor motivation and non-retention of PHC workers weakens the health systems' ability to meet the above goals.Aim: To assessed the job satisfaction of primary health care workers in Rivers State, Nigeria.Methodology: The study utilized the descriptive cross-sectional design and the mixed methods of data collection. The quantitative method used semi-structured, pretested, self- administered questionnaires to obtain information on socio-demographic and occupational characteristics, job satisfaction, motivation, frustration, retention potentials and awareness of existing policies and incentives of respondents. The respondents which included Community Health Extension Workers (CHEW), Community Health Officers (CHO), nurses and doctors in Primary health facilities in the State, were selected using the multistage sampling method. Quantitative data was analyzed using SPSS version 20.0 software and results presented using tables and charts.Results: A total of 378 respondents participated in the study. Nurses constituted 47.6% of the respondents, with equal proportions of CHEWs and CHOs [23.8% and 23.8% respectively] and 4.8% were doctors. The mean age of the respondents was39.8±8.1 years; with 89.7% females and 10.3% males. Of all the respondents, 79.6% were married,82% were senior cadre staff and 78.8% were Pentecostal Christians. Ikwerre, Ogoni and Kalabari had the highest distribution in ethnicity (19.3%, 14.8% and14.0% respectively). Among the respondents, 75.7% had worked for less than 7 years in their current facility while 82.9% had worked for same duration in their previous facility. Almost two third 240 (63.5%) reported that their workplace was far from their residence while 12 (3.2%) stated that it was very close. A high proportion of the respondents (78.3%) were satisfied with the general working condition in their Primary Health Care facility while 21.7% of the respondents were satisfied with the pay and promotion potentials of their work place. Notably, while 97.9% of the respondents were satisfied with their work relationships, 57.7% were satisfied with the use of their skills and abilities at their workplace and 88.1% of the respondents were satisfied with their work activities. These gave a good job satisfaction score for 88.9% of the respondents. Profession, community, distance from work and duration of work were significant factors (p < 0.05).Conclusion: This study concluded that age, marital status, profession, and location of health facility, duration of work played vital roles in level of satisfaction of PHC workers. Hence, offering opportunities for professional advancement through training of the healthcare workers though already included in the Nigerian National Healthcare policy, should be efficiently implemented and monitored by the government and other relevant stakeholders to improve job satisfaction and in turn quality health service delivery.Keywords: Job Satisfaction, Healthcare Workers

Needs and dynamics of the Primary Healthcare workforce in Brazil.

Primary care and the healthcare workforce can be considered the greatest challenges of SUS (Sistema Único de Saúde), principally in recent decades. This article aims to describe the growth and regional distribution of the professions requiring higher education registered in the primary healthcare units. This descriptive study with a quantitative approach is concerned with the 14 accredited professions in the five major regions of Brazil from 2008 to 2013. The data was collected from the national database of the Ministry of Health. Among the professional categories with the greatest rates of national growth are physical education teachers, nutritionists, occupational therapists, physiotherapists, and pharmacists. In the North region of Brazil, physiotherapy, social work, and speech therapy stand out as having the greatest growth rates; in the Northeast, physical education, physiotherapy, and occupational therapy; and in the Center-West, nutrition and physiotherapy; in the Southeast, nutrition and pharmacology; and physical education showed prominent growth in the South. The major losses occurred in the professions of biologist and veterinary doctors in all regions. In general, the professional categories that comprise the Family Health Support Nuclei, NASF, demonstrate greater growth rates than nurses and doctors.

The evolution of the Community Health Worker program in Papua New Guinea

New Guinea (PNG) has a special history in regard to the training of Community Health Workers (CHWs) and is currently preparing its frontline health workforce to serve the 85% of the total PNG population of 7.3 million people who live in rural and remote settings. This article identifies and explains the five major developmental stages in the current CHW training program, as well as the changes that have occurred over the past century. The developmental stages are: (1) traditional; (2) early contact; (3) innovation; (4) the 1980s; and (5) new millennium. These developmental stages are discussed in the context of the early literature and investigation by the primary author and examination of the lived experiences of early missionary health workers and local people. This paper documents the development of a CHW program in PNG from the colonisation period, which began in 1883, to the present day. As a developing nation, PNG has gone through many challenges and changes to its healthcare system and has gradually developed an effective program to train its frontline primary health care (PHC) workforce. This article contributes new information with regard to the past and current development of CHW programs in PNG as well as in other developing countries. The training of competent CHWs with the essential skills and knowledge may help deliver quality and cost-effective PHC services to the rural majority and the urban disadvantaged, thereby fulfilling the PNG government's National Health Plan for 2011-2020. Systematic evaluation of the effectiveness of the CHW program will provide guidance for continued development of this frontline health workforce. Improving and introducing a competency-based curriculum is an essential step towards building a healthier nation.

The system leadership challenge facing the primary healthcare workforce

The system leadership challenge facing the primary healthcare workforce

Barriers and enablers for the development and implementation of allied health clinical practice guidelines in South African primary healthcare settings: a qualitative study

BackgroundThe South African allied health (AH) primary healthcare (PHC) workforce is challenged with the complex rehabilitation needs of escalating patient numbers. The application of evidence-based care using clinical practice guidelines (CPGs) is one way to make efficient and effective use of resources. Although CPGs are common for AH in high-income countries, there is limited understanding of how to do this in low- to middle-income countries. This paper describes barriers and enablers for AH CPG uptake in South African PHC.MethodsSemi-structured individual interviews were undertaken with 25 South African AH managers, policymakers, clinicians and academics to explore perspectives on CPGs. Interviews were conducted by researcher dyads, one being familiar with South African AH PHC practice and the other with CPG expertise. Rigour and transparency of data collection was ensured. Interview transcripts were analysed by structuring content into codes, categories and themes. Exemplar quotations were extracted to support themes.ResultsCPGs were generally perceived to be relevant to assist AH providers to address the challenges of consistently providing evidence-based care in South African PHC settings. CPGs were considered to be tools for managing clinical, social and economic complexities of AH PHC practice, particularly if CPG recommendations were contextusalised. CPG uptake was one way to deal with increasing pressures to make efficient use of scarce financial resources, and to demonstrate professional legitimacy. Themes comprised organisational infrastructures and capacities for CPG uptake, interactions between AH actors and interaction with broader political structures, the nature of AH evidence in CPGs, and effectively implementing CPGs into practice.ConclusionCPGs contextualised to local circumstances offer South African PHC AH services with an efficient vehicle for putting evidence into practice. There are challenges to doing this, related to local barriers such as geography, AH training, workforce availability, scarce resources, an escalating number of patients requiring complex rehabilitation, and local knowledge. Concerted attempts to implement locally relevant CPGs for AH primary care in South Africa are required to improve widespread commitment to evidence-based care, as well as to plan efficient and effective service delivery models.

Experiences of registered nurses transitioning from employment in acute care to primary health care-quantitative findings from a mixed-methods study.

To describe the experiences of registered nurses who transition from acute to primary health care (PHC) employment. Internationally the provision of health care in PHC settings is increasing. Nurses are moving from acute care employment to meet the growing demand for a PHC workforce. However, little is known about the transition experiences of these nurses. A sequential mixed-methods study comprising a survey, and semi-structured interviews. This study reports on survey findings relating to the transition experience. Convenience and snowballing techniques were used to recruit 111 registered nurses who had transitioned from Australian acute settings to PHC employment within the last 5years. An online survey gathered data relating to personal and professional demographics, type of PHC setting and transition experiences. Most respondents (n=90, 81.1%) reported receiving some orientation, although the length and content varied considerably. Those working in metropolitan locations were more likely to report concerns associated with their orientation, with respondents from rural or remote locations more likely to have access to a preceptor than city/metropolitan respondents. Just under half of respondents found prioritising workload (n=47; 42.7%) or organisational knowledge (n=45; 40.9%) difficult or very difficult, and 47.7% (n=53) felt isolated or unsupported. 49.5% (n=55) reported being overwhelmed with the new role either sometimes or regularly. Barriers to transitioning successfully included limited employer support to attend professional development activities. Availability of specific support measures may assist in the transition process. Findings from our study should be considered by employers when recruiting nurses new to PHC, and when designing orientation and ongoing education programmes. This study highlights the challenges faced by nurses who transition from acute care into PHC employment. Understanding the barriers and facilitators to successful transitions enhances the process for future recruitment and retention of PHC nurses. This evidence can inform managers, educators and policymakers in developing support programmes for nurses moving into PHC.

Protocol for a nationwide survey of primary health care in China: the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) MPP (Million Persons Project) Primary Health Care Survey

IntroductionChina has pioneered advances in primary health care (PHC) and public health for a large and diverse population. To date, the current state of PHC in China has not been...

Australia’s first Transition to Professional Practice in Primary Care Program: Qualitative findings from a mixed-method evaluation

BackgroundIn Australia, there is an increasing demand for registered nurses in primary health care. Registered nurses graduating from university typically enter the workforce via supported transition to professional practice programs in acute-care hospital settings. A prospective strategy to create a sustainable primary health care workforce is to develop comparable transition programs in primary health care settings, such as general practice. We developed, implemented, and evaluated Australia’s first transition to professional practice in primary care program. AimTo explore the experiences and perceptions of graduate registered nurses and practice nurses participating in a novel transition to professional practice in primary care program. MethodsThematic analysis of semi-structured interviews with graduate registered nurses (n=4) and their preceptors (practice nurses, n=5) on completion of the program. FindingsThree themes emerged from the graduate registered nurse interviews: opportunities for education and clinical development, job satisfaction, and career progression opportunities. Graduate registered nurses were satisfied with the available learning opportunities, indicated a career in primary health care could be potentially rewarding, and anticipated moderate career progression opportunities within general practice. Preceptor themes included program positivity and early career opportunities. The preceptors were positive about the program and believed it supported the graduate registered nurses to become confident and competent. However, both the graduate registered nurses and preceptors perceived an acute-care hospital transition to professional practice program was necessary to gain adequate nursing skills, even if they intended to have a future career in primary health care. Furthermore, they appeared to believe that a career in general practice is more appropriate for “older nurses”. DiscussionThese beliefs may be a barrier for transition to professional practice in primary care programs to develop and support a sustainable primary health care workforce. ConclusionsImproved primary health care transition programs, policy, and educational strategies are required.

Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

ABSTRACTObjective:to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method:we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results:given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions:given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.

A study exploring the protean responses of nurses transitioning to primary healthcare.

Background Healthcare systems are faced with changing community health profiles and ageing populations. Together with economic considerations, these factors have influenced the increase in provision of care in primary rather than other healthcare settings. Many nurses are electing to move from acute care to meet demands for a skilled primary healthcare workforce. However, little is reported about these nurses' experiences of transition. Aim To describe how role theory provides a theoretical framework to inform the design of a mixed-methods study exploring the transition of acute care nurses to roles in primary health care. Discussion The paper explores the relevance of role theory and its components as a validated framework for informing the design of the quantitative and qualitative components of the study. The methodology consisted of a national survey of recently transitioned nurses, with questions that explored experiences of nurses in relation to role exit, role entry, role enactment, role ambiguity, role stress, role strain and rites of passage. The qualitative component of the study incorporated semi-structured interviews with selected participants to further explore aspects of the transition. Conclusion There are few published reports on the value of theoretical frameworks in the design of nursing research. This paper describes one example of the value of selecting an appropriate theoretical framework for a national study of experiences of transition. Implications for practice Nurses transitioning between clinical settings experience a range of personal and professional challenges. Role theory provides a valuable framework which is applicable to qualitative and quantitative research into these experiences.

Community matrons as problem-solvers for people living with multi-co-morbid disease.

Working with patients in their own homes gives community matrons an advantage of seeing patients in the context of their everyday lives. This allows comprehensive assessment of need with an aim of promoting health or promoting stability for people living with chronic disease. Complex issues are resolved through problem-solving and this can result in patients being maintained in their own homes and thus in reduced unplanned hospitalisation. Data were collected from participants using semi-structured interviews and audio diaries. The sample comprised professionals: CMs (n=21), managers (n=4), former commissioners (n=2) and GPs (n=3); and patients (n=10) and their family carers (n=5). In this article, data from community matrons is discussed. Community matrons often drew on the social determinants model of health to problem solve and to create meaningful strategies that work for patients in their care. Raising awareness of the high-level skills of community matrons and promoting appreciation of the importance of a social determinants model of health is important in explaining why nurses are such a crucial element of the primary health care workforce.

Australian primary health care nurses most and least satisfying aspects of work.

To identify the aspects of working in Australian primary health care that nurses rate as the most and least satisfying. The nursing workforce in Australian primary health care has grown exponentially to meet the growing demand for health care. To maintain and further growth requires the recruitment and retention of nurses to this setting. Understanding the factors that nurses' rate as the most and least satisfying about their job will inform strategies to enhance nurse retention. A cross-sectional online survey. Nurses employed in primary health care settings across Australia were recruited (n=1166) to participate in a survey which combined items related to the respondent, their job, type of work, clinical activities, job satisfaction and future intention, with two open-ended items about the most and least satisfying aspects of their work. Patient interactions, respect, teamwork, collegiality and autonomy were identified as the most satisfying professional aspects of their role. Personal considerations such as family friendly work arrangements and a satisfactory work-life balance were also important, overriding negative components of the role. The least satisfying aspects were poor financial support and remuneration, lack of a career path, physical work environment and time constraints. National restructuring of the primary health care environment was seen as a barrier to role stability and ability to work to a full scope of practice. This study has identified a range of positive and negative professional and personal aspects of the primary health care nursing role, which may impact on staff recruitment and retention. Findings from the study should be considered by employers seeking to retain and maximise the skills of their primary health care workforce. Understanding the factors that nurses perceive as being the most and least satisfying aspects of the work is can open up dialogue about how to improve the working experience of nurses in primary health care.

Index of Access: a new innovative and dynamic tool for rural health service and workforce planning.

Objective Improving access to primary health care (PHC) remains a key issue for rural residents and health service planners. This study aims to show that how access to PHC services is measured has important implications for rural health service and workforce planning. Methods A more sophisticated tool to measure access to PHC services is proposed, which can help health service planners overcome the shortcomings of existing measures and long-standing access barriers to PHC. Critically, the proposed Index of Access captures key components of access and uses a floating catchment approach to better define service areas and population accessibility levels. Moreover, as demonstrated through a case study, the Index of Access enables modelling of the effects of workforce supply variations. Results Hypothetical increases in supply are modelled for a range of regional centres, medium and small rural towns, with resulting changes of access scores valuable to informing health service and workforce planning decisions. Conclusions The availability and application of a specific 'fit-for-purpose' access measure enables a more accurate empirical basis for service planning and allocation of health resources. This measure has great potential for improved identification of PHC access inequities and guiding redistribution of PHC services to correct such inequities. What is known about the topic? Resource allocation and health service planning decisions for rural and remote health settings are currently based on either simple measures of access (e.g. provider-to-population ratios) or proxy measures of access (e.g. standard geographical classifications). Both approaches have substantial limitations for informing rural health service planning and decision making. What does this paper add? The adoption of a new improved tool to measure access to PHC services, the Index of Access, is proposed to assist health service and workforce planning. Its usefulness for health service planning is demonstrated using a case study to hypothetically model changes in rural PHC workforce supply. What are the implications for practitioners? The Index of Access has significant potential for identifying how rural and remote primary health care access inequities can be addressed. This critically important information can assist health service planners, for example those working in primary health networks, to determine where and how much redistribution of PHC services is needed to correct existing inequities.

Bases metodológicas da formação em Fisioterapia: discutindo o distanciamento entre os processos de formação e a utilização da força de trabalho

A partir das bases metodológicas que subjazem ao processo formativo em Fisioterapia e considerando as atribuições do fisioterapeuta nos Núcleos de Apoio à Saúde da Família (NASFs), buscou-se identificar os pontos de distanciamento entre a formação e a utilização da força de trabalho do fisioterapeuta na atenção básica à saúde em João Pessoa/PB. O estudo justificou-se pela necessidade de aprimorar os processos de formação em Fisioterapia, de modo a compatibilizá-los com os requerimentos de sua prática profissional, particularmente no nível primário de atenção à saúde. Trata-se de um estudo exploratório-descritivo e inferencial com abordagens quantitativas. Os dados foram analisados a partir do Teste de Hipótese, utilizado como método de tomada de decisão. A análise dos dados revelou, com evidências estatísticas, distanciamentos entre o que afirmam estudantes e professores, no processo de formação do fisioterapeuta nas instituições de ensino superior pesquisadas, bem como divergências entre o que atestam fisioterapeutas e gestores em relação ao processo de trabalho nos NASFs dos Distritos Sanitários do município. Concluiu-se ser necessária uma reformulação das bases metodológicas que compõem os planos de ensino relacionados à Saúde Coletiva nas instituições que oferecem o curso de Fisioterapia em João Pessoa, bem como uma melhor utilização da força de trabalho do fisioterapeuta junto aos NASFs, visando a uma redefinição das práticas deste profissional nos espaços da atenção básica à saúde.