scholarly journals Strengthening the primary health care response to COVID-19: an operational tool for policymakers

2021 ◽  
Vol 22 ◽  
Author(s):  
Anne S. Johansen ◽  
Amanda Shriwise ◽  
Daniel Lopez-Acuna ◽  
Pia Vracko
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
System Level ◽  
Guidance Document ◽  
Services Delivery ◽  
Primary Health ◽  
Modifiable Factors ◽  
Facility Level

Abstract Aims: The aim of this paper is to introduce an operational checklist to serve as a tool for policymakers in the WHO European Region to strengthen primary health care (PHC) services and address the COVID-19 pandemic more effectively and to present the results from piloting the tool in Armenia. Backgrounds: PHC has the potential to play a fundamental role in countries’ responses to COVID-19. However, this potential remains unrealized in many countries. To assist countries, the WHO Regional Office for Europe developed a guidance document – Strengthening the Health Systems Response to COVID-19: Adapting Primary Health Care Services to more Effectively Address COVID-19 – that identifies strategic actions countries can take to strengthen their PHC response to the pandemic. Based on this guidance document, an operational checklist was developed to serve as a tool for policymakers to operationalize the recommended actions. Methods: The operational checklist was developed by transforming key points in the guidance document into questions in order to identify potentially modifiable factors to strengthen PHC in response to COVID-19. The operational checklist was then piloted in Armenia in June 2020 as part of a WHO mission to provide technical advice on strengthening Armenia’s PHC response to COVID-19. Two WHO experts performed semi-structured, face-to-face interviews with nine key informants (both facility managers and clinical staff) in three PHC facilities (two in a rural and one in an urban area). The data collected were analyzed to identify underlying challenges limiting PHC providers’ ability to effectively and efficiently respond to COVID-19 and maintain essential health services. Findings: The paper finds that making adjustments only to health services delivery will be insufficient to address most of the challenges identified by PHC providers in the context of COVID-19 in Armenia. In particular, strategic responses to the pandemic were missed, due, in part, to the absence of COVID-19 management teams at the facility level. Furthermore, the absence of PHC experts in Armenia’s national pandemic response team meant that health system issues identified at the facility level could not easily be communicated to or addressed by policymakers. The checklist therefore helps policymakers identify critical challenges – at both the facility and health system level – that need to be addressed to strengthen the PHC response to the COVID-19 pandemic.

scholarly journals Evaluation of Access on the perspective of adult users of Primary Health Care in Fortaleza, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Borges Costa ◽  
C Salles Gazeta Vieira Fernandes ◽  
T Custódio Mota ◽  
E Torquato Santos ◽  
M Moura de Almeida ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
Assessment Tool ◽  
Health Coverage ◽  
Access To Health Services ◽  
Primary Health ◽  
Care Assessment ◽  
The City

Abstract The Alma-Ata Conference promoted Primary Health Care (PHC) worldwide as a form of universal and continuous access to quality and effective health services. In Brazil, PHC, through the Family Health Strategy (FHS), aims to be the gateway to the health system and its structuring axis. For this, it is necessary to promote access, an essential condition for the quality of health care services, following the attributes systematized by Barbara Starfield. The aim of this study was to evaluate the presence of the attribute “First Contact Access” on the perspective of adult users of public PHC services in the city of Fortaleza, Ceará, Brazil. A transversal study was carried out, in 19 PHC Units, from June to December 2019, using the Primary Care Assessment Tool (PCATool) Brazil version for adult users. Kruskal-Wallis test was used for statistical analysis. 233 users participated, mostly women (69.5%), aged 30 to 59 years old (55.3%), mixed-race (69.5%), with complete high school (38.2%), without private health coverage (89.3%), homeowners (68.7%) and belonging to families of up to 4 members (87.9%). The “Accessibility” component had the lowest score, 2.83, and the “Utilization” had the highest score, 8.06. Older age was associated with higher “Accessibility” scores (p = 0,018), while lower values of “Utilization” were associated with higher education (p = 0,004). The main problems observed were: low access for acute demand consultations, lack of access at nighttime and weekends, little access through non-personal ways, bureaucratic barriers and a long time for scheduling appointments. We conclude that, although there was an improvement in PHC coverage in the city over the years, mainly due to FHS, there is still a lot to improve to ensure timely access to health services. Key messages Users consider PHC as the usual source of care, demonstrated by the high score of 'Utilization', however, they are unable to use it when necessary, demonstrated by the low score of 'Accessibility'. Expanding forms of access is essential to contribute to the strengthening of PHC in Fortaleza, Brazil, facilitating the entry to its national Universal Health System.

scholarly journals 40 Years after Alma Ata: How People Trust in Primary Health Care?

2020 ◽  
Author(s):  
Homayoun Sadeghi Bazargani ◽  
Mohammad Saadati ◽  
Jafar Sadegh Tabrizi ◽  
Mostafa Farahbakhsh ◽  
Mina Golestani
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Linear Regression ◽  
Health Services ◽  
Public Trust ◽  
Health Services Delivery ◽  
Services Delivery ◽  
Trust Level ◽  
Primary Health ◽  
Individual Variables

Abstract Background: Primary Health Care (PHC) was introduced as the first level of health services delivery after Alma Ata declaration. PHC as a first level of health services delivery needs to be more trustfulness to achieve its defined goals. Public trust in PHC is one of the ignored issues in the context. The aim of this study was to explore public trust in PHC in Iran.Methods: This was a household survey study conducted in 2016 in East Azerbaijan Province, Iran. Two-stage cluster sampling method with probability proportional to size (PPS) approach was used. Totally 1178 households were enrolled in the study. PHC trust questionnaire and Ultra-short version of socio-economic status assessment questionnaire (SES-Iran) was used for data collection. Data were analyzed using STATA 15 through descriptive statistics and linear regression.Results: The mean age of the participants was 41.2, (SD: 15.1) and most of them (53.7%) were female. Mean score of PHC trust was 56.9±24.7 (out of 100). It was significantly different between inhabitants of Tabriz (the province capital city) and other cities in the province (p<0.001). Linear regression showed that younger age, gender, insurance type, being married and households higher socio-economic situation had a significant positive influence on PHC trust level with R2 = 0.14383 .Conclusions: Public trust in PHC system in Iran needs to be improved. Individual variables had a small but significant share in trust level. PHC trust not only influenced by individual variables and experience but also by health system and health providers characteristics and public sphere about PHC system. PHC trust level could be used as a public indicator in health systems especially in Low and Middle income countries to lead system strengthening policies in national and international levels.

scholarly journals Primary Health Care in Queensland

1995 ◽  
Vol 1 (1) ◽  
pp. 17
Author(s):  
Cobie Rudd
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
Health Care Policy ◽  
Institutional Care ◽  
Vital Role ◽  
Intersectoral Collaboration ◽  
System Reform ◽  
Primary Health

In 1993, the Queensland government responded to the challenges facing the Queensland health system when it released the Queensland Primary Health Care Policy. In the Policy, the public sector involvement in health system reform is outlined, and the vital role played by the non-government and private sectors are supported. The direction for the future delivery of health services clearly entails meeting the needs of local populations through an emphasis on community participation and development, intersectoral collaboration and co-ordination of health services. The Policy supports an improved balance between tertiary, high cost institutional care and community-based primary health care. The development and extension of community health services is recognised in the Plan as an important strategy in achieving a more balanced health system.

scholarly journals Nurse practitioners and pharmacist prescribers in primary health care: A realist evaluation of the New Zealand experience

2021 ◽  
Author(s):  
◽  
Tara Officer
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Services ◽  
Health System ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Health Workforce ◽  
Primary Health ◽  
Advanced Practitioner

<p>Internationally, health workforce redesign provides a means to cope with an increasing demand for health services. The development of advanced practitioner professions provides a major change in health service delivery that challenges traditional practice boundaries. Yet, we know very little about how to introduce such roles into existing health systems successfully. This research investigates how nurse practitioner and pharmacist prescriber roles are developing in New Zealand primary health care, and what is needed to better support the future development of these roles.  A realist methodology guided this research. The study used a qualitative research design involving semi-structured interviews of (1) policy, training, and advocacy stakeholders; (2) primary health care nurse practitioners, pharmacist prescribers, and general practitioners; and (3) patients of advanced practitioners and carers of patients using such services. Documents provided by interviewees relating to practice-specific roles supplemented these interviews. Data analysis facilitated the generation, testing, and refinement of theories on nurse practitioner and pharmacist prescriber role development.  This research provided an account of the complexities of developing new health professional roles in an already established health system. Theories formed in this research considered advanced practitioner role creation, realisation, and subsequent delivery of health services. Mechanisms for their development included: (1) engagement in planning and integrating roles; (2) establishing opportunities as part of a well-defined career pathway; and (3) championing role uptake and work to full scopes of practice. Various health system and workplace contexts, practitioner goals, and patient needs influenced the ability for these mechanisms to trigger and thus have an effect on role development.  Theories arising from this research emphasise the complexity inherent in the development of advanced practitioner roles. In addition, the findings demonstrate that a structured and informed health workforce redesign could improve use of roles, such as those of the nurse practitioner and pharmacist prescriber. In light of these results, this study recommends, implementing a national strategy that aligns policy and practice decisions if we are to succeed in making better use of such practitioner skills and expertise.</p>

scholarly journals Η αξιολόγηση της πρωτοβάθμιας φροντίδας υγείας ως δομικού συστατικού του υγειονομικού συστήματος της Κύπρου

2002 ◽  
Author(s):  
Πέτρος Μάτσας
Keyword(s):  
Mental Health ◽  
Job Satisfaction ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Special Reference ◽  
Primary Health ◽  
Health Authorities

The main aim of the present study is the evaluation of the Primary Health Care in Cyprus provided by the Health Authorities in the island. More particularly the specific objectives of the said research project are as follows: a) evaluation of primary healthcare in general practice; special reference as made to the job satisfaction of the General Practitioner as well as the satisfaction felt by the patients served by the health system (patients’ satisfaction). b) evaluation of primary health care within the mental health services in Cyprus; Special reference again is made to the job satisfaction of the psychiatric staff as well as the satisfaction felt or experience by the patients visitors served by the Mental Health Services. c) evaluation of the services provided by the School Health Services of the Ministry of Health. The present research was basically based on a qualitative approach employing questionnaires as the methodological instrument. The research findings have revealed the essential weaknesses inherent in the current primary Health Care System of Cyprus and pertinent suggestions and proposals have been made in a way that a productive utilization of the said findings can be made by the Health Authorities of Ministry of Health with a new to the amelioration of the existing health System.

VP159 Strengthening Primary Health Care In Nigeria By Patient Involvement

2017 ◽  
Vol 33 (S1) ◽  
pp. 221-222
Author(s):  
Sylvester Adeyemi ◽  
Aniekan Ekpenyong
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Service Delivery ◽  
Health System ◽  
Environmental Sustainability ◽  
Health Workers ◽  
Consumer Involvement ◽  
Record System ◽  
Primary Health

INTRODUCTION:The Health system in Nigeria is structured into three tiers which include tertiary health care, secondary health care and primary health care (PHC). The latter forms the grassroots system of delivering basic health services to communities in both rural and urban centers. However PHC in Nigeria have been affected by poor service delivery. This has resulted in underuse of PHC due to the acceptance and utilization of health services delivered through this system. This research seek to bridge the gap of inequality, reaffirm that implementing PHC is a human right/duty and fosters patient and consumer involvement for economic, social and environmental sustainability of PHC.METHODS:A qualitative method of research was adopted using a participatory research model. The relative data was sourced secondarily from recent findings (July 2015) carried out in seventy-three primary health centers across Anambra State, Benue State, Kaduna State, Plateau State and Federal Capital Territory (FCT) of Nigeria. Issues that were examined included: client perspective and community involvement, status of available services, utilization and service delivery, and infrastructure and human resource capacities. The respondent of 294 client/service user population from interview were recorded and analyzed.RESULTS:The assessment showed client dissatisfaction to services being provided. In most centers, National Primary Health Care Development Agency (NPHCDA) requirements like availability of basic functional equipment, well trained health workers, patient record system, and access to water and sanitation were not met. Most of the facilities visited reported to be disconnected from the health system due to supportive supervision.CONCLUSIONS:Conclusively, the interest of the underserved Nigerian could be advocated for through local committees of consumer organizations. Their involvement will have an impact in PHC evaluation, policy making, and implementation of action plans aimed at improving PHC services.

scholarly journals Presence and extent of the primary health care attributes among children hospitalized for pneumonia

2015 ◽  
Vol 23 (3) ◽  
pp. 512-519 ◽  
Author(s):  
Juliana Coelho Pina ◽  
Suzana Alves de Moraes ◽  
Maria Cândida de Carvalho Furtado ◽  
Débora Falleiros de Mello
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
Family Counseling ◽  
Coordination Of Care ◽  
Access To Health Services ◽  
Unified Health System ◽  
Primary Health ◽  
Access To Health

OBJECTIVE: to analyze the presence and extent of the primary health care attributes among children hospitalized for pneumonia.METHOD: observational and retrospective study with hospital-based case-control design, developed in three hospitals associated to the Brazilian Unified Health System, located in a city of the State of São Paulo, Brazil. The study included 690 children under five years old, with 345 cases and 345 controls.RESULTS: both groups scored high for access to health services. In contrast, high scores for attributes such as longitudinality and coordination of care were observed for the controls. Despite low scores, integrality and family counseling were also high for the controls.CONCLUSION: knowledge of the aspects involving the primary health care attributes and its provision for child care are very important because they have the potential to support professionals and managers of the Brazilian Unified Health System in the organization of health services.

scholarly journals Nurse practitioners and pharmacist prescribers in primary health care: A realist evaluation of the New Zealand experience

2021 ◽  
Author(s):  
◽  
Tara Officer
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Services ◽  
Health System ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Health Workforce ◽  
Primary Health ◽  
Advanced Practitioner

<p>Internationally, health workforce redesign provides a means to cope with an increasing demand for health services. The development of advanced practitioner professions provides a major change in health service delivery that challenges traditional practice boundaries. Yet, we know very little about how to introduce such roles into existing health systems successfully. This research investigates how nurse practitioner and pharmacist prescriber roles are developing in New Zealand primary health care, and what is needed to better support the future development of these roles.  A realist methodology guided this research. The study used a qualitative research design involving semi-structured interviews of (1) policy, training, and advocacy stakeholders; (2) primary health care nurse practitioners, pharmacist prescribers, and general practitioners; and (3) patients of advanced practitioners and carers of patients using such services. Documents provided by interviewees relating to practice-specific roles supplemented these interviews. Data analysis facilitated the generation, testing, and refinement of theories on nurse practitioner and pharmacist prescriber role development.  This research provided an account of the complexities of developing new health professional roles in an already established health system. Theories formed in this research considered advanced practitioner role creation, realisation, and subsequent delivery of health services. Mechanisms for their development included: (1) engagement in planning and integrating roles; (2) establishing opportunities as part of a well-defined career pathway; and (3) championing role uptake and work to full scopes of practice. Various health system and workplace contexts, practitioner goals, and patient needs influenced the ability for these mechanisms to trigger and thus have an effect on role development.  Theories arising from this research emphasise the complexity inherent in the development of advanced practitioner roles. In addition, the findings demonstrate that a structured and informed health workforce redesign could improve use of roles, such as those of the nurse practitioner and pharmacist prescriber. In light of these results, this study recommends, implementing a national strategy that aligns policy and practice decisions if we are to succeed in making better use of such practitioner skills and expertise.</p>

scholarly journals Editorial

1996 ◽  
Vol 2 (2) ◽  
pp. 2
Author(s):  
Heather Gardner
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
Health Sector ◽  
Primary Health ◽  
The Social ◽  
Improve Health ◽  
Meaningful Communication

Much of the material in this issue is concerned with communication, but communication is much more than simply a means whereby information and knowledge is transferred between people. It is influenced by culture and by the social and policy contexts in which it takes place. In the primary health care area, meaningful communication is possibly even more important and more difficult than in any other area of the health system. It is more difficult, for example, because of the principles of primary health care to which practitioners subscribe, including the empowerment of those who would seek access to the system, re-orienting the health sector, and intersectoral co-operation in attempting to improve health and health services. The contributors demonstrate that in primary health care and in thinking about what is health, what influences it, how is it perceived, and how is it to be improved, there are theoretical and practical ways of and approaching such issues.

scholarly journals Management of pharmaceutical services in the Brazilian primary health care

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Letícia Farias Gerlack ◽  
Margô Gomes de Oliveira Karnikowski ◽  
Camila Alves Areda ◽  
Dayani Galato ◽  
Aline Gomes de Oliveira ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Pharmaceutical Services ◽  
Limiting Factors ◽  
Health Board ◽  
Complex Samples ◽  
Financial Autonomy ◽  
Unified Health System ◽  
Primary Health

OBJECTIVE: To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). METHODS: This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. RESULTS: We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. CONCLUSIONS: Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening

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