scholarly journals Innovation in primary health care responses to COVID-19 in Sub-Saharan Africa

2021 ◽  
Vol 22 ◽  
Author(s):  
Sunanda Ray ◽  
Robert Mash
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Family Medicine ◽  
Health Services ◽  
Primary Care Providers ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Primary Health ◽  
Lessons Learnt

Abstract Background: In May 2020, the African Journal of Primary Health Care and Family Medicine invited submissions on lessons learnt from responses to the COVID-19 pandemic from primary care providers in Africa. This included descriptions of innovations and good practices, the management of COVID-19 in district health services and responses of communities to the outbreak. Aim: To synthesise the lessons learnt from the COVID-19 pandemic in the Africa region. Methods: A thematic document analysis was conducted on twenty-seven short report publications from Botswana, Ghana, Nigeria, South Africa, Uganda and Zimbabwe. Findings: Eight major themes were derived from the data: community-based activities; screening and testing; reorganisation of health services; emergency care for COVID-19; maintenance of essential non-COVID-19 health services; caring for the vulnerable; use of information technology; and reframing training opportunities. Community health workers were a vital community resource, delivering medications and other supplies to homes, as well as following up on patients with chronic conditions. More investment in community partnerships and social mobilisation was proposed. Difficulties with procurement of test kits and turn-around times were constraints for most countries. Authors described how services were reorganised for focused COVID-19 activities, sometimes to the detriment of essential services and training of junior doctors. Innovations in use of internet technology for communication and remote consultations were explored. The contribution of family medicine principles in upholding the humanity of patients and their families, clear leadership and planning, multidisciplinary teamwork and continuity of care was emphasised even in the context of providing critical care. Conclusions: The community-orientated primary care approach was emphasised as well as long-term benefits of technological innovations. The pandemic exposed the need to deliver on governmental commitments to strengthening primary health care and universal health coverage.

scholarly journals The expectations of transgender people in the face of their health-care access difficulties and how they can be overcome. A qualitative study in France

2020 ◽  
Vol 21 ◽  
Author(s):  
Emmanuel Allory ◽  
Ellie Duval ◽  
Marion Caroff ◽  
Candan Kendir ◽  
Raphaël Magnan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Access ◽  
Primary Care Providers ◽  
Care Providers ◽  
Transgender People ◽  
Care Access ◽  
Care Services ◽  
Primary Health

Abstract Aim: Our objective was to explore the difficulties experienced by transgender people in accessing primary health-care services and their expectations towards primary care providers to improve their health-care access. Background: Because transgender people are exposed to many discriminations, their health-care access is particularly poor. Guidelines recommend greater involvement of primary care providers in the processes because of the accessibility feature of primary care services. Methods: A qualitative study using semi-directed interviews was conducted among 27 transgender people (February 2018 – August 2018). These voluntary participants were recruited through different means: local trans or LGBTI (lesbian, gay, bisexual, trans, and/or intersex) associations, primary care providers, and social networks. The data analysis was based on reflexive thematic analysis in an inductive approach. Findings: Difficulties in accessing health-care occurred at all the levels of the primary health-care system: primary care providers – transgender people interaction, access to the primary care team facility (starting with the secretariat), access to secondary care specialists, and continuity of care. Transgender people report ill-adapted health-care services as a result of gender-based identification in health-care settings. Their main expectation was depsychiatrization and self-determination. They supported mixed health network comprising primary care providers and transgender people with a coordinating role for the general practitioner. These expectations should be priorities to consider in our primary health-care system to improve access to health-care for transgender people.

scholarly journals Perception of service users and their caregivers on primary care-based mental health services: a qualitative study in Nepal

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
N. P. Luitel ◽  
M. J. D. Jordans ◽  
P. Subba ◽  
I. H. Komproe
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health Workers ◽  
Service Users ◽  
Care Providers ◽  
Primary Health

Abstract Background Integration of mental health services into primary health care systems has been advocated as a strategy to minimize the tremendous mental health treatment gap, particularly in low- and middle-income countries. Barriers to integration of mental health into primary health care have been widely documented; however, very little is known about the perception of service users and their caregivers on primary care-based mental health services. This study assessed service users’ and caregivers’ perceptions of mental health services provided by trained primary health care workers in Nepal. Methods A qualitative study was conducted among people with depression, psychosis, alcohol use disorder and epilepsy, and their caregivers in Chitwan, a district in southern Nepal. Semi-structured interviews were conducted with 43 service users and 38 caregivers to assess their perceptions about the accessibility of the services, types of services they received, skills and competencies of health care providers, satisfaction and barriers to receiving services. Results Overall, both service users and caregivers were satisfied with the mental health services provided by primary health care providers. They also perceived health workers to be competent and skillful because the services they received were effective in reducing their mental health problems. Both psychological and pharmacological services were made available free of cost, however, they considered psychological services more effective than pharmacological treatment. Major challenges and difficulties accessing services were associated with frequent transfer of trained health workers, non-availability of the same health care provider at follow-ups, frequent stock-out of medicines or non-availability of required medicines, lack of a confidential space for consultation in health facilities, and stigmatizing and negative behavior of some health workers. Conclusion The results demonstrated that both service users and caregivers perceived primary care-based mental health services to be accessible, acceptable and effective. The key recommendations emerging from this study for improving mental health services in primary care include the provision of a separate cadre of psychosocial workers to provide psychological interventions, developing quick and efficient mechanisms for the procurement and supply of psychotropic medicines, establishing a confidential place within health facilities for consultation, and further training of health workers to reduce stigma.

scholarly journals Primary health care assessment tools: a literature review and metasynthesis

2014 ◽  
Vol 19 (12) ◽  
pp. 4851-4860 ◽  
Author(s):  
Lislaine Aparecida Fracolli ◽  
Maria Fernanda Pereira Gomes ◽  
Fabiana Rodrigues Zequini Nabão ◽  
Mariana Souza Santos ◽  
Verusca Kelly Cappellini ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Assessment Tool ◽  
Primary Care Providers ◽  
Assessment Tools ◽  
Care Providers ◽  
Primary Health ◽  
Care Assessment ◽  
Primary Care Assessment Tool

This study comprises a systematic review and metasynthesis of qualitative literature on national and international databases to identify the main tools used to assess Primary Health Care (PHC). A total of 3,048 results were returned for literature written in Portuguese, Spanish and English published between 1979 and 2013. Thirty-three articles/studies were selected after thorough reading and analysis. Eight of these studies addressed the use of one or more of the following validated PHC assessment tools: the WHO Primary Care Assessment Tool (PCET); the ADHD Questionnaire for Primary Care Providers (AQ-PCP); the General Practice Assessment Questionnaire (GPAQ), PACOTAPS (primary health care software); and the PCAT (Primary Care Assessment Tool). The study showed that the majority of these tools were used internationally. The PCAT and EUROPEP were used in Brazil and the most commonly used tool in this country was the PCAT. The results show that the use of research tools to assess PHC may assist in the creation of new proposals to improve family healthcare and that PCAT is the most adequate tool for this purpose.

scholarly journals Performing Through Privatization: An Ecological Natural Experiment of the Impact of the Swedish Free Choice Reform on Ambulatory Care Sensitive Conditions

2021 ◽  
Vol 9 ◽  
Author(s):  
Paola A. Mosquera ◽  
Miguel San Sebastian ◽  
Bo Burström ◽  
Anna-Karin Hurtig ◽  
Per E. Gustafsson
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Free Choice ◽  
Primary Care Providers ◽  
Ambulatory Care Sensitive Conditions ◽  
Care Providers ◽  
Intervention Period ◽  
Private Provision ◽  
Primary Health

Background: In 2010, Sweden opened up for establishment of privately owned primary health care providers, as part of a national Free Choice in Primary Health Care reform. The reform has been highly debated, and evidence on its effects is scarce. The present study therefore sought to evaluate whether the reform have impacted on primary health care service performance.Methods: This ecological register-based study used a natural experimental approach through an interrupted time series design. Data comprised the total adult population of the 21 counties of Sweden 2001–2009 (pre-intervention period) and 2010–2016 (post-intervention period). Hospitalizations and emergency department visits for ambulatory care sensitive conditions (ACSC) were used as indicators of primary health care performance. Segmented regression analysis was used to assess the effects of the reform, in Sweden as a whole, as well as compared between counties grouped by (i) change in private provision pre- to post reform; (ii) the timing of the implementation; and (iii) sustained presence of private providers both pre- and post-reform.Results: The results suggest that, following the introduction of the reform in Sweden as a whole, the trends in total hospitalizations rates were slowed down by 1.0% albeit acute emergency visits increased 1.1% more rapidly after the introduction of the reform. However, we found no evidence of more beneficial effects in counties where the reform had been implemented more ambitiously, specifically those with a larger increase in private primary care providers, or where the reform was introduced early and thus had longer time effects to emerge. Lastly, counties with a sustained high presence of private primary care providers displayed the least favorable development when it comes to ACSC.Conclusion: Taken together, the present study does not support that the Swedish Free Choice reform has improved performance of the primary care delivery system in Sweden, and suggests that high degree of private provision may involve worse performance and higher care burden for specialized health care. Further evaluations of the consequences of the reform are dire needed to provide a comprehensive picture of its intended and unintended impact on health care provision, delivery and results.

scholarly journals Erythematous plaques of the vulvo-perineal region

2021 ◽  
Vol 16 (3) ◽  
pp. 101-103
Author(s):  
Qin Jian Low ◽  
Tzyy Huei Lim ◽  
Shu Ann Hon ◽  
Seng Wee Cheo ◽  
Noranizah Wagino ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Primary Care Providers ◽  
Care Providers ◽  
Primary Health ◽  
Primary Health Care Providers ◽  
Slow Evolution ◽  
Skin Conditions

Skin conditions are a common reason for consulting primary health care. The public frequently expects their primary health care providers to be able to recognise and treat common skin conditions with confidence. Primary care providers must be able to identify ‘red flag’ skin conditions that require dermatology referral. However, diagnosis is often delayed due to the non-specific clinical presentation, low incidence, slow evolution and long-term history of such lesions. We report the case of a patient with extramammary Paget’s disease that presented to her primary care provider and subsequently underwent a wide local excision.

'I demand to be treated as the person I am': experiences of accessing primary health care for Australian adults who identify as gay, lesbian, bisexual, transgender or queer

Sexual Health ◽  
2014 ◽  
Vol 11 (3) ◽  
pp. 258 ◽  
Author(s):  
Chee S. Koh ◽  
Melissa Kang ◽  
Tim Usherwood
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Sexual Identity ◽  
Health Care Providers ◽  
Primary Care Providers ◽  
Free Text ◽  
Care Providers ◽  
Care Services ◽  
Primary Health

Background Individuals who identify as gay, lesbian, bisexual, transgender or queer (GLBTQ) suffer higher rates of illness and morbidity compared with the general population but may experience significant barriers to accessing primary health care. Method: We used an online questionnaire to explore GLBTQ adults’ experiences of accessing primary health care in Australia. We developed the questionnaire in consultation with individuals who belonged to or worked closely with the GLBTQ community. Questions were open-ended and sought information about four topic areas: sexual identity and its meaning, utilisation of primary health care services, disclosure of sexual identity to primary care providers and experiences of accessing primary health care. Data were analysed by coding free-text responses into themes. Results: Ninety-nine valid responses were received. Participants were 18–60+ years old (modal age group: 20–29 years); 70% lived in cities. Of these, 49% identified as gay, 35% as lesbian, 13% as bisexual, 8% as queer and 3% as transgender. Some participants indicated more than one identity. GLBTQ-identifying adults often divided care, seeking different primary care services for different health concerns. Themes in relation to disclosure of sexual identity were: taking a rights-based position, experiences of homophobia and clinical context. Themes about access to primary health care were: diversity and heterogeneity, real or perceived discrimination, visual symbols and respect. Conclusion: Despite diversity, GLBTQ adults experience many barriers to accessing health care due to sexual identity. General practitioners and other primary health care providers have a role in ensuring equitable access to health care.

scholarly journals Impact of mental health and addiction NIMHANS ECHO on primary care physicians: study from a rural state of India

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S157-S157
Author(s):  
Shabinabegam A M Sheth ◽  
Bhavya Bairy ◽  
Aurobind Ganesh ◽  
Sumi Jain ◽  
Prabhat Chand ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Mental Health Problems ◽  
Health Problems ◽  
Care Providers ◽  
Primary Health ◽  
Secondary Outcomes

AimsAs per National Mental Health Survey-2015-16, 83 out of 100 people having mental health problems do not have access to care in India. Further, primary health care providers (PCPs) have not been adequately trained in the screening, diagnosis, and initial management of common mental health conditions. There is thus a need to train health care providers at the State level to incorporate mental health into primary health care. In this paper, we report the findings of a collaborative project between the National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore India, and the state of Chhattisgarh incorporating mental health into primary care and addressing urban-rural disparities through tele-mentoring.MethodWe assessed the impact of the NIMHANS Extended Community Health Care Outcome (ECHO), an online, blended training program on participants' knowledge and competence (primary outcome) and commitment, satisfaction, and performance (Secondary outcomes) using Moore's evaluation framework. Primary and secondary outcomes were determined through a pre-post evaluation, assessment of trainee participation in the quarterly tele ECHO clinic as well as periodic assignments, respectively.ResultOver ten months of the NIMHANS ECHO program, there was a significant improvement in the participants' knowledge post-ECHO (p < 0.05, t = −3.52). Self-efficacy in diagnosis and management of mental health problems approached significance; p < 0.001. Increased engagement in tele-ECHO sessions was associated with better performance for declarative and procedural knowledge. The attrition rate was low (5 out of 30 dropped out), and satisfaction ratings of the course were high across all fields. The participants reported a 10- fold increase in the number of patients with mental health problems they had seen, following the training. A statistically significant increase in the number of psychotropic drugs prescribed post ECHO with t = −3.295, p = 0.01.ConclusionThe outcomes indicate that the NIMHANS ECHO with high participant commitment is a model with capacity building potential in mental health and addiction for remote and rural areas by leveraging technology. This model has the potential to be expanded to other states in the country in providing mental health care to persons in need of care.

scholarly journals Satisfaction of clients with disabilities with services offered at primary health care centres in Ndola, Zambia

2012 ◽  
Vol 68 (2) ◽  
Author(s):  
N. Mlenzana ◽  
R. Mwansa
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health Professionals ◽  
Health Care Services ◽  
Waiting Times ◽  
Care Providers ◽  
Persons With Disabilities ◽  
Care Services ◽  
Primary Health

To establish satisfaction level of persons with disabilitiesregarding health services at primary health care centres in Ndola, Zambia.Key stakeholders views on satisfaction of services is an important componentof service rendering thus obtaining information is important in assistingwith the evaluation of health care service delivery. This will assist in improvingeffectiveness and availability of health care services to persons with physicaldisabilities.All persons with disabilities attending both rehabilitation centres andprimary health care centres in Ndola, Zambia, were targeted for this study. Willing participants were convenientlyselected to take part in the study.A cross sectional, descriptive study design using quantitative methods of data collection was used. The GeneralPractice Assessment Questionnaire was adjusted, piloted for Ndola population and used in this study to establishsatisfaction of participants. The study was ethically cleared at the University of the Western Cape and Zambia.Information and consent forms were signed by participants.Quantitative data was analysed descriptively and was reported in percentages.In the current study there were 191 participants of whom 56% were male and 44% were female with age rangefrom 18-65 years. Fifty-two percent of the participants presented with learning disabilities and 38% of persons withphysical disabilities. Majority of clients (54%) were dissatisfied with availability of services and health care servicesat the health care centres. Areas that clients were dissatisfied with were accessibility, consultation with health professionals,waiting times and opening hours of the health care centres.Clients with disabilities who accessed health care services from selected health centres in Ndola were dissatisfiedwith aspects of health services. Accessibility, consultation with health professionals, waiting times and opening hoursof the health care centres were the origin of client dissatisfaction. Other clients were satisfied with thoroughness ofhealth care providers regarding symptoms, feelings, reception and treatment received at the primary health care centre.Understanding the views of the clients is essential in improving health delivery services and could impact on thecompliance of people attending primary health care services.

Factors Influencing Access to Primary Health Care via School Health Services

PEDIATRICS ◽  
1980 ◽  
Vol 65 (3) ◽  
pp. 585-591
Author(s):  
Philip R. Nader ◽  
Susan Gilman ◽  
David E. Bee
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
School Health ◽  
Preventive Health Care ◽  
School Health Services ◽  
Family Status ◽  
Primary Health ◽  
Poor Access

The school health and community primary health care contacts were studied for a group of elementary school children who have sociodemographic characteristics often associated with poor access to primary health services. The school system is engaged in a demonstration project that attempts to link the home with community and school services. Visits to the school health room accounted for 85% of all contacts. A visit rate of 1.13 visits/child/year occurred at primary care sites. Ethnicity is the single most important predictor of use of school health services, followed by family status and number of visits for primary health care in the community. In contrast, use of community primary care facilities is best predicted by socioeconomic status (SES), family status, and sex. The patterns of care received by the population were characterized. Children whose care was initiated, referred, or facilitated by the school were designated as receiving "interactive" care, which occurred mostly among minority and lower SES children. The data suggest that the school provides access to preventive health care for all children and facilitates care for segments of the population that usually have difficulty achieving access to the health care system.

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