Impact of community participation in primary health care: what is the evidence?

2015 ◽  
Vol 21 (1) ◽  
pp. 2 ◽  
Author(s):  
Jessamy Bath ◽  
John Wakerman
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Outcomes ◽  
Community Participation ◽  
Service Providers ◽  
Developmental Process ◽  
Service Access ◽  
Primary Health ◽  
Intermediate Outcomes ◽  
The Impact

Community participation is a foundational principle of primary health care, with widely reputed benefits including improved health outcomes, equity, service access, relevance, acceptability, quality and responsiveness. Despite considerable rhetoric surrounding community participation, evidence of the tangible impact of community participation is unclear. A comprehensive literature review was conducted to locate and evaluate evidence of the impact of community participation in primary health care on health outcomes. The findings reveal a small but substantial body of evidence that community participation is associated with improved health outcomes. There is a limited body of evidence that community participation is associated with intermediate outcomes such as service access, utilisation, quality and responsiveness that ultimately contribute to health outcomes. Policy makers should strengthen policy and funding support for participatory mechanisms in primary health care, an important component of which is ongoing support for Aboriginal Community Controlled Health Services as exemplars of community participation in Australia. Primary health-care organisations and service providers are encouraged to consider participatory mechanisms where participation is an engaged and developmental process and people are actively involved in determining priorities and implementing solutions.

The Politics of Primary Health Care

2019 ◽  
Author(s):  
David Sanders ◽  
Louis Reynolds
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Participation ◽  
Service Providers ◽  
Determinants Of Health ◽  
Economic Order ◽  
Financial Flows ◽  
Primary Health ◽  
The Social ◽  
Vested Interests

The global project to achieve Health for All through Primary Health Care (PHC) is a profoundly political one. In seeking to address both universal access to health care and the social determinants of health (SDH) it challenges power blocs which have material vested interests in technical approaches to health and development. The forces that have shaped PHC include Community Oriented Primary Care and the Health Centre Movement, the “basic health services approach,” and nongovernmental and national initiatives that exemplified comprehensive and participatory approaches to health development. The 1978 Alma-Ata Declaration codified these experiences and advocated Health for All by the year 2000 through PHC. It emphasized equitable and appropriate community and primary-level health care as well as intersectoral actions and community participation to address the social and environmental determinants of health. This would need the support of a new international economic order. The concept of “Selective Primary Health Care” emerged soon after Alma-Ata, privileging a limited set of technical interventions directed at selected groups, notably young children. This was soon operationalized as UNICEF’s Child Survival Revolution. The visionary and comprehensive policy of PHC was further eroded by the 1970s debt crisis and subsequent economic policies including structural adjustment and accelerated neoliberal globalization that deregulated markets and financial flows and reduced state expenditure on public services. This translated, in many countries, as “health sector reform” with a dominant focus on cost efficiency to the detriment of broad developmental approaches to health. More recently this selective approach has been aggravated by the financing of global health through public-private partnerships that fund specific interventions for selected diseases. They have also spawned many “service delivery” NGOs whose activities have often reinforced a biomedical emphasis, supported by large philanthropic funding such as that of the Gates Foundation. Educational institutions have largely failed to transform their curricula to incorporate the philosophy and application of PHC to inform the practice of students and graduates, perpetuating weakness in its implementation. Revitalizing PHC requires at least three key steps: improved equity in access to services, a strong focus on intersectoral action (ISA) to address SDH and prioritization of community-based approaches. The third sustainable development goal (SDGs) focuses on health, with universal health coverage (UHC) at its center. While UHC has the potential to enhance equitable access to comprehensive health care with financial protection, realizing this will require public financing based on social solidarity. Groups with vested interests such as private insurance schemes and corporate service providers have already organized against this approach in some countries. The SDGs also provide an opportunity to enhance ISA, since they include social and environmental goals that could also support the scaling up of Community Health Worker programs and enhanced community participation. However, SDG-8, which proposes high economic growth based substantially on an extractivist model, contradicts the goals for environmental sustainability. Human-induced environmental degradation, climate change, and global warming have emerged as a major threat to health. As presciently observed at Alma-Ata, the success of PHC, and Health for All requires the establishment of a new, ecologically sustainable, economic order.

Community participation in rural primary health care: intervention or approach?

2010 ◽  
Vol 16 (1) ◽  
pp. 4 ◽  
Author(s):  
Robyn Preston ◽  
Hilary Waugh ◽  
Sarah Larkins ◽  
Judy Taylor
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Outcomes ◽  
Community Participation ◽  
Care Service ◽  
Health Care Service ◽  
Positive Health ◽  
Conceptual Approach ◽  
Level Of Evidence ◽  
Primary Health

Community participation is considered important in primary health care development and there is some evidence to suggest it results in positive health outcomes. Through a process of synthesising existing evidence for the effectiveness of community participation in terms of health outcomes we identified several conceptual areas of confusion. This paper builds on earlier work to disentangle the conceptual gaps in this area, and clarify our common understanding of community participation. We conducted a research synthesis of 689 empirical studies in the literature linking rural community participation and health outcomes. The 37 final papers were grouped and analysed according to: contextual factors; the conceptual approach to community participation (using a modification of an existing typology); community participation process; level of evidence; and outcomes reported. Although there is some evidence of benefit of community participation in terms of health outcomes, we found only a few studies demonstrating higher levels of evidence. However, it is clear that absence of evidence of effect is not necessarily the same as absence of an effect. We focus on areas of debate and lack of clarity in the literature. Improving our understanding of community participation and its role in rural primary health care service design and delivery will increase the likelihood of genuine community–health sector partnerships and more responsive health services for rural communities.

scholarly journals Community participation in the collaborative governance of primary health care facilities, Uasin Gishu County, Kenya

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248914
Author(s):  
Jackline Sitienei ◽  
Lenore Manderson ◽  
Mabel Nangami
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Participation ◽  
Health Facility ◽  
Service Providers ◽  
Collaborative Governance ◽  
Health Care Facilities ◽  
Primary Health ◽  
Care Facilities ◽  
Primary Health Care Facilities

Introduction Community participation in the governance of health services is an important component in engaging stakeholders (patients, public and partners) in decision-making and related activities in health care. Community participation is assumed to contribute to quality improvement and goal attainment but remains elusive. We examined the implementation of community participation, through collaborative governance in primary health care facilities in Uasin Gishu County, Western Kenya, under the policy of devolved governance of 2013. Methods Utilizing a multiple case study methodology, five primary health care facilities were purposively selected. Study participants were individuals involved in the collaborative governance of primary health care facilities (from health service providers and community members), including in decision-making, management, oversight, service provision and problem solving. Data were collected through document review, key informant interviews and observations undertaken from 2017 to 2018. Audio recording, notetaking and a reflective journal aided data collection. Data were transcribed, cleaned, coded and analysed iteratively into emerging themes using a governance attributes framework. Findings A total of 60 participants representing individual service providers and community members participated in interviews and observations. The minutes of all meetings of five primary health care facilities were reviewed for three years (2014–2016) and eight health facility committee meetings were observed. Findings indicate that in some cases, structures for collaborative community engagement exist but functioning is ineffective for a number of reasons. Health facility committee meetings were most frequent when there were project funds, with discussions focusing mainly on construction projects as opposed to the day-to-day functioning of the facility. Committee members with the strongest influence and power had political connections or were retired government workers. There were no formal mechanisms for stakeholder forums and how these worked were unclear. Drug stock outs, funding delays and unclear operational guidelines affected collaborative governance performance. Conclusion Implementing collaborative governance effectively requires that the scope of focus for collaboration include both specific projects and the routine functioning of the primary health care facility by the health facility committee. In the study area, structures are required to manage effective stakeholder engagement.

The Roots of Global Health Inequity

2017 ◽  
Author(s):  
Joia S. Mukherjee
Keyword(s):  
Health Care ◽  
World War Ii ◽  
Primary Health Care ◽  
Economic Policies ◽  
World War ◽  
The Public ◽  
The World Bank ◽  
Primary Health ◽  
The Cold War ◽  
The Impact

This chapter outlines the historical roots of health inequities. It focuses on the African continent, where life expectancy is the shortest and health systems are weakest. The chapter describes the impoverishment of countries by colonial powers, the development of the global human rights framework in the post-World War II era, the impact of the Cold War on African liberation struggles, and the challenges faced by newly liberated African governments to deliver health care through the public sector. The influence of the World Bank and the International Monetary Fund’s neoliberal economic policies is also discussed. The chapter highlights the shift from the aspiration of “health for all” voiced at the Alma Ata Conference on Primary Health Care in 1978, to the more narrowly defined “selective primary health care.” Finally, the chapter explains the challenges inherent in financing health in impoverished countries and how user fees became standard practice.

scholarly journals Cohort study of ageing from Bagé (SIGa-Bagé), Brazil: profile and methodology

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elaine Thumé ◽  
Marciane Kessler ◽  
Karla P. Machado ◽  
Bruno P. Nunes ◽  
Pamela M. Volz ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cohort Study ◽  
Primary Health Care ◽  
Rio Grande ◽  
Cognitive Testing ◽  
Rio Grande Do Sul ◽  
Primary Health ◽  
The Impact

Abstract Background The Bagé Cohort Study of Ageing is a population-based cohort study that has recently completed the first follow-up of a representative sample of older adults from Bagé, a city with more than 100,000 inhabitants located in the state of Rio Grande do Sul, Brazil. This is one of the first longitudinal studies to assess the impact of primary health care coverage on health conditions and inequalities. Our aim is to investigate the prevalence, incidence and trends of risk factors, health behaviours, social relationships, non-communicable diseases, geriatric diseases and disorders, hospitalisation, self-perceived health, and all-cause and specific-cause mortality. In addition, we aim to evaluate socioeconomic and health inequalities and the impact of primary health care on the outcomes under study. Methods/design The study covers participants aged 60 or over, selected by probabilistic (representative) sampling of the urban area of the city of Bagé, which is covered by Primary Health Care Services. The baseline examination included 1593 older adults and was conducted from July 2008 to November 2008. After eight to nine years (2016/2017), the first follow-up was conducted from September 2016 to August 2017. All participants underwent an extensive core assessment programme including structured interviews, questionnaires, cognitive testing (baseline and follow-up), physical examinations and anthropometric measurements (follow-up). Results Of the original participants, 1395 (87.6%) were located for follow-up: 757 elderly individuals (47.5%) were re-interviewed, but losses in data transfer occurred for 22. The remaining 638 (40.1%) had died. In addition, we had 81 (5.1%) refusals and 117 (7.3%) losses. Among the 1373 older adults who were followed down, there was a higher proportion of female interviewees (p=0.042) and a higher proportion of male deaths (p=0.001) in 2016/2017. There were no differences in losses and refusals according to gender (p=0.102). There was a difference in average age between the interviewees (68.8 years; SD ±6.5) and non-interviewees (73.2 years; SD ±9.0) (p<0.001). Data are available at the Department of Social Medicine in Federal University of Pelotas, Rio Grande do Sul, Brazil, for any collaboration.

The Use of and Attitude Towards Telehealth in Rural Communities

2007 ◽  
Vol 13 (3) ◽  
pp. 29 ◽  
Author(s):  
Emily Mauldon
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Routine Practice ◽  
Care Providers ◽  
Urban Hospital ◽  
Primary Health ◽  
The Impact ◽  
Rural Patients

This paper reports on the attitudes of a sample of health care providers towards the use of telehealth to support rural patients and integrate rural primary health and urban hospital care. Telehealth and other information technologies hold the promise of improving the quality of care for people in rural and remote areas and for supporting rural primary health care providers. While seemingly beneficial for rural patients, study participants believed that telehealth remains underused and poorly integrated into their practice. In general, participants thought that telehealth is potentially beneficial but places constraints on their activities, and few actually used it. Published literature usually reports either on the success of telehealth pilot projects or initiatives that are well resourced and do not reflect the constraints of routine practice, or has an international focus limiting its relevance to the Australian context. Because of the paucity of systematic and generalisable research into the effects of the routine use of telehealth to support rural patients, it is unclear why health care professionals choose to provide such services or the costs and benefits they incur in doing so. Research and policy initiatives continue to be needed to identify the impact of telehealth within the context of Australian primary health care and to develop strategies to support its use.

Community midwifery: a primary health care approach to care during pregnancy for Aboriginal and Torres Strait Islander women

2021 ◽  
Vol 27 (1) ◽  
pp. 57
Author(s):  
Ailsa Munns
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Torres Strait Islander ◽  
Service Providers ◽  
Early Years ◽  
Health Staff ◽  
Liaison Officer ◽  
Primary Health ◽  
Comprehensive Primary Health Care ◽  
Torres Strait

Comprehensive primary health care is integral to meaningful client-centred care, with nurses and midwives central to partnership approaches with individuals, families and communities. A primary health model of antenatal care is needed for Aboriginal and Torres Strait Islander women in rural and remote areas, where complex social determinants of health impact on pregnancy outcomes, early years and lifelong health. Staff experiences from a community midwifery-led antenatal program in a remote Western Australian setting were explored, with the aim of investigating program impacts from health service providers’ perspectives. Interviews with 19 providers, including community midwives, child health nurses, program managers, a liaison officer, doctors and community agency staff, examined elements comprising a culturally safe community antenatal program for Aboriginal and Torres Strait Islander women, exploring program benefits and challenges. Thematic analysis derived five themes: Organisational and Accessibility Factors; Culturally Appropriate Support; Staff Availability and Competencies; Collaboration; and Sustainability. The ability of program staff to work in culturally safe partnerships with clients in collaboration with community agencies was essential to building meaningful and sustainable antenatal strategies. Midwifery primary health care competencies were viewed as a strong enabling factor, with potential to reduce health disparities in accordance with Australian Government and research recommendations.

scholarly journals Promoting cross-jurisdictional primary health care research: developing a set of common indicators across 12 community-based primary health care teams in Canada

2018 ◽  
Vol 20 ◽  
Author(s):  
Sabrina T. Wong ◽  
Julia M. Langton ◽  
Alan Katz ◽  
Martin Fortin ◽  
Marshall Godwin ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Working Group ◽  
Scale Up ◽  
Data Sources ◽  
Knowledge Generation ◽  
Community Based ◽  
Primary Health ◽  
The Impact

AbstractAimTo describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources.BackgroundA pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators.MethodsA working group representing the 12 teams was established. They undertook an iterative process to consider existing primary care indicators identified from the literature and by stakeholders. Indicators were agreed upon with the intention of addressing three objectives across the 12 teams: (1) describing the impact of improving access to CBPHC; (2) examining the impact of alternative models of chronic disease prevention and management in CBPHC; and (3) describing the structures and context that influence the implementation, delivery, cost, and potential for scale-up of CBPHC innovations.FindingsNineteen common indicators within the core dimensions of primary care were identified: access, comprehensiveness, coordination, effectiveness, and equity. We also agreed to collect data on health care costs and utilization within each team. Data sources include surveys, health administrative data, interviews, focus groups, and case studies. Collaboration across these teams sets the foundation for a unique opportunity for new knowledge generation, over and above any knowledge developed by any one team. Keys to success are each team’s willingness to engage and commitment to working across teams, funding to support this collaboration, and distributed leadership across the working group. Reaching consensus on collection of common indicators is challenging but achievable.

scholarly journals Melhores práticas de enfermagem na saúde da pessoa idosa

2020 ◽  
Vol 14 ◽  
Author(s):  
Maria Alice De Freitas ◽  
Angela Maria Alvarez
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Best Practices ◽  
Methodological Approach ◽  
Family Health ◽  
The Elderly ◽  
Structured Interview ◽  
Primary Health ◽  
La Red ◽  
The Impact

Objetivo: compreender, dentro das melhores práticas, as experiências de busca por conhecimento e utilização da experiência profissional dos enfermeiros no cuidado da pessoa idosa na Atenção Primária à Saúde. Método: trata-se de um estudo qualitativo, descritivo e exploratório, com 30 enfermeiros atuantes nas Estratégias Saúde da Família. Utilizou-se um instrumento de entrevista semiestruturado. Analisaram-se os dados pela técnica de Análise de Conteúdo na modalidade Análise Temática. Resultados: revelaram-se a busca por conhecimento com outros profissionais e o acesso à rede de internet como fontes de conhecimento. Evidenciou-se a necessidade do estabelecimento de uma rotina de estudos sistematizada e agenda de educação permanente sob a temática do envelhecimento. Conclusão: conclui-se que o estudo confirma que os enfermeiros realizam ações que carecem de notoriedade e que estão preocupados com o impacto de suas ações para o usuário idoso, mas, para que as melhores práticas sejam completamente estabelecidas,  se faz necessária a imersão científica e metodológica dos profissionais e da gestão, além da busca por conhecimento e valorização da experiência, que já coexistem. Descritores: Idoso; Enfermagem; Conhecimento, Atenção Primária à Saúde; Saúde da Pessoa Idosa; Dinâmica Populacional.AbstractObjective: to understand, within the best practices, the experiences of searching for knowledge and using nurses' professional experience in the care of the elderly in Primary Health Care. Method: this is a qualitative, descriptive and exploratory study, with 30 nurses working in the Family Health Strategies. A semi-structured interview instrument was used. Data was analyzed using the Content Analysis technique in the Thematic Analysis modality. Results: the search for knowledge with other professionals and access to the internet network as sources of knowledge were revealed. The need to establish a systematic study routine and a permanent education agenda under the theme of aging became evident. Conclusion: it is concluded that the study confirms that nurses perform actions that lack notoriety and that they are concerned with the impact of their actions for the elderly user, but, for the best practices to be completely established, scientific immersion is necessary and methodological approach of professionals and management, in addition to the search for knowledge and appreciation of experience, which already coexist. Descriptors: Elderly; Nursing; Knowledge; Primary Health Care; Elderly health; Population Dynamics.ResumenObjetivo: comprender, dentro de las mejores prácticas, las experiencias de búsqueda de conocimiento y el uso de la experiencia profesional de los enfermeros en el cuidado de ancianos en Atención Primaria de Salud. Método: estudio cualitativo, descriptivo y exploratorio con 30 enfermeros activos en las Estrategias de Salud Familiar. Se utilizó un instrumento de entrevista semiestructurada. Los datos se analizaron utilizando la técnica de Análisis de Contenido en la modalidad de Análisis Temático. Resultados: se reveló la búsqueda de conocimiento con otros profesionales y el acceso a la red de Internet como fuentes de conocimiento. La necesidad de establecer una rutina de estudio sistemática y una agenda de educación permanente bajo el tema del envejecimiento se hizo evidente. Conclusión: se concluye que el estudio confirma que los enfermeros realizan acciones que carecen de notoriedad y que están preocupados por el impacto de sus acciones para el usuario mayor, pero, para que las mejores prácticas se establezcan por completo, es necesaria la inmersión científica y enfoque metodológico de profesionales y directivos, además de la búsqueda de conocimiento y valoración de la experiencia, que ya coexisten. Descriptores: Anciano; Enfermería; Conocimiento; Atencíon Primária de la Salud; Saúde do Idoso; Dinámica Poblacional.

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