A roadmap for the implementation of mHealth innovations for image-based diagnostic support in clinical and public-health settings: a focus on front-line health workers and health-system organizations

ABSTRACT Background Public health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic. Methods Between 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. Results The prevalence of depression, anxiety, and poor self-rated health was 21.3, 19.0, and 9.8%, respectively, among public health workers (27.1, 20.6, and 15.0% among CDC workers and 17.5, 17.9, and 6.8% among PHI workers). The majority (71.6%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), initiating COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and ability to persist for > 1 month at the current work intensity (ORm=0.44~0.55, p<0.001). Conclusions Chinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19.

Download Full-text

A sustainable community based model of non-communicable disease risk factor surveillance: “SHRADDHA-JAGRITHI project” (Preprint)

10.2196/preprints.27299 ◽

2021 ◽

Author(s):

Jaideep Menon ◽

Mathews Numpeli ◽

Sajeev.P. Kunjan ◽

Beena.V. Karimbuvayilil ◽

Aswathy Sreedevi ◽

...

Keyword(s):

Public Health ◽

Health System ◽

Public Health System ◽

Health Workers ◽

Communicable Disease ◽

Community Based ◽

Frontline Health Workers ◽

The Individual ◽

Non Communicable Disease

UNSTRUCTURED Abstract: India has a massive non-communicable disease (NCD) burden at an enormous cost to the individual, family, society and health system at large, in spite of which prevention and surveillance is relatively neglected. Risk factors for atherosclerotic cardiovascular disease if diagnosed early and treated adequately would help decrease the mortality and morbidity burden. India is in a stage of rapid epidemiological transition with the state of Kerala being at the forefront, pointing us towards likely disease burden and outcomes for the rest of the country, in the future. A previous study done by the same investigators, in a population of >100,000, revealed poor awareness and treatment of NCDs and also poor adherence to medicines in individuals with CVD. The investigators are looking at a sustainable, community based model of surveillance for NCDs with corporate support wherein frontline health workers check all individuals in the target group ( > age 30 years) with further follow up and treatment planned in a “spoke and hub” model using the public health system of primary health centres (PHCs) as spokes to the hubs of Taluk or District hospitals. All data entry done by frontline health workers would be on a Tab PC ensuring rapid acquisition and transfer of participant health details to PHCs for further follow up and treatment. The model will be evaluated based on the utilisation rate of various services offered at all tier levels. The proportions of the target population screened, eligible individuals who reached the spoke or hub centres for risk stratification and care and community level control for hypertension and diabetes in annual surveys will be used as indicator variables. The model ensures diagnosis and follow up treatment at no cost to the individual entirely through the tiered public health system of the state and country.

Download Full-text

Empowerment of Public Health System in Rapid Response and Early Detection by Building Front-line Epidemiological Capacity - Egypt, 2017

Iproceedings ◽

10.2196/10542 ◽

2018 ◽

Vol 4 (1) ◽

pp. e10542

Author(s):

Hala Saad ◽

S Elshourbagy ◽

H Abu Elsood ◽

S Refaey ◽

A Kandeel

Keyword(s):

Public Health ◽

Early Detection ◽

Health System ◽

Public Health System ◽

Rapid Response ◽

Front Line

Download Full-text

Health strike is unlikely to shape Kenya national vote

Emerald Expert Briefings ◽

10.1108/oxan-db218220 ◽

2017 ◽

Keyword(s):

Public Health ◽

Public Sector ◽

Health System ◽

Public Health System ◽

Health Workers ◽

Content Type ◽

The Public ◽

General Elections ◽

Slow Progress ◽

National Settlement

Significance Public sector doctors have been on strike since early December citing multiple grievances including pay, conditions at facilities and lack of investment in the public health system. The bitter dispute is the latest in a series of public-sector strikes and comes amid campaigning for August’s general elections. Impacts Agreeing to the strikers' full demands would add pressure for higher salaries in private facilities and the public sector. A national settlement could slow progress towards full devolution of health responsibilities to the counties. Elite segments of society do not rely on the public health system and may be less sympathetic to health workers’ grievances.

Download Full-text

Canada's public health system: building support for front-line physicians

Canadian Medical Association Journal ◽

10.1503/cmaj.061460 ◽

2006 ◽

Vol 176 (1) ◽

pp. 36-37 ◽

Cited By ~ 3

Author(s):

D. Butler-Jones

Keyword(s):

Public Health ◽

Health System ◽

Public Health System ◽

Front Line ◽

System Building

Download Full-text

Prevalence of mental health problems and associated factors among front-line public health workers during the COVID-19 pandemic in China: an effort–reward imbalance model-informed study

BMC Psychology ◽

10.1186/s40359-021-00563-0 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Jing Zhang ◽

Yijing Wang ◽

Jingdong Xu ◽

Hua You ◽

Yan Li ◽

...

Keyword(s):

Public Health ◽

Mental Health ◽

Mental Health Problems ◽

Health Workers ◽

Health Problems ◽

Depression And Anxiety ◽

Front Line ◽

Effort Reward Imbalance ◽

Public Health Workers ◽

Reward Imbalance

Abstract Background Poor mental health status and associated risk factors of public health workers have been overlooked during the COVID-19 pandemic. This study used the effort–reward imbalance model to investigate the association between work-stress characteristics (effort, over-commitment, reward) and mental health problems (anxiety and depression) among front-line public health workers during the COVID-19 pandemic in China. Methods A total of 4850 valid online questionnaires were collected through a self- constructed sociodemographic questionnaire, the adapted ERI questionnaire, the 9-item Patient Health Questionnaire (PHQ-9) and the 7-item General Anxiety Disorder Scale (GAD-7). Hierarchical logistic regression analysis was conducted to investigate the association between ERI factors and mental health problems (i.e., depression and anxiety), with reward treated as a potential moderator in such associations. Results The data showed that effort and over-commitment were positively associated with depression and anxiety, while reward was negatively associated with depression and anxiety. Development and job acceptance were the two dimensions of reward buffered the harmful effect of effort/over-commitment on depression and anxiety, whereas esteem was non-significant. Conclusions This study confirmed the harmful effects of effort and over-commitment on mental health among public health workers during the COVID-19 pandemic in China. Such effects could be alleviated through an appropriate reward system, especially the development and job acceptance dimensions of such a system. These findings highlight the importance of establishing an emergency reward system, comprising reasonable work-allocation mechanism, bonuses and honorary titles, a continuous education system and better career-development opportunities.

Download Full-text

Working conditions and health status of 6,317 front line public health workers across five provinces in China during the COVID-19 epidemic: a cross-sectional study

10.21203/rs.3.rs-44254/v4 ◽

2021 ◽

Author(s):

Jinghua Li ◽

Jingdong Xu ◽

Huan Zhou ◽

Hua You ◽

Xiaohui Wang ◽

...

Keyword(s):

Public Health ◽

Mental Health ◽

Health Status ◽

Health Outcomes ◽

Working Conditions ◽

Health Workers ◽

Front Line ◽

Cross Sectional ◽

Self Rated Health ◽

Public Health Workers

Abstract Background: Public health workers at the Chinese Centre for Disease Control and Prevention (China CDC) and primary health care institutes (PHIs) were among the main workers who implemented prevention, control, and containment measures. However, their efforts and health status have not been well documented. We aimed to investigate the working conditions and health status of front line public health workers in China during the COVID-19 epidemic.Methods: Between 18 February and 1 March 2020, we conducted an online cross-sectional survey of 2,313 CDC workers and 4,004 PHI workers in five provinces across China experiencing different scales of COVID-19 epidemic. We surveyed all participants about their work conditions, roles, burdens, perceptions, mental health, and self-rated health using a self-constructed questionnaire and standardised measurements (i.e., Patient Health Questionnaire and General Anxiety Disorder scale). To examine the independent associations between working conditions and health outcomes, we used multivariate regression models controlling for potential confounders. Results: The prevalence of depression, anxiety, and poor self-rated health was 21.3%, 19.0%, and 9.8%, respectively, among public health workers (27.1%, 20.6%, and 15.0% among CDC workers and 17.5%, 17.9%, and 6.8% among PHI workers). The majority (71.6%) made immense efforts in both field and non-field work. Nearly 20.0% have worked all night for more than 3 days, and 45.3% had worked throughout the Chinese New Year holiday. Three risk factors and two protective factors were found to be independently associated with all three health outcomes in our final multivariate models: working all night for >3 days (multivariate odds ratio [ORm]=1.67~1.75, p<0.001), concerns about infection at work (ORm=1.46~1.89, p<0.001), perceived troubles at work (ORm=1.10~1.28, p<0.001), initiating COVID-19 prevention work after January 23 (ORm=0.78~0.82, p=0.002~0.008), and ability to persist for > 1 month at the current work intensity (ORm=0.44~0.55, p<0.001).Conclusions: Chinese public health workers made immense efforts and personal sacrifices to control the COVID-19 epidemic and faced the risk of mental health problems. Efforts are needed to improve the working conditions and health status of public health workers and thus maintain their morale and effectiveness during the fight against COVID-19.

Download Full-text

Empowerment of Public Health System in Rapid Response and Early Detection by Building Front-line Epidemiological Capacity - Egypt, 2017

10.2196/preprints.10542.a ◽

2018 ◽

Author(s):

Hala Saad ◽

S Elshourbagy ◽

H Abu Elsood ◽

S Refaey ◽

A Kandeel

Keyword(s):

Public Health ◽

Early Detection ◽

Health System ◽

Public Health System ◽

Rapid Response ◽

Front Line

Download Full-text

The importance of strengthening public health systems based on primary health care in designing a successful vaccination strategy: an example of qualitative research in three regions of Senegal.

10.21203/rs.2.17007/v1 ◽

2019 ◽

Author(s):

Jacopo Bianchi ◽

Chiara Milani ◽

Angela Bechini ◽

Sara Boccalini ◽

Maria José Caldes Pinilla ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Primary Health Care ◽

Health System ◽

Public Health System ◽

Health Workers ◽

Conventional Medicine ◽

Specific Information ◽

The Public ◽

Primary Health

Abstract Background Because of its low cost and its capability in reducing child mortality and morbidity, vaccination is considered a successful preventive deed in Low and Middle-Income Countries. In Senegal, vaccines are provided free of charge by the public health system, but the provision of the service is not evenly distributed between and within the Regions. Our study aimed at identifying barriers and enabling factors towards vaccination in three Regions of Senegal. Methods We performed 41 face-to-face semi-structured interviews with health services’ workers and three focus groups with local women in nine different structures in three different Regions of Senegal. We combined health workers’ (HW) and mothers’ points of view with direct observation in order to fulfill our purpose. Results We identified three groups of barriers – structural, personal and psychological – and many subthemes for each of them. Structural and personal barriers such as inadequacy of health structures, shortage of HW, lack of money, distance between villages and health facilities and lack of public transport, hamper mothers from utilising the vaccination service, even when they want to. The lack of effective communication between health personnel and mothers, the lack of collaboration between traditional and conventional medicine and the lack of trust in the public health system as a whole, are major problems to the vaccination uptake too. Conclusions The interlink of several elements in conditioning vaccination coverage suggests the need of implementing global and national strategies to overcome them. The key factor is the presence of a solid health system, publicly funded, based on primary health care. On the other hand, context-specific determinants cannot be detected based on global and non-specific information. The role of community health workers (CHWs) is crucial in overcoming wrong beliefs, lack of knowledge and distrust. They must be regarded as a bridge between HW and population. CHWs should be formally included in the organization of the social-health system, adequately formed and enhanced.

Download Full-text

Abstract MP64: Estimated Impact Of Public Health System Reforms To Increase Hypertension Treatment Coverage In India

Hypertension ◽

10.1161/hyp.78.suppl_1.mp64 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Matti Marklund ◽

Rajeev Cherukupalli ◽

Priya Pathak ◽

Dinesh Neupane ◽

Ashish Krishna ◽

...

Keyword(s):

Public Health ◽

Health System ◽

Public Health System ◽

Health Workers ◽

Scale Up ◽

System Reform ◽

Task Sharing ◽

Treatment Coverage ◽

The Public ◽

The Status

Background: Approaches to scale up hypertension (HTN) treatment are needed in India, where only ~10% of individuals with HTN have controlled blood pressure. Objective: Estimate the current HTN treatment capacity of the public health system in India and model the effects of selected health system reform options. Methods: Using constrained optimization models, we estimated the HTN treatment capacity and salary costs of HTN-treating staff within the public health system; and simulated the potential effects of 1) increased workforce, 2) greater task sharing, and/or 3) reduced visit frequency (quarterly) vs the common practice of monthly visits for prescription refills. Results: An estimated 8% of all adults with HTN could be treated in the status quo (current number of health workers, no further task sharing, and monthly visits) (Figure). Treating 70% of adults with HTN with monthly visits without greater task sharing could require an additional 1.6 million staff, with ~200 billion ₹ (≈US$2.7 billion)) in additional annual salaries. Greater task sharing was estimated to allow the current workforce to treat ~25% of individuals with HTN with monthly visits. Quarterly visits (i.e., longer prescription periods) together with greater task sharing could allow the current workforce to treat ~70% of patients with HTN in India. Conclusion: Expanding HTN treatment coverage through workforce expansion alone will require substantial human and financial resources. The combination of greater task sharing and quarterly visits could increase the coverage of HTN treatment to ~70% of adults with HTN in India, without any expansion of the current workforce of the public health system.

Download Full-text