scholarly journals Digitally-enabled approach to improving primary care in a rural and remote low-resource setting

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Ansell
Keyword(s):  
Primary Care ◽  
Public Sector ◽  
Low Income ◽  
Digital Health ◽  
Health Priorities ◽  
Rural And Remote ◽  
Low Resource Settings ◽  
Digital Platform ◽  
Low Resource ◽  
Out Of Pocket Payments

Abstract Introduction An innovative digitally-supported multi-sectoral solution for supporting end-to-end primary care for rural and remote low-income populations in Western Visayas, Philippines was examined to determine its efficacy in supporting health access. This solution brings together multisectoral stakeholders using a digital platform to coordinate the provision of a virtual primary care system. The solution also supports ordering and delivery of low-cost insurance and medicines, with the aim of reducing out-of-pocket payments and complementing public-sector services. Methods Processes and outputs for a novel data-driven digital health solution were documented and analyzed through a mixed methods approach. Researchers conducted interviews with a range of stakeholders, including program beneficiaries and partners. Quantitative data focusing on the project outputs were also examined. Results Through an integrated digital platform to coordinate inputs from the public sector (Department of Health); private sector (pharmaceutical, insurance, and telecom firms); and community (in the form of a peer-worker network), this model offers an example of an innovative approach to primary health delivery in low-resource settings. These inputs are leveraged and informed by a 'big-data' precision approach, based on detailed epidemiological profiles of community residents. This dataset allows for the evidence-based identification of village-specific health priorities and development of corresponding interventions. This approach has contributed to increased access to medicines; affordability of medicines and health services; and community resilience among the target populations. However, barriers involving a local shortage of health human resources and cumbersome eHealth regulations affect program impact. Conclusions This research provides evidence for the scale-up of a multisectoral digital approach to support the implementation of UHC targets in Philippines. Key messages Implementing digital health solutions in low-resource settings is possible. Changes are needed in Philippines health regulations for digital health to properly support UHC implementation.

scholarly journals Tuberculosis: an opportunity to integrate mental health services in primary care in low-resource settings

2018 ◽  
Vol 5 (12) ◽  
pp. 952-954 ◽  
Author(s):  
Annika C Sweetland ◽  
Ernesto Jaramillo ◽  
Milton L Wainberg ◽  
Neerja Chowdhary ◽  
Maria A Oquendo ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Low Resource Settings ◽  
Low Resource

scholarly journals The good and the bad: using C reactive protein to distinguish bacterial from non-bacterial infection among febrile patients in low-resource settings

2020 ◽  
Vol 5 (5) ◽  
pp. e002396 ◽  
Author(s):  
Camille Escadafal ◽  
Sandra Incardona ◽  
B Leticia Fernandez-Carballo ◽  
Sabine Dittrich
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Bacterial Infections ◽  
Laboratory Diagnostics ◽  
Antibiotic Prescribing ◽  
Health Coverage ◽  
C Reactive Protein ◽  
Low Resource Settings ◽  
Low Resource ◽  
Reactive Protein

C reactive protein (CRP), a marker for the presence of an inflammatory process, is the most extensively studied marker for distinguishing bacterial from non-bacterial infections in febrile patients. A point-of-care test for bacterial infections would be of particular use in low-resource settings where other laboratory diagnostics are not always available, antimicrobial resistance rates are high and bacterial infections such as pneumonia are a leading cause of death. This document summarises evidence on CRP testing for bacterial infections in low-income and middle-income countries (LMICs). With a push for universal health coverage and prevention of antimicrobial resistance, it is important to understand if CRP might be able to do the job. The use of CRP polarised the global health community and the aim of this document is to summarise the ‘good and the bad’ of CRP in multiple settings in LMICs. In brief, the literature that was reviewed suggests that CRP testing may be beneficial in low-resource settings to improve rational antibiotic use for febrile patients, but the positive predictive value is insufficient to allow it to be used alone as a single tool. CRP testing may be best used as part of a panel of diagnostic tests and algorithms. Further studies in low-resource settings, particularly with regard to impact on antibiotic prescribing and cost-effectiveness of CRP testing, are warranted.

scholarly journals Improving Information and Communications Technology (ICT) Knowledge and Skills to Develop Health Research Capacity in Kenya

2019 ◽  
Vol 11 (3) ◽  
Author(s):  
Aliza Monroe-Wise ◽  
John Kinuthia ◽  
Sherrilynne Fuller ◽  
Matthew Dunbar ◽  
David Masuda ◽  
...  
Keyword(s):  
Data Management ◽  
Low Income ◽  
Clinical Care ◽  
Research Capacity ◽  
Information And Communications Technology ◽  
Learning Program ◽  
Knowledge And Skills ◽  
Low Resource Settings ◽  
Low Resource ◽  
Ict Tools

ObjectivesInformation and communication technology (ICT) tools are increasingly important for clinical care, research, data management, international collaborations, and dissemination. Many technologies would be particularly useful for healthcare workers in resource-limited settings; however, these individuals are the least likely to utilize ICT tools, in part because they lack knowledge and skills necessary to use them. Our program aimed to train researchers in low-resource settings on using ICT tools.MethodsWe conducted a tiered, blended learning program for researchers in Kenya on three areas of ICT: geographic information systems, data management, and communication tools. Tiers included didactic online courses for 100-300 students for each topic, skills workshops for 30 students, and mentored projects for 10. Concurrently, a training of trainers course comprised of an online course and a skills workshop to ensure sustainable ongoing training.ResultsCourse ratings were high, particularly when participants engaged in hands-on skill building activities. Teaching that incorporated local examples was most valuable. Discussion boards were sometimes distracting, depending on multiple factors. Mentored projects were most useful when there were clear expectations, pre-existing projects or data, and clear timelines.DiscussionTraining in the use of ICT tools is essential to improve their use among researchers in low-income settings. However, very few training courses have been described. Our students demonstrated acquisition of new skills and felt these skills to be valuable in their workplaces.ConclusionsFurther and ongoing training in ICT skills should be considered in other low-resource settings, and could use our program as a foundational model.

scholarly journals International Neurotrauma Training Based on North-South Collaborations: Results of an Inter-institutional Program in the Era of Global Neurosurgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Andrés M. Rubiano ◽  
Dylan P. Griswold ◽  
P. David Adelson ◽  
Raul A. Echeverri ◽  
Ahsan A. Khan ◽  
...  
Keyword(s):  
Medical Students ◽  
Low Income ◽  
Health Research ◽  
Systems Of Care ◽  
Academic Support ◽  
High Income ◽  
Global Health Research ◽  
Fellowship Program ◽  
Low Resource Settings ◽  
Low Resource

Objective: Shortage of general neurosurgery and specialized neurotrauma care in low resource settings is a critical setback in the national surgical plans of low and middle-income countries (LMIC). Neurotrauma fellowship programs typically exist in high-income countries (HIC), where surgeons who fulfill the requirements for positions regularly stay to practice. Due to this issue, neurosurgery residents and medical students from LMICs do not have regular access to this kind of specialized training and knowledge-hubs. The objective of this paper is to present the results of a recently established neurotrauma fellowship program for neurosurgeons of LMICs in the framework of global neurosurgery collaborations, including the involvement of specialized parallel education for neurosurgery residents and medical students.Methods: The Global Neurotrauma Fellowship (GNTF) program was inaugurated in 2015 by a multi-institutional collaboration between a HIC and an LMIC. The course organizers designed it to be a 12-month program based on adapted neurotrauma international competencies with the academic support of the Barrow Neurological Institute at Phoenix Children's Hospital and Meditech Foundation in Colombia. Since 2018, additional support from the UK, National Institute of Health Research (NIHR) Global Health Research in Neurotrauma Project from the University of Cambridge enhanced the infrastructure of the program, adding a research component in global neurosurgery and system science.Results: Eight fellows from Brazil, Venezuela, Cuba, Pakistan, and Colombia have been trained and certified via the fellowship program. The integration of international competencies and exposure to different systems of care in high-income and low-income environments creates a unique environment for training within a global neurosurgery framework. Additionally, 18 residents (Venezuela, Colombia, Ecuador, Peru, Cuba, Germany, Spain, and the USA), and ten medical students (the United Kingdom, USA, Australia, and Colombia) have also participated in elective rotations of neurotrauma and critical care during the time of the fellowship program, as well as in research projects as part of an established global surgery initiative.Conclusion: We have shown that it is possible to establish a neurotrauma fellowship program in an LMIC based on the structure of HIC formal training programs. Adaptation of the international competencies focusing on neurotrauma care in low resource settings and maintaining international mentoring and academic support will allow the participants to return to practice in their home-based countries.

scholarly journals Patient-level predictors of detection of depressive symptoms, referral, and uptake of depression counseling among chronic care patients in KwaZulu-Natal, South Africa

2020 ◽  
Vol 7 ◽  
Author(s):  
Christopher G. Kemp ◽  
Ntokozo Mntambo ◽  
Max Bachmann ◽  
Arvin Bhana ◽  
Deepa Rao ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Depressive Symptoms ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Resource Settings ◽  
Low Resource ◽  
Patient Level ◽  
Kwazulu Natal

Abstract Background Integration of depression treatment into primary care could improve patient outcomes in low-resource settings. Losses along the depression care cascade limit integrated service effectiveness. This study identified patient-level factors that predicted detection of depressive symptoms by nurses, referral for depression treatment, and uptake of counseling, as part of integrated care in KwaZulu-Natal, South Africa. Methods This was an analysis of baseline data from a prospective cohort. Participants were adult patients with at least moderate depressive symptoms at primary care facilities in Amajuba, KwaZulu-Natal, South Africa. Participants were screened for depressive symptoms prior to routine assessment by a nurse. Generalized linear mixed-effects models were used to estimate associations between patient characteristics and service delivery outcomes. Results Data from 412 participants were analyzed. Nurses successfully detected depressive symptoms in 208 [50.5%, 95% confidence interval (CI) 38.9–62.0] participants; of these, they referred 76 (36.5%, 95% CI 20.3–56.5) for depression treatment; of these, 18 (23.7%, 95% CI 10.7–44.6) attended at least one session of depression counseling. Depressive symptom severity, alcohol use severity, and perceived stress were associated with detection. Similar factors did not drive referral or counseling uptake. Conclusions Nurses detected patients with depressive symptoms at rates comparable to primary care providers in high-resource settings, though gaps in referral and uptake persist. Nurses were more likely to detect symptoms among patients in more severe mental distress. Implementation strategies for integrated mental health care in low-resource settings should target improved rates of detection, referral, and uptake.

scholarly journals Medical equipment donation in low-resource settings: a review of the literature and guidelines for surgery and anaesthesia in low-income and middle-income countries

2019 ◽  
Vol 4 (5) ◽  
pp. e001785 ◽  
Author(s):  
Isobel H Marks ◽  
Hannah Thomas ◽  
Marize Bakhet ◽  
Edward Fitzgerald
Keyword(s):  
Low Income ◽  
Medical Equipment ◽  
Grey Literature ◽  
National Guidelines ◽  
Middle Income ◽  
Low Resource Settings ◽  
Low Resource ◽  
User Training ◽  
Biomedical Equipment ◽  
Donation Process

BackgroundMedical equipment donation to low-resource settings is a frequently used strategy to address existing disparities, but there is a paucity of reported experience and evaluation. Challenges such as infrastructure gaps, lack of technological and maintenance capabilities, and non-prioritisation of essential supplies have previously been highlighted. This pragmatic review summarises existing guidelines and literature relevant to surgical and anaesthesia equipment, with recommendations for future initiatives and research.MethodsRetrospective literature review including both academic and grey literature from 1980 to 2018. We conducted a narrative synthesis to identify key factors that were condensed thematically.ResultsThirty-three biomedical equipment donation guidelines were identified from governments, WHO, World Bank, academic colleges and non-governmental organisations, and 36 relevant studies in peer-reviewed literature. These highlighted the need to consider all stages of the donation process, including planning, sourcing, transporting, training, maintaining and evaluating equipment donation. Donors were advised to consult national guidelines to ensure equipment was appropriate, desirable and non-costly to both parties. User training and access to biomechanical engineers were suggested as necessary for long-term sustainability. Finally, equitable partnerships between donors and recipients were integral to reducing inappropriate donations and to improve follow-up and evaluation.ConclusionThere is a paucity of evidence on the causes of success or failure in medical equipment donation, despite its domination of equipment sourcing across many low-resource settings. Equitable partnerships, consultation of policies and guidelines, and careful planning may improve equipment usability and life span. A concerted effort is required to increase awareness of guidelines among health professionals worldwide.

Community-Based Education in Global Low-Resource Settings: A Unique Interprofessional Collaborative Experience in Primary Care Delivery

2019 ◽  
Vol 6 (1) ◽  
pp. 56-62
Author(s):  
Mabel Ezeonwu
Keyword(s):  
Primary Care ◽  
Health Education ◽  
Global Health ◽  
Care Delivery ◽  
Collaborative Practice ◽  
Community Based ◽  
Community Based Education ◽  
Low Resource Settings ◽  
Low Resource ◽  
Global Health Education

The complex nature of global health issues requires multidisciplinary efforts, namely, interprofessional education (IPE) and collaborative practice. For American students to develop skills and competencies that contribute to global primary care workforces, they must receive community-based education in various environments around the world. This article presents a global health education program that offers community-based, health-related IPE that is centered on primary care, collaborative practice, and a unique three-way partnership. Using a “classroom in the field” hybrid model, this program placed graduate and undergraduate students from different majors into experienced multidisciplinary health care teams and gave them hands-on, firsthand public health experiences in eight low-resource settings in Guatemala. The curricular design was informed by the Consortium of Universities for Global Health’s global health education competencies. At the completion of the program, all partners, participants, and local communities involved saw significant positive outcomes. Notably, students were able to articulate the essentials of primary care in a global context and demonstrate knowledge and skills in global health competencies. Such community-based approaches promote student understanding of disease prevention and health promotion as key elements of primary care that could improve health outcomes for underserved global populations.

Diagnosis of acute tonsillopharyngitis in primary care: a new approach for low-resource settings

2013 ◽  
Vol 25 (3) ◽  
pp. 148-155 ◽  
Author(s):  
Zuleyha Alper ◽  
Yesim Uncu ◽  
Halis Akalin ◽  
Ilker Ercan ◽  
Melda Sinirtas ◽  
...  
Keyword(s):  
Primary Care ◽  
New Approach ◽  
Low Resource Settings ◽  
Low Resource
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