scholarly journals How ready is the system to deliver primary healthcare? Results of a primary health facility assessment in Enugu State, Nigeria

2020 ◽  
Vol 35 (Supplement_1) ◽  
pp. i97-i106
Author(s):  
Adanma Ekenna ◽  
Ijeoma Uchenna Itanyi ◽  
Ugochukwu Nwokoro ◽  
Lisa R Hirschhorn ◽  
Benjamin Uzochukwu
Keyword(s):  
Service Delivery ◽  
Urban Health ◽  
Primary Healthcare ◽  
Communicable Disease ◽  
Service Availability ◽  
Facility Assessment ◽  
Primary Health ◽  
Health Centres ◽  
Service Readiness ◽  
Enugu State

Abstract Primary health centres are an effective means of achieving access to primary healthcare (PHC) in low- and middle-income countries. We assessed service availability, service readiness and factors influencing service delivery at public PHC centres in Enugu State, Nigeria. We conducted a cross-sectional study of 60 randomly selected public health centres in Enugu using the World Health Organization’s Service Availability and Readiness Assessment (SARA) survey. The most senior health worker available was interviewed using the SARA questionnaire, and an observational checklist was used for the facility assessment. None of the PHC centres surveyed had all the recommended service domains, but 52 (87%) offered at least half of the recommended service domains. Newborn care and immunization (98.3%) were the most available services across facilities, while mental health was the least available service (36.7%). None of the surveyed facilities had a functional ambulance or access to a computer on the day of the assessment. The specific-service readiness score was lowest in the non-communicable disease (NCD) area (33% in the rural health centres and 29% in the urban health centres) and NCD medicines and supplies. Availability of medicine and supplies was also low in rural PHC centres for the communicable disease area (36%) and maternal health services (38%). Basic equipment was significantly more available in urban health centres (P = 0.02). Urban location of facilities and the presence of a medical officer were found to be associated with having at least 50% of the recommended infrastructure / basic amenities and equipment. Continuing medical education, funding and security were identified by the health workers as key enablers of service delivery. In conclusion, despite a focus on expanding primary care in Enugu State, significant gaps exist that need to be closed for PHC to make significant contributions towards achieving universal healthcare, core to achieving the health-related Sustainable Development Goal agenda.

scholarly journals Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria

2021 ◽  
Vol 6 (8) ◽  
pp. e006069
Author(s):  
Hamish R Graham ◽  
Omotayo E Olojede ◽  
Ayobami A Bakare ◽  
Agnese Iuliano ◽  
Oyaniyi Olatunde ◽  
...  
Keyword(s):  
Health Facility ◽  
Point Of Care ◽  
Assessment Tools ◽  
Operating Theatre ◽  
Facility Assessment ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres ◽  
The Cost

The COVID-19 pandemic has highlighted global oxygen system deficiencies and revealed gaps in how we understand and measure ‘oxygen access’. We present a case study on oxygen access from 58 health facilities in Lagos state, Nigeria. We found large differences in oxygen access between facilities (primary vs secondary, government vs private) and describe three key domains to consider when measuring oxygen access: availability, cost, use. Of 58 facilities surveyed, 8 (14%) of facilities had a functional pulse oximeter. Oximeters (N=27) were typically located in outpatient clinics (12/27, 44%), paediatric ward (6/27, 22%) or operating theatre (4/27, 15%). 34/58 (59%) facilities had a functional source of oxygen available on the day of inspection, of which 31 (91%) facilities had it available in a single ward area, typically the operating theatre or maternity ward. Oxygen services were free to patients at primary health centres, when available, but expensive in hospitals and private facilities, with the median cost for 2 days oxygen 13 000 (US$36) and 27 500 (US$77) Naira, respectively. We obtained limited data on the cost of oxygen services to facilities. Pulse oximetry use was low in secondary care facilities (32%, 21/65 patients had SpO2 documented) and negligible in private facilities (2%, 3/177) and primary health centres (<1%, 2/608). We were unable to determine the proportion of hypoxaemic patients who received oxygen therapy with available data. However, triangulation of existing data suggested that no facilities were equipped to meet minimum oxygen demands. We highlight the importance of a multifaceted approach to measuring oxygen access that assesses access at the point-of-care and ideally at the patient-level. We propose standard metrics to report oxygen access and describe how these can be integrated into routine health information systems and existing health facility assessment tools.

Assessment of Clinical Solid Waste Management in Selected Primary Healthcare Centres in Lagos Metropolis

2019 ◽  
Vol 45 (3) ◽  
pp. 349-354
Author(s):  
James O. Akanmu ◽  
Oladayo T. Ogunyomi
Keyword(s):  
Waste Management ◽  
Solid Waste ◽  
Primary Healthcare ◽  
Solid Waste Management ◽  
Generation Rate ◽  
Disposal Site ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres

This paper investigates clinical waste management in five selected primary health centres in Lagos Metropolis, Nigeria. The research used quantitative and qualitative techniques to evaluate data on clinical waste sources, types, rate of generation, collection and transportation and disposal at the health centres. The average generation rate of clinical waste generated was found to be 6.7kg/day, 20.3kg/day and 56.4kg/day at Adeniyi Jones, Ajuwon and Aregbesola primary health centres respectively while average daily waste generated per patient were found to be 0.11kg/patient/day, 0.20kg/patient/day, 0.26kg/patient/day, 0.45kg/patient/day and 0.69kg/patient/day at Ikeja Phc, Adeniyi Jones Phc, Ajuwon Phc, Ikosi-Ketu Phc and Aregbesola Phc respectively. Segregations of waste at generation source were properly done however, sometimes; they were haphazardly thrown into a common dustbin at the point of transporting to the disposal site. The paper concludes that the collection and transportation of the wastes are fairly effective and required improvement through training of the personnel and regular collection of wastes generated to avoid infections and outbreak of epidemics.

Staff perceptions of primary healthcare service change: influences on staff satisfaction

2014 ◽  
Vol 38 (5) ◽  
pp. 580 ◽  
Author(s):  
Rachel Tham ◽  
Penny Buykx ◽  
Leigh Kinsman ◽  
Bernadette Ward ◽  
John S. Humphreys ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Service Delivery ◽  
Health Outcomes ◽  
Population Health ◽  
Primary Healthcare ◽  
Visionary Leadership ◽  
Staff Satisfaction ◽  
Primary Health ◽  
Service Change

Strong primary healthcare (PHC) services are efficient, cost-effective and associated with better population health outcomes. However, little is known about the role and perspectives of PHC staff in creating a sustainable service. Staff from a single-point-of-entry primary health care service in Elmore, a small rural community in north-west Victoria, were surveyed. Qualitative methods were used to collect data to show how the key factors associated with the evolution of a once-struggling medical service into a successful and sustainable PHC service have influenced staff satisfaction. The success of the service was linked to visionary leadership, teamwork and community involvement while service sustainability was described in terms of inter-professional linkages and the role of the service in contributing to the broader community. These factors were reported to have a positive impact on staff satisfaction. The contribution of service delivery change and ongoing service sustainability to staff satisfaction in this rural setting has implications for planning service change in other primary health care settings. What is known about this topic? Integrated PHC services have an important role to play in achieving equitable population health outcomes. Many rural communities struggle to maintain viable PHC services. Innovative PHC models are needed to ensure equitable access to care and reduce the health differential between rural and metropolitan people. What does this paper add? Multidisciplinary teams, visionary leadership, strong community engagement combined with service partnerships are important factors in the building of a rural PHC service that substantially contributes to enhanced staff satisfaction and service sustainability. What are the implications for practitioners? Understanding and engaging local community members is a key driver in the success of service delivery changes in rural PHC services.

scholarly journals Exploring Communication Processes in Referral Pathways for Chronic Disease Management: Malaysian Public Primary Health care Experiences

2020 ◽  
Vol 12 (13) ◽  
pp. 115
Author(s):  
Zalilah Abdullah ◽  
Low Lee Lan ◽  
Iqbal Ab Rahim ◽  
Syafinas Azam ◽  
Mohammad Zabri Johari ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Primary Healthcare ◽  
Information Transfer ◽  
Communicable Disease ◽  
Healthcare Providers ◽  
Advanced Technology ◽  
Communication Process ◽  
Healthcare Facilities ◽  
Primary Health

BACKGROUND: Referrals are a two-way communication between healthcare facilities to enable information transfer for the continuity of patient care. The Enhanced Primary Healthcare (EnPHC) initiative, a complex intervention package to improve non-communicable disease (NCD) management, introduced improvements to the NCD&rsquo;s referral mechanism from primary healthcare clinics to the hospital. This study explores the communication process between the Malaysian public primary healthcare and hospital for chronic care management.&nbsp; METHOD: A qualitative exploratory study using purposive sampling was done in all twenty EnPHC intervention clinics. In-depth interviews and focus group discussions were carried out among all healthcare providers working in EnPHC clinics. The 47 interview sessions were audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS: A total of 97 healthcare providers participated. Three main themes of the communication process between the primary health care and hospital during the implementation of EnPHC intervention emerged from the analysis. These are; (1) structured information relay, (2) no show appointment tracking via various communication devices has strengthened the mechanism to monitor the referred patient appointment scheduling and their adherence to the appointment, and (3) inter-facility networking facilitated the implementation of EnPHC&rsquo;s referral mechanism. CONCLUSION: The EnPHC referral mechanism created a platform for PHC clinics and hospitals to communicate and build rapport to help ensure care continuity for NCD patients. The traditional method of communication between healthcare facilities should change and instead start using the newest or most current, advanced technology.

scholarly journals Process evaluation of enhancing primary health care for non-communicable disease management in Malaysia: Uncovering the fidelity & feasibility elements

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245125
Author(s):  
Lee Lan Low ◽  
Fathullah Iqbal A. B. Rahim ◽  
Nur Aqlili Riana Hamzah ◽  
Mohd Safiee Ismail
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Service Delivery ◽  
Human Resource ◽  
Communicable Disease ◽  
Evaluation Research ◽  
Good Clinical Practice ◽  
Evaluation Study ◽  
Physical Structure ◽  
Primary Health

Background In combating the increasing trend of non-communicable diseases (NCDs) over the last two decades in the country, the Ministry of Health Malaysia developed the Enhanced Primary Health Care (EnPHC) initiative to improve care management across different levels of the public service delivery network. An evaluation research component was embedded to explore the implementation issues in terms of fidelity, feasibility, adaptation and benefit of the initiative’s components which were triage, care coordination, screening, risk management and referral system. Methods A mixed methods study was conducted at 20 participating EnPHC clinics in Johor and Selangor, two months after the intervention was initiated. Data collected from self-reported forms and a structured observation checklist were descriptively analysed. In-depth interviews were also conducted with 20 participants across the clinics selected to clarify any information gaps observed in each clinic, and data were thematically analysed. Results Evaluation showed that all components of EnPHC intervention had been successfully implemented except for the primary triage counter and visit checklist. The challenges were mainly discovered in terms of human resource and physical structure. Although human resource was a common implementation challenge across all interventions, clinic-specific issues could still be identified. Among the adaptive measures taken were task sharing among staff and workflow modification to match the clinic’s capacity. Despite the challenges, early benefits of implementation were highlighted especially in terms of service outcomes. Conclusions The evaluation study disclosed issues of human resource and physical infrastructure when a supplementary intervention is implemented. To successfully achieve a scaled-up PHC service delivery model based on comprehensive management of NCDs patient-centred care, the adaptive measures in local clinic context highlight the importance of collaboration between good organisational process and good clinical practice and process.

scholarly journals A Study on Service Availability and Readiness Assessment of Non-Communicable Diseases Using the WHO Tool for Gazipur District in Bangladesh

2016 ◽  
Vol 7 (2) ◽  
pp. 1-13 ◽  
Author(s):  
Mohammad Rashemdul Islam ◽  
Shamima Parvin Laskar ◽  
Darryl Macer
Keyword(s):  
Respiratory Disease ◽  
Chronic Respiratory Disease ◽  
Communicable Diseases ◽  
Health Facilities ◽  
Essential Medicines ◽  
Service Availability ◽  
Diabetes Diagnosis ◽  
Cross Sectional ◽  
Non Communicable Diseases ◽  
Service Readiness

Non-communicable diseases (NCDs) disproportionately affect low and middle-income countries where nearly three quarters of NCD deaths occur. Bangladesh is also in NCD burden. This cross-sectional study was done on 50 health facilities centres at Gazipur district in Bangladesh from July 2015 to December 2015 to introduce SARA for better monitoring and evaluation of non-communicable diseases health service delivery. The General Service readiness index score was 61.52% refers to the fact that about 62% of all the facilities were ready to provide general services like basic amenities, basic equipment, standard precautions for infection prevention, and diagnostic capacity and essential medicines to the patients. But in case of non-communicable diseases, among all the health facilities 40% had chronic respiratory disease and cardiovascular diseases diagnosis/ management and only 32% had availability of diabetes diagnosis/management. Overall readiness score was 52% in chronic respiratory disease, 73% in cardiovascular disease and 70% in diabetes. Therefore, service availability and readiness of the health facilities to provide NCD related health services were not up to the mark for facing future targets.  A full-scale census survey of all the facilities of the study area would give a better understanding of the availability and service readiness.

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