scholarly journals Team-based primary health care for non-communicable diseases: complexities in South India

2020 ◽  
Vol 35 (Supplement_2) ◽  
pp. ii22-ii34 ◽  
Author(s):  
Dorothy Lall ◽  
Nora Engel ◽  
Narayanan Devadasan ◽  
Klasien Horstman ◽  
Bart Criel
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Chronic Care ◽  
South India ◽  
Health Workers ◽  
Communicable Diseases ◽  
Non Communicable Diseases ◽  
Primary Care Clinics ◽  
Primary Health ◽  
Team Based Care

Abstract Chronic non-communicable diseases (NCDs), such as diabetes and cardiovascular diseases, have reached epidemic proportions worldwide. Health systems, especially those in low- and middle-income countries, such as India, struggle to deliver quality chronic care. A reorganization of healthcare service delivery is needed to strengthen care for chronic conditions. In this study, we evaluated the implementation of a package of tailored interventions to reorganize care, which were identified following a detailed analysis of gaps in delivering quality NCD care at the primary care level in India. Interventions included a redesign of the workflow at primary care clinics, a redistribution of tasks, the introduction of patient information records and the involvement of community health workers in the follow-up of patients with NCDs. An experimental case study design was chosen to study the implementation of the quality improvement measures. Three public primary care facilities in rural South India were selected. Qualitative methods were used to gain an in-depth understanding of the implementation process and outcomes of implementation. Observations, field notes and semi-structured interviews with staff at these facilities (n = 15) were thematically analysed to identify contextual factors that influenced implementation. Only one of the primary health centres implemented all components of the intervention by the end of 9 months. The main barriers to implementation were hierarchical arrangements that inhibited team-based care, the amount of time required for counselling and staff transfers. Team cohesion, additional staff and staff motivation seem to have facilitated implementation. This quality improvement research highlights the importance of building relational leadership to enable team-based care at primary care clinics in India. Redesigned organization of care and task redistribution is important solutions to deliver quality chronic care. However, implementing these will require capacity building of local primary care teams.

scholarly journals Quality of care for patients with non-communicable diseases in the Dedza District, Malawi

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Rachel Wood ◽  
Vanessa Viljoen ◽  
Lisa Van Der Merwe ◽  
Robert Mash
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Health Workers ◽  
Quality Care ◽  
Communicable Diseases ◽  
Primary Health Care System ◽  
Fee For Service ◽  
Non Communicable Diseases ◽  
Significant Burden

Introduction: In Malawi, non-communicable diseases (NCDs) are thought to cause 28% of deaths in adults. The aim of this study was to establish the extent of primary care morbidity related to NCDs, as well as to audit the quality of care, in the primary care setting of Dedza District, central Malawi.Methods: This study was a baseline audit using clinic registers and a questionnaire survey of senior health workers at 5 clinics, focusing on care for hypertension, diabetes, asthma and epilepsy.Results: A total of 82 581 consultations were recorded, of which 2489 (3.0%) were for the selected NCDs. Only 5 out of 32 structural criteria were met at all 5 clinics and 9 out of 29process criteria were never performed at any clinic. The only process criteria performed at all five clinics was measurement of blood pressure. The staff’s knowledge on NCDs was basic and the main barriers to providing quality care were lack of medication and essential equipment, inadequate knowledge and guidelines, fee-for-service at two clinics, geographic inaccessibility and lack of confidence in the primary health care system by patients.Conclusion: Primary care morbidity from NCDs is currently low, although other studies suggest a significant burden of disease. This most likely represents a lack of utilisation, recognition, diagnosis and ability to manage patients with NCDs. Quality of care is poor due to a lack of essential resources, guidelines, and training.

scholarly journals Integrated management of non-communicable diseases in low-income settings: palliative care, primary care and community health synergies

2018 ◽  
pp. bmjspcare-2018-001579 ◽  
Author(s):  
Daniel Munday ◽  
Vandana Kanth ◽  
Shadrach Khristi ◽  
Liz Grant
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Community Health ◽  
Low Income ◽  
Integrated Management ◽  
Premature Mortality ◽  
Communicable Diseases ◽  
Health Coverage ◽  
Non Communicable Diseases ◽  
Care Community

Palliative care is recognised as a fundamental component of Universal Health Coverage (UHC), which individual countries, led by the United Nations and the WHO, are committed to achieving worldwide by 2030—Sustainable Development Goal (SDG) 3.8. As the incidence of non-communicable diseases (NCD) in low-income and middle-income countries (LMICs) increases, their prevention and control are the central aspects of UHC in these areas. While the main focus is on reducing premature mortality from NCDs (SDG 3.4), palliative care is becoming increasingly important in LMICs, in which 80% of the need is found. This paper discusses the challenges of providing comprehensive NCD management in LMICs, the role of palliative care in addressing the huge and growing burden of serious health-related suffering, and also its scope for leveraging various aspects of primary care NCD management. Drawing on experiences in India and Nepal, and particularly a project on the India–Nepal border in which palliative care, community health and primary care-led NCD management are being integrated, we explore the synergies arising and describe a model where palliative care is integral to the whole spectrum of NCD management, from promotion and prevention, through treatment, rehabilitation and palliation. We believe this model could provide a framework for integrated NCD management more generally in rural India and Nepal and also other LMICs as they work to make NCD management as part of UHC a reality.

scholarly journals Partnership in Practice: a multidisciplinary approach to quality improvement in primary health care

1995 ◽  
Vol 19 (6) ◽  
pp. 371-371
Author(s):  
Michael Phelan
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Primary Health Care ◽  
General Practitioners ◽  
Multidisciplinary Approach ◽  
Professional Groups ◽  
Primary Health ◽  
Audit Team

This one day seminar was arranged by the King's Fund Organisational Audit team (KFOA), to take a multidisciplinary view of quality improvement in primary care. Despite the title of the day all the speakers were general practitioners and managers, and input from other professional groups was limited to questions and comments from the audience of nearly 200.

scholarly journals Strengthening management of non-communicable diseases in primary care, Malawi: A short report

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Amos Mailosi ◽  
Christina Miller ◽  
Catherine Hodge ◽  
Serah Msimuko
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Team Building ◽  
Health Centre ◽  
Communicable Diseases ◽  
Short Report ◽  
Medicine Department ◽  
Non Communicable Diseases ◽  
The Relationship ◽  
Initial Focus

Within the community-orientated primary care module for training family physicians at the Kamuzu University of Health Sciences in Malawi, a relationship was formed between Nkhoma Mission Hospital’s Family Medicine Department and the Diamphwe Community Health Centre (HC) to strengthen the continuity of healthcare and capacity team building. The initial focus was on improving the management of hypertension and diabetes in terms of diagnosis, tracking of the patients in a registry and timely referral to secondary care facilities The relationship has received positive support from Diamphwe healthcare workers, which then improved the management of non-communicable diseases and patient care at Diamphwe. It has also shown how family medicine physicians can improve HC capacity through support and mentorship.

scholarly journals Edukasi dan Pemeriksaan Darah dalam Rangka Pencegahan Penyakit Tidak Menular

2020 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Margareta Haiti ◽  
Novita Anggraini ◽  
Victoria Ire Tominik
Keyword(s):  
Public Health ◽  
Regular Education ◽  
Health Workers ◽  
Communicable Diseases ◽  
The Body ◽  
Community Leaders ◽  
Non Communicable Diseases ◽  
Blood Tests ◽  
Community Awareness ◽  
Health Checks

Non-communicable diseases (PTM) are a group of chronic diseases, not contagious and can attack all organs of the body, so PTM has a large impact both in terms of morbidity and mortality on public health. Based on information from community leaders from the Sukarami Village, many people experience hypertension, diabetes, rheumatism or pain in the joints so that people are very much expecting help from health workers to provide counseling and health checks in order to prevent disease or attempt to find the cause of the disease. Residents who attended the PKM activities amounted to 138 people. The results of glucose level examination obtained a normal category of 111 people, Prediabetes category as many as 21 people and diabetes category as many as 6 people while the examination of uric acid levels obtained normal results as many as 101 people, abnormal category as many as 36 people and not examined as many as 1 person but the results the measurement of people's blood pressure that came showed 67 (48.6%) more than normal meaning that quite a lot of people tended to suffer from hypertension. It was concluded that community awareness of the importance of checking blood sugar and gout, especially for those aged> 40 years, still needs to be improved through regular education and blood tests to prevent (preventive efforts), especially non-communicable diseases.

Sign in / Sign up

Export Citation Format

Share Document