scholarly journals How context affects implementation of the Primary Health Care approach: an analysis of what happened to primary health centres in India

2019 ◽  
Vol 3 (Suppl 3) ◽  
pp. e001381 ◽  
Author(s):  
Sudha Ramani ◽  
Muthusamy Sivakami ◽  
Lucy Gilson
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Historical Review ◽  
Contextual Influences ◽  
Private Practitioners ◽  
Patient Interviews ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres ◽  
Care Approach

IntroductionIn this paper, we elucidate challenges posed by contexts to the implementation of the Primary Health Care (PHC) approach, using the example of primary health centres (rural peripheral health units) in India. We first present a historical review of ‘written’ policies in India—to understand macro contextual influences on primary health centres. Then we highlight micro level issues at primary health centres using a contemporary case study.MethodsTo elucidate macro level factors, we reviewed seminal policy documents in India and some supporting literature. To examine the micro context, we worked with empirical qualitative data from a rural district in Maharashtra—collected through 12 community focus group discussions, 12 patient interviews and 34 interviews with health system staff. We interpret these findings using a combination of top–down and bottom–up lenses of the policy process.ResultsPrimary health centres were originally envisaged as ‘social models’ of service delivery; front-line institutions that delivered integrated care close to people’s homes. However, macro issues of chronic underfunding and verticalisation have resulted in health centres with poor infrastructure, that mainly deliver vertical programmes. At micro levels, service provision at primary health centres is affected by doctors’ disinterest in primary care roles and an institutional context that promotes risk-averseness and disregard of outpatient care. Primary health centres do not meet community expectations in terms of services, drugs and attention provided; and hence, private practitioners are preferred. Thus, primary health centres today, despite having the structure of a primary-level care unit, no longer embody PHC ideals.ConclusionsThis paper highlights some contextual complexities of implementing PHC—considering macro (pertaining to ideologies and fiscal priorities) and micro (pertaining to everyday behaviours and practices of actors) level issues. As we recommit to Alma-Ata, we must be cautious of the ceremonial adoption of interventions, that look like PHC—but cannot deliver on its ideals.

scholarly journals Quality of Health Assistants in primary Health centres in Rural Maharashtra, India

2013 ◽  
Vol 6 ◽  
pp. HSI.S11226
Author(s):  
Enakshi Ganguly ◽  
Bishan S. Garg
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Primary Health Care System ◽  
Job Descriptions ◽  
Continuous Training ◽  
Primary Health ◽  
Primary Health Centres ◽  
Quality Assurance Mechanism ◽  
Health Centres

Introduction Health assistants are important functionaries of the primary health care system in India. Their role is supervision of field-based services among other things. A quality assurance mechanism for these health assistants is lacking. The present study was undertaken with the objectives of developing a tool to assess the quality of health assistants in primary health centres (PHCs) and to assess their quality using this tool. Methodology Health assistants from three PHCs in the Wardha district of India were observed for a year using a tool developed from primary health care management Aavancement program modules. Data was collected by direct observation, interview, and review of records for quality of activities. Results Staff strength of health assistants was 87.5%. None of the health assistants were clear about their job descriptions. A supervisory schedule for providing supportive supervision to auxiliary nurse midwives (ANMs) was absent; most field activities pertaining to maternal and child health received poor focus. Monthly meetings lacked a clear agenda, and comments on quality improvement of services provided by the ANMs were missing. Conclusion Continuous training with sensitization on quality issues is required to improve the unsatisfactory quality.

scholarly journals Availability of personnel, facilities and services in Primary Health Care Centres in a Local Government Area in Benin City, Nigeria

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Vincent Yakubu Adam ◽  
Joy Chinyere Nwaogwugwu
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Local Government ◽  
Healthcare Services ◽  
Local Government Area ◽  
Benin City ◽  
Essential Drugs ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres

Background: Effective delivery of healthcare services especially at the Primary Health Care level requires availability of adequate infrastructure, basic diagnostic medical equipment, drugs and well-trained medical personnel. Quality Primary Health Care initiatives have been recognized as fundamental to improving health outcomes. This study assessed the resources available for Primary Health Care delivery in a Local Government Area in Benin City, Nigeria. Materials and Methods: This was a descriptive cross-sectional study. All the public primary health centres in Egor LGA, Benin City, Nigeria were assessed for availability of personnel, facilities/ equipment and services using an adapted observational checklist. Results: All the 10 public primary health centres were assessed. The primary health centres had inadequate skilled-manpower: only 1 (10.0%) had a medical officer, Community Health Officers and nurse/midwives were adequate in only 2 (20.0%), and none of them (0.0%) had a medical record officer and pharmacy technician. Basic equipment for examination of clients were available in 3 of the health facilities (30.0%). All 10 of the health centres (100.0%) offered basic services but not for 24 hours. Essential drugs were not regularly available in all the facilities. Conclusions: Basic healthcare services were rendered but not for 24 hours. Several challenges such as inadequate skilled health personnel, lack of basic amenities, and shortage of essential drugs affect the primary health centres. Basic hospital facilities/equipment needed to enhance 24 hours’ service delivery at the primary health centres should be provided by the Local Government.

scholarly journals Quality of Service of Primary Health Centres: Insights from a Field Study

2004 ◽  
Vol 29 (3) ◽  
pp. 71-82 ◽  
Author(s):  
P Rameshan ◽  
Shailendra Singh
Keyword(s):  
Health Care ◽  
Quality Of Service ◽  
Primary Health Care ◽  
Local Government ◽  
Health Care Facilities ◽  
Community Members ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres

This paper provides an evaluation of the quality of services and customer orientation of Primary Health Centres (PHCs) against the backdrop of the changed environment in the country with customer focus and efficiency emerging as the cornerstones of economic transactions in private and public sectors alike. It focuses on ten selected PHCs of Uttar Pradesh and covers the following stakeholders: Customers including patients who use the health care facilities of PHCs as well as the relatives and their personal attendants. Community members covering the village public, local shopkeepers, local government functionaries, local intelligentsia such as teachers and others having an interest or stake in PHC activities. Doctors and staff of the PHCs. District Medical Officials responsible for controlling and monitoring the PHC activities. The paper draws, among others, the following conclusions: The customers and community members of the villages perceived the facilities and services of PHCs to be deficient in many respects. Neither doctors and PHC staff nor the district officials are able to refute adequately the issues raised by villagers about the quality of service of PHCs. While villagers do not like the panchayat (local government) coming into the picture for improving the services of PHCs, district officials totally discount privatization as a means for providing effective primary health care in rural areas. While it is not very easy to solve the primary health care problems of the Indian villagers, yet the policy-makers can take recourse to the following measures to improve the facilities and services of PHCs in future: Form village committees to monitor PHC facilities, resources, and services. Identify industry patrons/sponsors for each PHC for developing infrastructure, facilities, and logistics without straining the scarce government resources. Constitute district-level user committees to monitor not only the PHC activities of a district but also the activities of the District Medical Offices. Enable panchayat and district administration to perform monitoring and supporting functions to ensure multiple checks on activities of the PHCs and District Medical Offices.

scholarly journals Setting the scene for an ARI control programme: is it worthwhile in Saudi Arabia?

1999 ◽  
Vol 5 (1) ◽  
pp. 111-117
Author(s):  
T. A. Khoja ◽  
K. K. Al Mohammad ◽  
K. M. Aziz
Keyword(s):  
Health Care ◽  
Saudi Arabia ◽  
Primary Health Care ◽  
Respiratory Infections ◽  
Diagnostic Procedures ◽  
Control Programme ◽  
Acute Respiratory Infections ◽  
Survey Questionnaire ◽  
Primary Health ◽  
Health Centres

Baseline data on acute respiratory infections [ARI] were collected by a survey questionnaire distributed to physicians of 10% of the health centres randomly selected from each of the five provinces of Saudi Arabia. The physicians estimated that ARI was the cause of sickness in 50% of ill children < 5 years in 1995. None of the physicians had had any training in ARI and they were not aware of any national protocol or programme. Physicians’ responses indicated an over-use of antibiotics and diagnostic procedures. A national protocol for diagnosis and treatment of ARI has been prepared and distributed and leaders of primary health care and 55 national trainers have been trained

Community Participation in the National Development Plan Through Primary Health Care

2019 ◽  
pp. 160-178
Author(s):  
Johannes Ntshilagane Mampane
Keyword(s):  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
Community Participation ◽  
National Development ◽  
Development Plan ◽  
National Development Plan ◽  
Primary Health ◽  
Lgbt Community ◽  
Care Approach

The chapter explores and describes community participation in the National Development Plan through Primary Health Care by using case studies of LGBT organizations in South Africa. Post-Apartheid and democratic South Africa has endorsed community participation as one of the fundamental pillars of the public Primary Health Care approach in its governance structures. This chapter focuses on the current major health issue in South Africa, the HIV epidemic, which is one of the leading causes of death in the country. Particular attention is paid to members of the LGBT community because of their discrimination in public healthcare facilities on grounds of their sexual orientation. The chapter relies on secondary sources of data collection from extant literature, textbooks, journal articles, and internet sources. Challenges to address LGBT community discrimination in HIV testing, prevention, treatment, care, and support were identified and solutions to uphold their human rights were proffered. These solutions are based on the principles of social justice, inclusion, diversity, and equality.

Community Participation in the National Development Plan Through Primary Health Care

2022 ◽  
pp. 657-671
Author(s):  
Johannes Ntshilagane Mampane
Keyword(s):  
South Africa ◽  
Health Care ◽  
Primary Health Care ◽  
Community Participation ◽  
National Development ◽  
Development Plan ◽  
National Development Plan ◽  
Primary Health ◽  
Lgbt Community ◽  
Care Approach

The chapter explores and describes community participation in the National Development Plan through Primary Health Care by using case studies of LGBT organizations in South Africa. Post-Apartheid and democratic South Africa has endorsed community participation as one of the fundamental pillars of the public Primary Health Care approach in its governance structures. This chapter focuses on the current major health issue in South Africa, the HIV epidemic, which is one of the leading causes of death in the country. Particular attention is paid to members of the LGBT community because of their discrimination in public healthcare facilities on grounds of their sexual orientation. The chapter relies on secondary sources of data collection from extant literature, textbooks, journal articles, and internet sources. Challenges to address LGBT community discrimination in HIV testing, prevention, treatment, care, and support were identified and solutions to uphold their human rights were proffered. These solutions are based on the principles of social justice, inclusion, diversity, and equality.

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