Repackaging Primary Healthcare in Odisha: Can ‘Task Shifting’ to AYUSH Doctors Address Human Resources Deficit?

2021 ◽  
pp. 097206342110351
Author(s):  
Shridhar Kadam ◽  
Bhuputra Panda ◽  
Srinivas Nallala ◽  
Sanghamitra Pati ◽  
Mohammed Akhtar Hussain ◽  
...  
Keyword(s):  
Public Health ◽  
Human Resources ◽  
Health System ◽  
National Health ◽  
Primary Healthcare ◽  
Task Shifting ◽  
Key Informants ◽  
The Public ◽  
Public Health Programmes ◽  
Health Programmes

Provision of primary healthcare in India received thrust of National Health Policy 2017. Vacancy, chronic absenteeism and non-availability of allopathic doctors is a chronic problem of the public health system. Engagement of alternative human resources could get the ailing health system rid of this shortage. AYUSH doctors in Odisha are involved in clinical and public health activities since 1970s. This study aims to examine perspectives of key stakeholders on ‘task shifting’ as a possible policy alternative. We reviewed the policies and guidelines of government of Odisha on human resources deployment, recruitment, retention and terms of reference of their engagement in the public health sector. Further, 76 AYUSH doctors and 30 key informants were interviewed. Ethical clearance was obtained beforehand. Most AYUSH doctors were involved in monitoring and supervising community-based public health programmes and village-level health service providers, respectively. Their involvement in the implementation of national health programmes was found to range from 8% to 62%. A sizeable proportion of AYUSH doctors had not been trained on management of national vector borne disease control, Tuberculosis control, immunisation (RI) and disease surveillance. More than 70% of respondents showed interest in implementing and managing public health programmes. Almost all key informants recommended for improved involvement of AYUSH doctors in public health activities. Inadequate logistics support, insufficient training on public health and unequal administrative authorities was perceived to be systemic bottlenecks. Job enrichment, management capacity development, and pre-deployment orientation of AYUSH doctors may precede the opportunity of ‘task-shifting’ of public health functions.

scholarly journals One size doesn’t fit all: Tailoring adult antiretroviral treatment

2014 ◽  
Vol 15 (3) ◽  
pp. 77-78 ◽  
Author(s):  
Nathan Geffen ◽  
M Robinson ◽  
F Venter ◽  
M Low
Keyword(s):  
Public Health ◽  
Side Effects ◽  
Health System ◽  
Antiretroviral Treatment ◽  
Public Health System ◽  
Flexible Approach ◽  
The Public ◽  
Public Health Programmes ◽  
Health Programmes

Advances in antiretroviral treatment mean that patients in the public health system can be given more options in the management of their treatment. Although public health programmes tend to offer one-size-fits-all approaches, patients might benefit from a more flexible approach. In particular, we propose that people with HIV should be given more choice with regard to when to start treatment, and patients who experience efavirenz side-effects should be encouraged to switch to other medications, which will be facilitated by faster registration and lower prices of newer antiretrovirals. 

A Systematic Approach towards the Typology of Functions of National Health System

2016 ◽  
pp. 179-212
Author(s):  
Mostafa Zamanian ◽  
Zohreh Karimmian
Keyword(s):  
Public Health ◽  
Health System ◽  
National Health ◽  
Policy Making ◽  
National Health System ◽  
National Development ◽  
Comprehensive Model ◽  
The Public ◽  
Functional Aspects ◽  
National Systems

As one of the main national systems in any country, the health system has always been considered by governments. What distinguishes health system from other systems is that its purpose is directly related to the public health. Different countries adopt different structural patterns in this field but one can consider relatively common functions for a national health system which includes all functional aspects for this system. In recent years, attempts have been made for offering a comprehensive model in describing the functions. The OECD determined principles needed to offer an appropriate typology that should be independent of the names of health programs in different countries. In this chapter, it's tried to provide an overview of the proposed models for structures and functions of the health system and to propose a comprehensive model for it with an emphasis on theoretical aspects of public policy-making and binding functions in any national development system. This comprehensive model, provides the possibility to evaluate the success of a health system.

A Systematic Approach towards the Typology of Functions of National Health System

2016 ◽  
pp. 1228-1256
Author(s):  
Mostafa Zamanian ◽  
Zohreh Karimmian
Keyword(s):  
Public Health ◽  
Health System ◽  
National Health ◽  
Policy Making ◽  
National Health System ◽  
National Development ◽  
Comprehensive Model ◽  
The Public ◽  
Functional Aspects ◽  
National Systems

As one of the main national systems in any country, the health system has always been considered by governments. What distinguishes health system from other systems is that its purpose is directly related to the public health. Different countries adopt different structural patterns in this field but one can consider relatively common functions for a national health system which includes all functional aspects for this system. In recent years, attempts have been made for offering a comprehensive model in describing the functions. The OECD determined principles needed to offer an appropriate typology that should be independent of the names of health programs in different countries. In this chapter, it's tried to provide an overview of the proposed models for structures and functions of the health system and to propose a comprehensive model for it with an emphasis on theoretical aspects of public policy-making and binding functions in any national development system. This comprehensive model, provides the possibility to evaluate the success of a health system.

scholarly journals Transdisciplinarity of India's Master's Level Public Health Programmes: Evidence from Admission Criteria of the Programmes Offered Since 1995

2021 ◽  
Author(s):  
Kumaravel Ilangovan ◽  
Sendhilkumar Muthappan ◽  
Keerthiga Govindarajan ◽  
Vignesh Vairamani ◽  
Vettrichelvan Venkatasamy ◽  
...  
Keyword(s):  
Public Health ◽  
Indian Subcontinent ◽  
Academic Disciplines ◽  
Admission Criteria ◽  
Master's Level ◽  
The Public ◽  
Educational Backgrounds ◽  
Location Type ◽  
Public Health Programmes ◽  
Health Programmes

Abstract Background In Indian subcontinent, Master's level public health (MPH) programmes attract graduates of diverse academic disciplines from health and non-health sciences alike. Considering the current and futuristic importance of the public health cadre, we described them and reviewed their transdisciplinarity status based on MPH admissibility criteria 1995 to 2021. Methods Using a search strategy, we abstracted information available in the public domain on MPH and their admissibility criteria. We classified disciplines specified for admission into Science, Social sciences and Arts, Health and Non-health categories. We described the MPH programmes by location, type of institutions, course duration, pedagogical methods, specialisations offered, and nature of admission criteria statements. We calculated descriptive statistics for eligible educational qualifications for admission to MPH programmes. Results Overall, 74 Indian institutions offered 88 MPH programmes. We included 85 for review. These programmes represent 50% increase (n = 44) from that of 2016-17. They are mostly concentrated in 21 provinces and union territories of India. These programmes stated that they admit candidates of but not limited to "graduation in any life sciences", "three-year bachelors degree in any discipline", “graduation from any Indian universities”, and "graduation in any discipline". Of the 72 institutions, 14 admit multidisciplinary academic graduates in their 16 programmes. Except three institutions from public sector, 69 provide MPH admission opportunities to multidisciplinary health and non-health academic graduates. Conclusion Our review suggests that India's MPH programmes are less transdisciplinary. India's Master's level public health programmes should transcend to be more inclusive and admit graduates of various academic educational backgrounds.

scholarly journals Observations by and Conversations with Health Workers and Hospital Personnel Involved in Transferring Māori Patients and Whānau to Waikato Hospital in Aotearoa New Zealand

2020 ◽  
Vol 17 (23) ◽  
pp. 8833
Author(s):  
Bridgette Masters-Awatere ◽  
Donna Cormack ◽  
Rebekah Graham ◽  
Rachel Brown
Keyword(s):  
Public Health ◽  
Health System ◽  
Public Health System ◽  
Health Workers ◽  
Hospital Staff ◽  
Home Base ◽  
Key Informants ◽  
The Public ◽  
Aotearoa New Zealand ◽  
Meaningful Engagement

The predominant focus of Aotearoa New Zealand’s public health system on biomedical models of health has left little room for meaningful engagement with holistic indigenous approaches. Culturally appropriate provision and support are recognized for their relevance and importance during hospital transferals. Hospital staff involved in transfers to one of New Zealand’s trauma centers share their observations of whānau Māori engagement during an admission away from their home base. Sixteen key informants share their experiences, which are presented as strategies and challenges to whānau engagement. Three main themes highlight challenges within the health system that make it difficult for hospital staff to engage whānau in the desired ways and as often as both parties would like. Key informants described services and practices that are not designed with patients and their whānau in mind; instead they are designed by clinicians around the needs of administrative systems. As employees within the public health system, key informants felt powerless to challenge dominant settings. Nevertheless, employees managed to circumnavigate processes. Our findings highlight the need for continued decolonization and anti-racism work within public health settings.

scholarly journals Transdisciplinarity of India's Master's Level Public Health Programmes: Evidence from Admission Criteria of the Programmes Offered Since 1995

2021 ◽  
Author(s):  
Kumaravel Ilangovan ◽  
Sendhilkumar Muthappan ◽  
Keerthiga Govindarajan ◽  
Vignesh Vairamani ◽  
Vettrichelvan Venkatasamy ◽  
...  
Keyword(s):  
Public Health ◽  
Indian Subcontinent ◽  
Academic Disciplines ◽  
Admission Criteria ◽  
Master's Level ◽  
The Public ◽  
Educational Backgrounds ◽  
Location Type ◽  
Public Health Programmes ◽  
Health Programmes

Abstract BackgroundIn Indian subcontinent, Master's level public health (MPH) programmes attract graduates of diverse academic disciplines from health and non-health sciences alike. Considering the current and futuristic importance of the public health cadre, we described them and reviewed their transdisciplinarity status based on MPH admissibility criteria 1995 to 2021. MethodsUsing a search strategy, we abstracted information available in the public domain on MPH and their admissibility criteria. We classified disciplines specified for admission into Science, Social sciences and Arts, Health and Non-health categories. We described the MPH programmes by location, type of institutions, course duration, pedagogical methods, specialisations offered, and nature of admission criteria statements. We calculated descriptive statistics for eligible educational qualifications for admission to MPH programmes. ResultsOverall, 74 Indian institutions offered 88 MPH programmes. We included 85 for review. These programmes represent 50% increase (n=44) from that of 2016-17. They are mostly concentrated in 21 provinces and union territories of India. These programmes stated that they admit candidates of but not limited to "graduation in any life sciences", "three-year bachelors degree in any discipline", “graduation from any Indian universities”, and "graduation in any discipline". Of the 72 institutions, 14 admit multidisciplinary academic graduates in their 16 programmes. Except three institutions from public sector, 69 provide MPH admission opportunities to multidisciplinary health and non-health academic graduates. ConclusionOur review suggests that India's MPH programmes are less transdisciplinary. India's Master's level public health programmes should transcend to be more inclusive and admit graduates of various academic educational backgrounds.

Funding models and expenditures with primary healthcare in Salvador, Bahia, Brazil metropolitan area

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
T Vivas ◽  
M Duarte ◽  
A Pitta ◽  
B Christovam
Keyword(s):  
Public Health ◽  
Metropolitan Area ◽  
Primary Healthcare ◽  
Healthcare Services ◽  
Ministry Of Health ◽  
Healthcare Budget ◽  
Health Budget ◽  
The Public ◽  
Before And After ◽  
The Government

Abstract Background The government investments in quality primary healthcare are the basis to strengthening the health systems and monitoring the public expenditure in this area is a way to assess the effectiveness and efficiency of the public health policies. The Brazil Ministry of Health changed, in 2017, the method of onlending federal resources to states and cities seeking to make the public funds management more flexible. This change, however, suppressed mandatory investments in primary healthcare. This research aims to determine the difference of expenditures on primary healthcare in Salvador, Bahia, Brazil metropolitan area before and after this funding reform, seeking to verify how it can impact the quality of primary healthcare services and programs. Methods This is an ecological time-series study that used data obtained in the Brazil Ministry of Health budget reports. The median and interquartile range of expenditures on primary healthcare (set as the percentage of total public health budget applied in primary care services and programs) of the 13 cities in the Salvador metropolitan area were compared two years before and after the reform. Results The median of expenditures on primary healthcare in Salvador metropolitan area was 25.5% (13,9% - 32,2%) of total public health budget before and 24.8% (20.8% - 30.0%) of total public health budget after the reform (-0.7% difference). Seven cities decreased the expenditures on primary healthcare after the reform, ranging from 1.2% to 10.8% reduction in the primary healthcare budget in five years. Conclusions Expenditures on primary healthcare in Salvador metropolitan area decreased after the 2017 funding reform. Seven of 13 cities reduced the government investments on primary healthcare services and programs in this scenario. Although the overall difference was -0.7%, the budget cuts ranged from 1.2% to 10.8% in the analyzed period and sample. More studies should assess these events in wide areas and with long time ranges. Key messages Public health funding models can impact the primary healthcare settings regardless of the health policy. Reforms in the funding models should consider the possible benefits before implementation. Funding models and methods that require mandatory investments in primary healthcare may be considered over more flexible ones.

scholarly journals Retrospective study of the distribution of doctors in municipalities of extreme poverty in Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
B L O Luizeti ◽  
E M M Massuda ◽  
L F G Garcia
Keyword(s):  
Public Health ◽  
Health System ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Extreme Poverty ◽  
The Public ◽  
The North ◽  
Unified Health System ◽  
Shortage Of Doctors ◽  
Demographic Distribution

Abstract In view of the national scenario of scarcity of material and human resources in public health in Brazil, the survey verified the demographics of doctors who attend the Unified Health System (SUS) in municipalities of extreme poverty. An observational, analytical and cross-sectional study was carried out, based on secondary quantitative data from the Department of Informatics of the SUS using the TABNET of December 2019. The care networks variable was restricted to infer the number of physicians who attend the SUS in extreme poverty municipalities in Brazil. Municipalities of extreme poverty are those that at least 20% of the population have a household income of up to 145 reais per capita monthly. In Brazil, there are 1526 municipalities in extreme poverty, 27.4% of the country's total municipalities. 14,907 doctors linked to SUS work in this condition, 3.19% of the total of these professionals in Brazil. There is still disproportion between regions: North concentrates 11.2% of the municipalities in extreme poverty and 8.61% of the total number of doctors; Northeast, with 61.33% of these municipalities, for 61.5% of doctors; Southeast, with 15.46% of the municipalities in this condition, has 20.6% of doctors; South concentrates 10.87% of the municipalities under discussion with 5.61% of doctors and the Midwest, with 4.87% of these municipalities, has 3.54% of doctors. Between 2009 and 2018, there was a 39% increase in the number of doctors in these locations, however, for 2019, there was a decrease of 3.89%. The medical demographic distribution in Brazil is uneven, especially in the North. There is also the vulnerability of this population in view of the observed reduction in the number of professionals between 2018 and 2019 in municipalities of extreme poverty, for political reasons. It is evident the need to restructure the health system to guarantee access to health for this population, through the attraction and fixation of doctors in needy regions in Brazil. Key messages Shortage of doctors in extreme poverty municipalities reinforces the health vulnerability of the population in Brazil. The uneven medical demography in Brazil requires restructuring in the public health system.

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