Island Health: Hope and Challenges for Public Health

2009 ◽  
Vol 22 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Colin Binns ◽  
Tomiko Hokama ◽  
Wah Yun Low
Keyword(s):  
Public Health ◽  
Health Care ◽  
Rural Areas ◽  
Health Workers ◽  
Asia Pacific ◽  
Asia Pacific Region ◽  
Reasonable Expectation ◽  
Remote Locations ◽  
Primary Health ◽  
Special Responsibility

The Asia-Pacific region is a region of small islands, perhaps 100 000 of them. The health, communication, and development problems of islands present difficult challenges for the delivery of health care. The discussions at the Okinawa Symposium centred on how health can be provided to all in the region, not only those in metropolitan areas, but also the poor in rural areas and those on living on far-flung island archipelagos. It is important to apply principles of “public health” and “primary health care” so that all island residents may have a reasonable expectation of health care. Schools of public health have a special responsibility to educate those who are responsible for the delivery and management of health care in these remote locations. The development of telehealth systems will be important to support health workers in remote locations and to deliver continuing education programs.

scholarly journals Perspectives of health workers regarding primary health care delivery to the rural population in the Bothaville district*

Curationis ◽  
1999 ◽  
Vol 22 (4) ◽  
Author(s):  
E Janse van Rensburg
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Delivery ◽  
Rural Areas ◽  
Information Dissemination ◽  
Health Workers ◽  
Care Delivery ◽  
Public Health Services ◽  
Primary Health

This article reports on the views of public health workers regarding recent changes in the delivery of primary health care to people living and working in the Bothaville rural area. These changes in mobile health care form part of the Initiative for Sub-District Support’s programme to provide sustained, concerted support to sub-districts to bring about improvements in health care management and health care delivery. Main shortcomings of the recent changes were identified as inadequate transportation facilities in rural areas, insufficient information dissemination to rural dwellers and lack of farmers’ participation in rural health matters. Furthermore, poor communication and co-operation between different public health services prevailed and the need for an integration of these services was emphasised.

scholarly journals The impact of COVID-19 on primary health care and antibiotic prescribing in rural China: qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tingting Zhang ◽  
Xingrong Shen ◽  
Rong Liu ◽  
Linhai Zhao ◽  
Debin Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Rural Areas ◽  
Rural China ◽  
Antibiotic Prescribing ◽  
Epidemic Control ◽  
Primary Health ◽  
Tract Infections ◽  
The Impact

Abstract Background In China, the primary health care (PHC) system has been designated responsible for control and prevention of COVID-19, but not treatment. Suspected COVID-19 cases presenting to PHC facilities must be transferred to specialist fever clinics. This study aims to understand the impact of COVID-19 on PHC delivery and on antibiotic prescribing at a community level in rural areas of central China. Methods Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and analysed thematically. Results PHC practitioners reported a major shift in their work away from seeing and treating patients (due to government-mandated referral to specialist Covid clinics) to focus on the key public health roles of tracing, screening and educating in rural areas. The additional work, risk, and financial pressure that PHC practitioners faced, placed considerable strain on them, particularly those working in village clinics. Face to face PHC provision was reduced and there was no substitution with consultations by phone or app, which practitioners attributed to the fact that most of their patients were elderly and not willing or able to switch. Practitioners saw COVID-19 as outside of their area of expertise and very different to the non-COVID-19 respiratory tract infections that they frequently treated pre-pandemic. They reported that antibiotic prescribing was reduced overall because far fewer patients were attending rural PHC facilities, but otherwise their antibiotic prescribing practices remained unchanged. Conclusions The COVID-19 pandemic had considerable impact on PHC in rural China. Practitioners took on substantial additional workload as part of epidemic control and fewer patients were seen in PHC. The reduction in patients seen and treated in PHC led to a reduction in antibiotic prescribing, although clinical practice remains unchanged. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and increased public health roles and, in the case of the village clinics, remain financially viable.

scholarly journals Organisation of primary health care systems in low- and middle-income countries: review of evidence on what works and why in the Asia-Pacific region

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001487 ◽  
Author(s):  
Rebecca Dodd ◽  
Anna Palagyi ◽  
Stephen Jan ◽  
Marwa Abdel-All ◽  
Devaki Nambiar ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Engagement ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Middle Income ◽  
Middle Income Countries ◽  
What Works ◽  
Primary Health

IntroductionThis paper synthesises evidence on the organisation of primary health care (PHC) service delivery in low-income and middle-income countries (LMICs) in the Asia Pacific and identifies evidence of effective approaches and pathways of impact in this region.MethodsWe developed a conceptual framework describing key inputs and outcomes of PHC as the basis of a systematic review. We searched exclusively for intervention studies from LMICs of the Asia-Pacific region in an effort to identify ‘what works’ to improve the coverage, quality, efficiency, equity and responsiveness of PHC. We conducted a narrative synthesis to identify key characteristics of successful interventions.ResultsFrom an initial list of 3001 articles, we selected 153 for full-text review and included 111. We found evidence on the impact of non-physician health workers (NPHWs) on coverage and quality of care, though better integration with other PHC services is needed. Community-based services are most effective when well integrated through functional referral systems and supportive supervision arrangements, and have a reliable supply of medicines. Many studies point to the importance of community engagement in improving service demand. Few studies adopted a ‘systems’ lens or adequately considered long-term costs or implementation challenges.ConclusionBased on our findings, we suggest five areas where more practical knowledge and guidance is needed to support PHC systems strengthening: (1) NPHW workforce development; (2) integrating non-communicable disease prevention and control into the basic package of care; (3) building managerial capacity; (4) institutionalising community engagement; (5) modernising PHC information systems.

scholarly journals Domestic violence against women, public policies and community health workers in Brazilian Primary Health Care

2018 ◽  
Vol 23 (1) ◽  
pp. 93-102 ◽  
Author(s):  
Marcos Claudio Signorelli ◽  
Angela Taft ◽  
Pedro Paulo Gomes Pereira
Keyword(s):  
Public Health ◽  
Health Care ◽  
Domestic Violence ◽  
Primary Health Care ◽  
Community Health ◽  
Violence Against Women ◽  
Health Workers ◽  
Health Unit ◽  
Primary Health ◽  
Domestic Violence Against Women

Abstract Domestic violence creates multiple harms for women's health and is a ‘wicked problem’ for health professionals and public health systems. Brazil recently approved public policies to manage and care for women victims of domestic violence. Facing these policies, this study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy. We adopted qualitative ethnographic research methods with thematic analysis of emergent categories, interrogating data with gender theory and emergent Brazilian collective health theory. Field research was conducted in a local basic health unit and the territory for which it is responsible, in Southern Brazil. The study revealed: 1) a yawning gap between public health policies for domestic violence against women at the federal level and its practical application at local/decentralized levels, which can leave both professionals and women unsafe; 2) the key role of local community health workers, paraprofessional health promotion agents, who aim to promote dialogue between women experiencing violence, health care professionals and the health care system.

scholarly journals The Impact of COVID-19 on Primary Health Care and Antibiotic Prescribing in Rural China: Qualitative Study

2021 ◽  
Author(s):  
Tingting Zhang ◽  
Xingrong Shen ◽  
Rong Liu ◽  
Linhai Zhao ◽  
Debin Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Rural Areas ◽  
Rural China ◽  
Antibiotic Prescribing ◽  
Epidemic Control ◽  
Primary Health ◽  
Tract Infections ◽  
The Village

Abstract Background: Primary health care (PHC) system is designated to be responsible for epidemic control and prevention during the outbreak of COVID-19 in China, while COVID-19 suspected cases in PHC are required to be transferred to specialist fever clinics at higher level hospitals. This study aims to understand to impact of COVID-19 on PHC delivery and antibiotic prescribing at community level in the rural areas of central China.Methods: Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and thematically analysed.Results: Practitioners’ and patients’ views and perspectives on COVID-19 impacts on PHC services and antibiotic prescribing are organised into four broad themes. PHC practitioners took on a key public health role of tracing, screening and educating in rural areas, while their original role in seeing and treating patients was reduced since government required patients to be diverted. The additional work, risk, and financial pressure that PHC practitioners faced placed considerable strain on them, particularly those working in the village clinics. PHC largely diminished that related to the difficulty of PHC workforce with limited medical training and the high number of elderly patients in rural areas, and as a result of epidemic, rural patients found it more difficult to access health care. Antibiotic prescribing practices for non-COVID-19 respiratory tract infections remained unchanged and were not seen as relevant to practitioners’ knowledge of COVID-19, although overall antibiotic treatments were reduced because fewer patients were attending rural PHC clinics. Conclusions: Our study identified the considerable impact of COVID-19 epidemic on PHC in rural China. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and prevention and public health roles and, in the case of the village clinics, remain financially viable.

scholarly journals The effectiveness of classic lecture and workshop as interventions to improve primary health care providers knowledge and skill on the management of pediatric emergencies: a case study

2021 ◽  
Vol 5 (1) ◽  
pp. 133
Author(s):  
Ricky Indra Alfaray ◽  
Rahmat Sayyid Zharfan ◽  
Yudhistira Pradnyan Kloping ◽  
Yudith Annisa Ayu Rezkitha ◽  
Rafiqy Sa’adiy Faizun ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Rural Areas ◽  
Health Workers ◽  
Test Results ◽  
Care Providers ◽  
Primary Health ◽  
Significant Difference ◽  
Post Test

Abstract A preliminary study showed that most health workers in primary health care (PHC) claimed that they need a refreshing course because of their lack of updated knowledge and skill. This study enrolled 27 primary healthcare workers recruited from the PHC. The intervention used were classic lectures and workshops. The knowledge was evaluated using a paper-based test and practice, while the skill was evaluated using a practice test. Multiple questions (pre-test and post-test) based on current emergency management for pediatric were used for paper-based evaluation. Semi-structured interviews were conducted to confirm the subject's perspective on the intervention. A paired t-test was used for evaluating the pre- and post-test results, which was confirmed by a triangulation approach. There was a significant difference between the pre- and post-test results (p<0.001), and 8 of 10 subjects can demonstrate the procedure learned correctly after the intervention. A total of 14 interviewed subjects stated great effectiveness of the intervention, with several limitations on applicability in daily clinical practice. Classic lecture and workshop as an intervention in health education effectively increase health workers' knowledge and skill in PHC. This study might help other rural areas PHC apply the same method so the professionalism and quality of health workers in PHC providers can be maintained.Keywords                : primary health care, classic lecture; workshop; knowledge; skillCorrespondence     : [email protected]

scholarly journals The impact of COVID-19 on primary health care and antibiotic prescribing in rural China: qualitative study

2021 ◽  
Author(s):  
Tingting Zhang ◽  
Xingrong Shen ◽  
Rong Liu ◽  
Linhai Zhao ◽  
Debin Wang ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Rural Areas ◽  
Central China ◽  
Antibiotic Prescribing ◽  
Epidemic Control ◽  
Primary Health ◽  
Tract Infections ◽  
The Impact

ABSTRACTIntroductionPrimary health care (PHC) system is designated to be responsible for epidemic control and prevention during the outbreak of COVID-19 in China, while COVID-19 suspected cases in PHC are required to be transferred to specialist fever clinics at higher level hospitals. This study aims to understand to impact of COVID-19 on PHC delivery and antibiotic prescribing at community level in the rural areas of central China.MethodsQualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres (THCs) and nine village clinics (VCs) in two rural residential areas of Anhui province. Interviews were transcribed verbatim and thematically analysed.ResultsPractitioners’ and patients’ views and perspectives on COVID-19 impacts on PHC services and antibiotic prescribing are organised into four broad themes: switch from PHC to epidemic prevention and control, concerns and challenges faced by those delivering PHC, diminished PHC, and COVID-19 as a different class of illness.ConclusionThe COVID-19 epidemic has had a considerable impact on the roles of rural PHC clinics in China that shifted to public health from principal medical, and highlighted the difficulties in rural PHC including inadequately trained practitioners, additional work and financial pressure, particularly in VCs. Antibiotic prescribing practices for non-COVID-19 respiratory tract infections remained unchanged since the knowledge of COVID-19 was not seen as relevant to practitioners’ antibiotic treatment practices, although overall rates were reduced because fewer patients were attending rural PHC clinics. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and public health roles and, in the case of the VCs, remain financially viable.

scholarly journals The importance of strengthening public health systems based on primary health care in designing a successful vaccination strategy: an example of qualitative research in three regions of Senegal.

2019 ◽  
Author(s):  
Jacopo Bianchi ◽  
Chiara Milani ◽  
Angela Bechini ◽  
Sara Boccalini ◽  
Maria José Caldes Pinilla ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Public Health System ◽  
Health Workers ◽  
Conventional Medicine ◽  
Specific Information ◽  
The Public ◽  
Primary Health

Abstract Background Because of its low cost and its capability in reducing child mortality and morbidity, vaccination is considered a successful preventive deed in Low and Middle-Income Countries. In Senegal, vaccines are provided free of charge by the public health system, but the provision of the service is not evenly distributed between and within the Regions. Our study aimed at identifying barriers and enabling factors towards vaccination in three Regions of Senegal. Methods We performed 41 face-to-face semi-structured interviews with health services’ workers and three focus groups with local women in nine different structures in three different Regions of Senegal. We combined health workers’ (HW) and mothers’ points of view with direct observation in order to fulfill our purpose. Results We identified three groups of barriers – structural, personal and psychological – and many subthemes for each of them. Structural and personal barriers such as inadequacy of health structures, shortage of HW, lack of money, distance between villages and health facilities and lack of public transport, hamper mothers from utilising the vaccination service, even when they want to. The lack of effective communication between health personnel and mothers, the lack of collaboration between traditional and conventional medicine and the lack of trust in the public health system as a whole, are major problems to the vaccination uptake too. Conclusions The interlink of several elements in conditioning vaccination coverage suggests the need of implementing global and national strategies to overcome them. The key factor is the presence of a solid health system, publicly funded, based on primary health care. On the other hand, context-specific determinants cannot be detected based on global and non-specific information. The role of community health workers (CHWs) is crucial in overcoming wrong beliefs, lack of knowledge and distrust. They must be regarded as a bridge between HW and population. CHWs should be formally included in the organization of the social-health system, adequately formed and enhanced.

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