scholarly journals The management of microbial keratitis within Uganda’s primary health system: a situational analysis

2019 ◽  
Vol 4 ◽  
pp. 141 ◽  
Author(s):  
Simon Arunga ◽  
Naome Kyomugasho ◽  
Teddy Kwaga ◽  
John Onyango ◽  
Astrid Leck ◽  
...  
Keyword(s):  
Health System ◽  
Health Workers ◽  
Health Facilities ◽  
Eye Drops ◽  
Microbial Keratitis ◽  
Eye Health ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres ◽  
Training Schools

Background: Microbial keratitis (MK) frequently leads to sight-loss, especially when the infection is severe and/or appropriate treatment is delayed. The primary health system as an entry point plays a central role in facilitating and directing patient access to appropriate care. The purpose of this study was to describe the capacity of primary health centres in Uganda in managing MK. Methods: We carried out a rigorous assessment of primary health centres and mid-cadre training schools in South Western Uganda. Through interviews, checklists and a picture quiz, we assessed capacity and knowledge of MK management. In addition, we interviewed the heads of all the mid-cadre training schools to determine the level of eye health training provided in their curricula. Results: In total, 163 health facilities and 16 training schools were enrolled. Of the health facilities, only 6% had an Ophthalmic Clinical Officer. Only 12% of the health workers could make a diagnosis of MK based on the clinical signs in the picture quiz. Although 35% of the facilities had a microscope, none reported doing corneal scraping. None of the facilities had a stock of the recommended first line treatment options for MK (ciprofloxacin and natamycin eye drops). Among the training schools, 15/16 had an eye health component in the curriculum. However, the majority (56%) of tutors had no formal expertise in eye health. In 14/16 schools, students spent an average of two weeks in an eye unit. Conclusions: Knowledge among health workers and capacity of health facilities in diagnosis and management of MK was low. Training for eye health within mid-cadre training schools was inadequate. More is needed to close these gaps in training and capacity.

scholarly journals Implementing standard antenatal care interventions: health system cost at primary health facilities in Tanzania

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Amisa Tindamanyile Chamani ◽  
Amani Thomas Mori ◽  
Bjarne Robberstad
Keyword(s):  
Standard Model ◽  
Antenatal Care ◽  
Health System ◽  
Health Facilities ◽  
System Cost ◽  
Primary Health ◽  
Health System Cost ◽  
The Standard Model ◽  
Health Centres ◽  
Primary Health Facilities

Abstract Background Since 2002, Tanzania has been implementing the focused Antenatal Care (ANC) model that recommended four antenatal care visits. In 2016, the World Health Organization (WHO) reintroduced the standard ANC model with more interventions including a minimum of eight contacts. However, cost-implications of these changes to the health system are unknown, particularly in countries like Tanzania, that failed to optimally implement the simpler focused ANC model. We compared the health system cost of providing ANC under the focused and the standard models at primary health facilities in Tanzania. Methods We used a micro-costing approach to identify and quantify resources used to implement the focused ANC model at six primary health facilities in Tanzania from July 2018 to June 2019. We also used the standard ANC implementation manual to identify and quantify additional resources required. We used basic salary and allowances to value personnel time while the Medical Store Department price catalogue and local market prices were used for other resources. Costs were collected in Tanzanian shillings and converted to 2018 US$. Results The health system cost of providing ANC services at six facilities (2 health centres and 4 dispensaries) was US$185,282 under the focused model. We estimated that the cost would increase by about 90% at health centres and 97% at dispensaries to US$358,290 by introducing the standard model. Personnel cost accounted for more than one third of the total cost, and more than two additional nurses are required per facility for the standard model. The costs per pregnancy increased from about US$33 to US$63 at health centres and from about US$37 to US$72 at dispensaries. Conclusion Introduction of a standard ANC model at primary health facilities in Tanzania may double resources requirement compared to current practice. Resources availability has been one of the challenges to effective implementation of the current focused ANC model. More research is required, to consider whether the additional costs are reasonable compared to the additional value for maternal and child health.

scholarly journals Implementing Standard Antenatal Care Interventions: Health System Cost at Primary Health Facilities in Tanzania.

2021 ◽  
Author(s):  
Amisa Tindamanyile Chamani ◽  
Amani Thomas Mori ◽  
Bjarne Robberstad
Keyword(s):  
Standard Model ◽  
Antenatal Care ◽  
Health System ◽  
Health Facilities ◽  
System Cost ◽  
Primary Health ◽  
Health System Cost ◽  
The Standard Model ◽  
Health Centres ◽  
Primary Health Facilities

Abstract Background Since 2002, Tanzania has been implementing the focused Antenatal Care (ANC) model that recommended four antenatal care visits. In 2016, the World Health Organization (WHO) reintroduced the standard ANC model with more interventions including a minimum of eight contacts. However, cost-implications of these changes to the health system is unknown, particulary in countries like Tanzania, that failed to optimally implement the simpler focused ANC model. We compared the health system cost of providing ANC under the focused and the standard models at primary health facilities in Tanzania. Methods We used a micro-costing approach to identify and quantify resources used to implement the focused ANC model at six primary health facilities in Tanzania from July 2018 to June 2019. We also used the standard ANC implementation manual to identify and quantify additional resources required. We used basic salary and allowances to value personnel time while the Medical Store Department price catalogue and local market prices were used for other resources. Cost were collected in Tanzanian shillings and converted to 2018 US$. Results The health system cost of providing ANC services was US$185,282 under the focused model and the cost increased by about 90% at health centres and 97% at dispensaries to US$358,290 for the standard model. Personnel cost accounted for more than one third of the total cost for both models. With the standard model, costs per pregnancy increased from about US$33 to US$63 at health centres and from about US$37 to US$72 at dispensaries Conclusion Introduction of a standard ANC model at primary healthcare facilities in Tanzania will double resources use compared to current practice. While resources availability has been one of the challenge to effective implementation of the focused ANC model, more research is required, to consider whether these costs are reasonable compared to the additional value for maternal and child health.

scholarly journals Prescribers’ Adherence to Treatment Guidelines for Uncomplicated Malaria in Primary Health Centres in Bayelsa State, Nigeria

2021 ◽  
Vol 16 (2) ◽  
pp. 177-184
Author(s):  
I. A. Suleiman ◽  
S. T. Dandyson ◽  
K. A. Ganiyu ◽  
A. S. Oyeyemi
Keyword(s):  
Uncomplicated Malaria ◽  
Treatment Guidelines ◽  
Health Workers ◽  
Severe Disease ◽  
Treatment Guideline ◽  
Antimalarial Drugs ◽  
National Treatment ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres

Background: Malaria, though preventable and treatable, remains a disease with unacceptably high mortality in Nigeria. Effective and prompt treatment of uncomplicated cases reduces progression to severe disease, development of drug resistance, and cuts the costs of the disease.Objective: To assess adherence by prescribers to recommended treatment (based on National Treatment Guideline) for uncomplicated malaria in primary health centres (PHCs) in the eight Local Government Areas (LGAs) of Bayelsa State, Nigeria.Methods: A retrospective review of case notes and prescription sheets for suspected malaria cases treated at 28 PHCs within a year of data collection was done. Relevant data about the prescribers, the patients, and the antimalarial drugs prescribed were collected and analyzed as appropriate.Results: A total of 2,303 case notes of patients attending PHCs were examined over the study period. A high proportion of malaria (1422, 61.7%) was observed among the 2,303 cases. The median age (years) of adults was 28.0 (IQR = 14), and for children of 0-5, 2.0 (IQR = 2.17). Majority of those treated were females (792, 55.7%) and children (967, 68.0%). Artemisinin-based combination therapies (ACTs) were the most prescribed antimalarials (961, 67.6%), followed by artemisinin monotherapies in 23.8% of cases. Proportion of treated cases of malaria that could be considered rational across the LGAs was 67.6%.Conclusion: Adherence of prescribers to National Treatment Guidelines of uncomplicated malaria in PHCs in Bayelsa State was below the required standard, with continued usage of obsolete agents, such as artemisinin monotherapies. Training on case management for prescribers at this level of care is urgently needed. Keywords: Antimalarial drugs, Malaria, Primary Health Centres, Community Health Workers, Bayelsa State.

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.

What Causes Medicine Shortages in Primary Health Centres?

2015 ◽  
Vol 17 (1) ◽  
pp. 86-97 ◽  
Author(s):  
Shweta Raut-Marathe ◽  
Nilangi Sardeshpande ◽  
Deepali Yakkundi
Keyword(s):  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres

scholarly journals Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India

2018 ◽  
Vol 3 (5) ◽  
pp. e000907 ◽  
Author(s):  
Ramesh Agarwal ◽  
Deepak Chawla ◽  
Minakshi Sharma ◽  
Shyama Nagaranjan ◽  
Suresh K Dalpath ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Management Strategy ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Primary Health ◽  
Cluster Randomised ◽  
Primary Health Centres ◽  
Health Centres

BackgroundLow/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models.MethodsWe conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3  months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for ‘months of intervention’.ResultsThe intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities.ConclusionA multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India.Trial registration numberCTRI/2016/05/006963.

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