scholarly journals Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

2020 ◽  
Author(s):  
Peter O. Otieno ◽  
Elvis Omondi Achach Wambiya ◽  
Shukri M Mohamed ◽  
Martin Kavao Mutua ◽  
Peter M Kibe ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Associated Factors ◽  
Healthcare Services ◽  
Urban Slums ◽  
Public Facility ◽  
Health Coverage ◽  
Ordinal Logistic Regression Analysis ◽  
Access To Primary Care ◽  
Female Headed Households

Abstract Background: Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods: The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recorded into tertiles with categories labeled as poor, moderate, and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios (AOR) and 95 percent confidence intervals were used to interpret the strength of associations. Results: The odds of being in the highest access tertile versus the combined categories of lowest and moderate access tertile were 3.5 times higher for males than female-headed households (AOR 3.05 [95% CI 1.47-6.37]; p<.05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥$30 had significantly lower odds of being in the highest versus combined categories of lowest and moderate access tertile compared to those spending ≤ $5.(AOR 0.36 [95% CI 0.18-0.74]; p<.05). Households that sought primary care from private facilities had significantly higher odds of being in the highest versus combined categories of lowest and moderate access tertiles compared to the public facilities (AOR 6.64 [95% CI 3.67-12.01]; p<.001). Conclusion: In Nairobi slums in Kenya, living in a female-headed household, seeking care from a public facility, and paying out of pocket for healthcare are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize quality improvement in public health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare

scholarly journals Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

2020 ◽  
Author(s):  
Peter O. Otieno ◽  
Elvis Omondi Achach Wambiya ◽  
Shukri M Mohamed ◽  
Martin Kavao Mutua ◽  
Peter M Kibe ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Associated Factors ◽  
Healthcare Services ◽  
Urban Slums ◽  
Public Facility ◽  
Health Coverage ◽  
Ordinal Logistic Regression Analysis ◽  
Access To Primary Care ◽  
Female Headed Households

Abstract Background: Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods: The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recorded into tertiles with categories labeled as poor, moderate, and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios (AOR) and 95 percent confidence intervals were used to interpret the strength of associations. Results: The odds of being in the highest access tertile versus the combined categories of lowest and moderate access tertile were three times higher for males than female-headed households (AOR 3.05 [95% CI 1.47-6.37]; p<.05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥USD 30 had significantly lower odds of being in the highest versus combined categories of lowest and moderate access tertile compared to those spending ≤ USD 5 (AOR 0.36 [95% CI 0.18-0.74]; p<.05). Households that sought primary care from private facilities had significantly higher odds of being in the highest versus combined categories of lowest and moderate access tertiles compared to those who sought care from public facilities (AOR 6.64 [95% CI 3.67-12.01]; p<.001). Conclusion: In Nairobi slums in Kenya, living in a female-headed household, seeking care from a public facility, and paying out-of-pocket for healthcare are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize quality improvement in public health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare.

scholarly journals Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

2020 ◽  
Author(s):  
Peter O. Otieno ◽  
Elvis Omondi Achach Wambiya ◽  
Shukri M Mohamed ◽  
Martin Kavao Mutua ◽  
Peter M Kibe ◽  
...  
Keyword(s):  
Primary Care ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Associated Factors ◽  
Healthcare Services ◽  
Urban Slums ◽  
Health Coverage ◽  
Ordinal Logistic Regression Analysis ◽  
Access To Primary Care ◽  
Universal Health

Abstract Background: Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage (UHC) policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods: The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recoded into tertiles with categories labeled as poor, moderate and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios and 95 percent confident intervals were used to interpret the strength of associations. Results : The odds of being in the lowest versus combined moderate and highest access tertile were significantly higher for female than male-headed households (AOR 1.91 [95% CI 1.03-3.54]; p < .05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥$30 had significantly lower odds of being in the lowest versus combined moderate and highest access tertile compared to those spending ≤ $5 quarterly (AOR 0.33 [95% CI 0.50-1.90]; p< .001). Households that sought care from private facilities had significantly higher odds of being in the lowest versus combined moderate and highest access compared to the public facilities (AOR 3.77 [95% CI 2.16-6.56]; p < .05). Conclusion : In Nairobi slums in Kenya, living in a female-headed household and seeking care from private facilities are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize the regulation of private health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare. Keywords: Access to primary healthcare, Universal health coverage, Urban slums, Penchansky and Thomas’s model.

scholarly journals Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

2019 ◽  
Author(s):  
Peter O. Otieno ◽  
Elvis Omondi Achach Wambiya ◽  
Shukri M Mohamed ◽  
Martin Kavao Mutua ◽  
Peter M Kibe ◽  
...  
Keyword(s):  
Primary Care ◽  
Universal Health Coverage ◽  
Primary Healthcare ◽  
Associated Factors ◽  
Healthcare Expenditure ◽  
Healthcare Services ◽  
Urban Slums ◽  
Health Coverage ◽  
Access To Primary Care ◽  
Universal Health

Abstract Background: Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods: The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recoded into tertiles with categories labeled as poor, moderate and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios and 95 percent confident intervals were used to interpret the strength of associations. Results : The odds of being in the lowest versus combined moderate and highest access tertile were significantly higher for female than male-headed households (AOR 1.91 [95% CI 1.03-3.54]; p < .05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥$30 had significantly lower odds of being in the lowest versus combined moderate and highest access tertile compared to those spending ≤ $5 quarterly (AOR 0.33 [95% CI 0.50-1.90]; p< .001). Households that sought care from private facilities had significantly higher odds of being in the lowest versus combined moderate and highest access compared to the public facilities (AOR 3.77 [95% CI 2.16-6.56]; p < .05). Conclusion : In Nairobi slums in Kenya, the gender of the household head, out of pocket healthcare expenditure, and source of primary care are significantly associated with access to primary care. Therefore, the universal health coverage program in this setting should be designed with an equity lens so that the most vulnerable groups within the community can have access.

scholarly journals Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Peter O. Otieno ◽  
Elvis O. A. Wambiya ◽  
Shukri M. Mohamed ◽  
Martin Kavao Mutua ◽  
Peter M. Kibe ◽  
...  
Keyword(s):  
Primary Healthcare ◽  
Associated Factors ◽  
Healthcare Services ◽  
Urban Slums

scholarly journals Integrative literature review: access to primary healthcare services

2018 ◽  
Vol 71 (3) ◽  
pp. 1178-1188 ◽  
Author(s):  
Maura Cristiane e Silva Figueira ◽  
Wellington Pereira da Silva ◽  
Eliete Maria Silva
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Primary Healthcare ◽  
Healthcare Services ◽  
Health Plans ◽  
Access To Health Services ◽  
Primary Health ◽  
Study Selection ◽  
Access To Health ◽  
Access To Primary Care

ABSTRACT Objective: Analyze the scientific production that describes the type of access to primary healthcare services and identify specific populations that have differentiated access to health services. Method: An integrative review. For study selection, the following databases were used: PubMed, Scopus, Bireme, and Cinahl. The sample included 22 national and international articles. Results: The results describe the access of specific populations to health services, the access to primary care through health plans and proposed improvements to the access to primary care. Conclusion: The access to services is a challenge in many countries and some strategies and policies are implemented to solve and improve primary health care.

scholarly journals Healthcare Providers’ Perceptions of Potentially Preventable Rural Hospitalisations: A Qualitative Study

2021 ◽  
Vol 18 (23) ◽  
pp. 12767
Author(s):  
Andrew Ridge ◽  
Gregory M. Peterson ◽  
Bastian M. Seidel ◽  
Vinah Anderson ◽  
Rosie Nash
Keyword(s):  
Primary Care ◽  
Health Literacy ◽  
Rural Communities ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Patient Specific ◽  
Care Services ◽  
Access To Primary Care ◽  
Appointment Availability

Potentially preventable hospitalisations (PPHs) are common in rural communities in Australia and around the world. Healthcare providers have a perspective on PPHs that may not be accessible by analysing routine patient data. This study explores the factors that healthcare providers believe cause PPHs and seeks to identify strategies for preventing them. Physicians, nurses, paramedics, and health administrators with experience in managing rural patients with PPHs were recruited from southern Tasmania, Australia. Semi-structured telephone interviews were conducted, and reflexive thematic analysis was used to analyse the data. Participants linked health literacy, limited access to primary care, and perceptions of primary care services with PPH risk. The belief that patients did not have a good understanding of where, when, and how to manage their health was perceived to be linked to patient-specific health literacy challenges. Access to primary healthcare was impacted by appointment availability, transport, and financial constraints. In contrast, it was felt that the prompt, comprehensive, and free healthcare delivered in hospitals appealed to patients and influenced their decision to bypass rural primary healthcare services. Strategies to reduce PPHs in rural Australian communities may include promoting health literacy, optimising the delivery of existing services, and improving social support structures.

scholarly journals Factors associated with the utilisation of primary care services: a cross-sectional study in public and private facilities in Albania

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040398
Author(s):  
Jonila Gabrani ◽  
Christian Schindler ◽  
Kaspar Wyss
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Professional Associations ◽  
Primary Care Providers ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Public Facility ◽  
Care Providers ◽  
Cross Sectional ◽  
Factors Influencing

ObjectivesTo identify key factors influencing the utilisation of governmental and private primary healthcare services in Albania.DesignA cross-sectional health facility survey using a 4-point Likert scale questionnaire to rank the importance of factors driving services utilisation.SettingExit interviews with patients who consulted one of 23 primary care providers (18 public and 5 private) in Fier district of Albania from the period of July–August 2018.ParticipantsRepresentative sample of 629 adults ≥18 years of age.Main outcomes measures(1) Factors influencing the decision to visit a governmental or private primary care provider and (2) the association of sociodemographic characteristics and patients’ decision to attend a given provider. Data were analysed using mixed logistic regression models.ResultsNearly half of the participants in this study were older than 60 years (45%). The majority (63%) reported to suffer from a chronic condition. Prevailing determinants for choosing a provider were ‘quality of care’ and ‘healthcare professionals’ attitudes. Solely looking at patients using a public provider, ‘geographical proximity’ was the most important factor guiding the decision (85% vs 11%, p<0.001). For private provider’s patients, the ‘availability of diagnostic devices’ was the most important factor (69% vs 9%, p<0.001). The odds of using public facilities were significantly higher among the patients who perceived their health as poor (OR 5.59; 95% CI 2.62 to 11.92), suffered from chronic conditions (OR 3.13; 95% CI 1.36 to 7.24) or were benefiting from a socioeconomic aid scheme (OR 3.52; 95% CI 1.64 to 7.56).ConclusionThe use of primary healthcare is strongly influenced by geographical and financial access for public facility users and availability of equipment for private users. This study found that aspects of acceptability and adequacy of services are equally valued. Additional commitment to further develop primary care through engagement of local decision-makers and professional associations is needed.

scholarly journals O direito à saúde na atenção básica no MERCOSUL: a fraternidade como possibilidade de garantia de direitos sociais / The Right to Primary Healthcare in MERCOSUL: the Fraternity as a Possibility of Social Rights Guarantee

2019 ◽  
Vol 6 (2) ◽  
pp. 33-43
Author(s):  
Sandra Regina Martini ◽  
Maria Isabel Barros Bellini
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
International Organization ◽  
Social Rights ◽  
Economic Policies ◽  
Time Limits ◽  
Access To Primary Care ◽  
The Right ◽  
Dividing Line

ABSTRACTThis article discusses health as a fundamental and universal right therefore not limited to border demarcation, races and / or any other indicator . The analysis Locus is MERCOSUL- international organization between Brazil, Argentina , Paraguay and Uruguay established in 1991 to facilitate the integration of economic policies between these countries, it is associated with Chile and Bolivia. Discusses the importance of resizing the limits of law in today's society , for which the "frontier" is at the same time limits and possibilities between these to promote access to primary care as a bridge to the execution of other social rights thus breaking with traditional dimensions of the border or transfrontier idea where the right ended at the dividing line between one country and another.RESUMENEste artigo aborda a saúde como direito fundamental e universal portanto não limitado a demarcação de fronteiras, raças e/ou qualquer outro indicador. O Lócus de análise é o MERCOSUL -organização internacional entre Brasil, Argentina, Paraguai e Uruguai criada em 1991 para facilitar a integração de políticas econômicas entre estes países, tem como associados o Chile e Bolívia. Discute a importância de redimensionar os limites do direito na sociedade atual, para a qual a “fronteira” representa, ao mesmo tempo limites e possibilidades entre estas o de promover o acesso à atenção básica como uma ponte para a efetivação de outros direitos sociais rompendo assim com as dimensões tradicionais da ideia de fronteira ou transfronteira onde o direito terminava na linha divisória entre um país e outro. Tem como pressupostos teóricos o Direito Vivo e a Metateoria do Direito Fraterno e  aposta no pressuposto da fraternidade como uma possibilidade de agregação e superação das divisões postas pelas fronteiras.

scholarly journals Atrial fibrillation screening: feasible approaches and implementation challenges across Europe

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
D Engler ◽  
C Hanson ◽  
L Desteghe ◽  
G Boriani ◽  
S Z Diederichsen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Healthcare Services ◽  
Sufficient Evidence ◽  
Opportunistic Screening ◽  
Structured Interviews ◽  
Implementation Challenges ◽  
Access To Primary Care ◽  
Public Grant ◽  
Personal Devices

Abstract Background Atrial fibrillation (AF) screening has the potential to increase early detection and possibly reduce complications of AF. Guidelines recommend screening, but the most appropriate approaches are unknown. Purpose We aimed to explore the views of stakeholders across Europe about the opportunities and challenges of implementing four different AF screening scenarios. Method This qualitative study included 21 semi-structured interviews with healthcare professionals and regulators potentially involved in AF screening implementation in nine European countries. Data were analysed using thematic analysis. Results Three themes evolved. 1) Current approaches to screening: there are no national AF screening programmes, with most AF detected in symptomatic patients. Patient-led screening exists via personal devices, creating screening inequity by the reach of screening programmes being limited to those who access healthcare services. 2) Feasibility of screening approaches: single time point opportunistic screening in primary care using single lead ECG devices was considered the most feasible approach and AF screening may be possible in previously unexplored settings such as dentists and podiatrists. Software algorithms may aid identification of patients suitable for screening and telehealth services have the potential to support diagnosis. However, there is a need for advocacy to encourage the use of telehealth to aid AF diagnosis, and training for screening familiarisation and troubleshooting. 3) Implementation requirements: sufficient evidence of benefit is required. National rather than pan-European screening processes must be developed due to different payment mechanisms and health service regulations. There is concern that the rapid spread of wearable devices for heart rate monitoring may increase workload due to false positives in low risk populations for AF. Data security and inclusivity for those without access to primary care or personal devices must be addressed. Conclusions There is an overall awareness of AF screening. Opportunistic screening appears to be most feasible across Europe. Challenges that need to be addressed concern health inequalities, identification of best target groups for screening, streamlined processes, the need for evidence of benefit, and a tailored approach adapted to national realities. Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): H2020 Screening Scenarios  Graphical abstract

scholarly journals Pharmacies in informal settlements: a retrospective, cross-sectional household and health facility survey in four countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
◽  
Pauline Bakibinga ◽  
Caroline Kabaria ◽  
Ziraba Kasiira ◽  
Peter Kibe ◽  
...  
Keyword(s):  
Primary Care ◽  
Urban Poor ◽  
Informal Settlements ◽  
Healthcare Services ◽  
Cross Sectional ◽  
Large Cities ◽  
Adults And Children ◽  
Access To Primary Care ◽  
Facility Survey ◽  
Almost All

Abstract Background Slums or informal settlements characterize most large cities in LMIC. Previous evidence suggests pharmacies may be the most frequently used source of primary care in LMICs but that pharmacy services are of variable quality. However, evidence on pharmacy use and availability is very limited for slum populations. Methods We conducted household, individual, and healthcare provider surveys and qualitative observations on pharmacies and pharmacy use in seven slum sites in four countries (Nigeria, Kenya, Pakistan, and Bangladesh). All pharmacies and up to 1200 households in each site were sampled. Adults and children were surveyed about their use of healthcare services and pharmacies were observed and their services, equipment, and stock documented. Results We completed 7692 household and 7451 individual adults, 2633 individual child surveys, and 157 surveys of pharmacies located within the seven sites. Visit rates to pharmacies and drug sellers varied from 0.1 (Nigeria) to 3.0 (Bangladesh) visits per person-year, almost all of which were for new conditions. We found highly variable conditions in what constituted a “pharmacy” across the sites and most pharmacies did not employ a qualified pharmacist. Analgesics and antibiotics were widely available but other categories of medications, particularly those for chronic illness were often not available anywhere. The majority of pharmacies lacked basic equipment such as a thermometer and weighing scales. Conclusions Pharmacies are locally and widely available to residents of slums. However, the conditions of the facilities and availability of medicines were poor and prices relatively high. Pharmacies may represent a large untapped resource to improving access to primary care for the urban poor.

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