scholarly journals A Sociotechnical Approach to Analyse Pharmaceutical Policy And Services In Primary Health Care

2020 ◽  
Author(s):  
Noemia Liege Maria Cunha Bernardo ◽  
Luciano Soares ◽  
Silvana Nair Leite
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Municipal Government ◽  
Central Element ◽  
Access To Medicines ◽  
Pharmaceutical Policy ◽  
Sociotechnical System ◽  
Primary Health ◽  
Social Components

Abstract Background: Access to medicines and its rational use are persistent global concerns. It have a major impact on the quality and sustainability of the health system and on the health outcomes. In Brazil, access to medicines is a legal right and municipal government have the duty to ensure access and the best use of medicines in primary health care public facilities, stablishing the local Pharmaceutical Policy and Services (PPS) system. This article presents and analyses an innovative experience of diagnosis of municipal PPS as a sociotechnical system, aiming to prepare the interventions in the system.Methods:We adopted a multi-methods approach and various data sources were used. Sociotechnical theory was the framework of the methodology of evaluation and design of systems, analysing the Components of External System (health system, stakeholders, financing) and Components of the Internal System (Goals, Management, Workforce, Infrastructure, Processes, Technology and Culture).Results:The component “aim” was identified as the central element of the system. The other system components interrelate with its scope. Medicines availability was a key part of the PPS architecture. Lack of central coordination, pharmaceutical services without central management and a fragmented organization prevented an integrated internal planning, and with other sectors. The stakeholders and documents referred only technical elements of the system: infrastructure, technical process and technology. The social components of workforce and culture were not mentioned in the Municipal Health Plan. People are essential socio-technical elements, as well the components affecting them, but they are not privileged in the system. The organizational culture established was the culture of isolation: “each one does his own”.Conclusions:The municipal PPS emphasized medicines and technical components and had limited scope as a public policy. It had constrained the characteristics of a complex and open system. Stakeholders understood PPS as a set of technical processes, without planning or integration. PPS has had a great development in Brazil in the last twenty years. A new level of development to ensure the populations right to access of treatment requires a turning point of strategy to understand municipal PPS as a sociotechnical system.

scholarly journals Access to medicines by patients of the primary health care in the Brazilian Unified Health System

2017 ◽  
Vol 51 ◽  
pp. 20s ◽  
Author(s):  
Juliana Álvares ◽  
Augusto Afonso Guerra Junior ◽  
Vânia Eloisa de Araújo ◽  
Alessandra Maciel Almeida ◽  
Carolina Zampirolli Dias ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Developed Countries ◽  
Access To Medicines ◽  
Essential Medicines ◽  
Unified Health System ◽  
Primary Health ◽  
Significant Difference ◽  
Good For

OBJECTIVE: To evaluate the access to medicines in primary health care of the Brazilian Unified Health System (SUS), from the patients’ perspective. METHODS: This is a cross-sectional study that used data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos – Services, 2015 (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), conducted by interviews with 8,591 patients in cities of the five regions of Brazil. Evaluation of access to medicines used concepts proposed by Penshansky and Thomas (1981), according to the dimensions: availability, accessibility, accommodation, acceptability, and affordability. Each dimension was evaluated by its own indicators. RESULTS: For the “availability” dimension, 59.8% of patients reported having full access to medicines, without significant difference between regions. For “accessibility,” 60% of patients declared that the basic health unit (UBS) was not far from their house, 83% said it was very easy/easy to get to the UBS, and most patients reported that they go walking (64.5%). For “accommodation,” UBS was evaluated as very good/good for the items “comfort” (74.2%) and “cleanliness” (90.9%), and 70.8% of patients reported that they do not wait to receive their medicines, although the average waiting time was 32.9 minutes. For “acceptability,” 93.1% of patients reported to be served with respect and courtesy by the staff of the dispensing units and 90.5% declared that the units’ service was very good/good. For “affordability,” 13% of patients reported not being able to buy something important to cover expenses with health problems, and 41.8% of participants pointed out the expense with medicines. CONCLUSIONS: Results show 70%–90% compliance, which is compatible with developed countries. However, access to medicines remains a challenge, because it is still heavily compromised by the low availability of essential medicines in public health units, showing that it does not occur universally, equally, and decisively to the population

scholarly journals A Sociotechnical Approach to Analyze Pharmaceutical Policy and Services Management in Primary Health Care in a Brazilian Municipality

Pharmacy ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 39
Author(s):  
Noemia Liege Maria da Cunha Bernardo ◽  
Luciano Soares ◽  
Silvana Nair Leite
Keyword(s):  
Health System ◽  
Central Element ◽  
Pharmaceutical Policy ◽  
Work Processes ◽  
Policy And Practice ◽  
Sociotechnical System ◽  
Integration Strategy ◽  
The Social ◽  
Central Coordination ◽  
Social Components

The decentralization of the Brazilian health system required that municipalities took responsibility for the local Pharmaceutical Policy and Services (PPS) system. This article presents and analyses an innovative experience of diagnosis of municipal PPS as a sociotechnical system. We adopted a multi-methods approach and various data sources. Sociotechnical theory was the framework of the methodology of evaluation and design of systems, analyzing the External System (health system, stakeholders, financing) and Internal System (goals, management, workforce, infrastructure, processes, technology and culture). The “objective” component of the PPS system was identified as the central element. The lack of a unified objective and of a central coordination and unmanaged pharmaceutical services prevented integrated internal planning and planning with other sectors. Stakeholders and documents referred only to technical elements of the system: Infrastructure, technical process, and technology. The social components of the workforce and culture were not mentioned. The organizational culture established was the culture of isolation: “Each one does his own”. The pharmacists working in the municipal health system did not know each other. There was no integration strategy between pharmacists and their work processes. Consequently, the municipal PPS had limited scope as a public policy. It had constrained the characteristics of PPS as a complex and open system. Understanding the municipal PPS as a sociotechnical system can push the development of a new level of policy and practice to ensure the population’s right to the access to and rational use of medicines.

scholarly journals Management of pharmaceutical services in the Brazilian primary health care

2017 ◽  
Vol 51 (suppl.2) ◽  
Author(s):  
Letícia Farias Gerlack ◽  
Margô Gomes de Oliveira Karnikowski ◽  
Camila Alves Areda ◽  
Dayani Galato ◽  
Aline Gomes de Oliveira ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Pharmaceutical Services ◽  
Limiting Factors ◽  
Health Board ◽  
Complex Samples ◽  
Financial Autonomy ◽  
Unified Health System ◽  
Primary Health

OBJECTIVE: To identify limiting factors in the management of pharmaceutical services in the primary health care provided by the Brazilian Unified Health System (SUS). METHODS: This study was based on the data from the Pesquisa Nacional sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM – National Survey on Access, Use and Promotion of Rational Use of Medicines), and it was conducted by interviews with professionals responsible for pharmaceutical services in Brazilian cities, in 2015. To identify the management limiting factors, we considered the organizational, operational, and sustainability indicators of the management. For the analyses, we included the weights and structure of analysis plan for complex samples. The results were expressed by frequencies and measures of central tendency with 95% confidence interval, considering the Brazilian geographic regions. RESULTS: We identified the following limiting factors: lack of pharmaceutical services in the Municipal Health Secretariat organization chart (24%) and in the health plan (18%); lack of participation of managers in the Health Board and the absence of reference to this topic in the agenda of meetings (58.4%); lack of financial autonomy (61.5%) and lack of knowledge on the available values (81.7%); lack of adoption of operational procedures (about 50%) for selection, scheduling, and acquisition; and the fact that most professionals evaluate the organization of pharmaceutical services as good and great (58.8%), despite the worrisome indicators. CONCLUSIONS: Pharmaceutical services management is currently supported by a legal and political framework that should guide and contribute to improve the pharmaceutical services in the Brazilian Unified Health System primary health care. However, there is a mismatch between the goals established by these guidelines and what is actually happening

scholarly journals Evaluation of Access on the perspective of adult users of Primary Health Care in Fortaleza, Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Borges Costa ◽  
C Salles Gazeta Vieira Fernandes ◽  
T Custódio Mota ◽  
E Torquato Santos ◽  
M Moura de Almeida ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health System ◽  
Assessment Tool ◽  
Health Coverage ◽  
Access To Health Services ◽  
Primary Health ◽  
Care Assessment ◽  
The City

Abstract The Alma-Ata Conference promoted Primary Health Care (PHC) worldwide as a form of universal and continuous access to quality and effective health services. In Brazil, PHC, through the Family Health Strategy (FHS), aims to be the gateway to the health system and its structuring axis. For this, it is necessary to promote access, an essential condition for the quality of health care services, following the attributes systematized by Barbara Starfield. The aim of this study was to evaluate the presence of the attribute “First Contact Access” on the perspective of adult users of public PHC services in the city of Fortaleza, Ceará, Brazil. A transversal study was carried out, in 19 PHC Units, from June to December 2019, using the Primary Care Assessment Tool (PCATool) Brazil version for adult users. Kruskal-Wallis test was used for statistical analysis. 233 users participated, mostly women (69.5%), aged 30 to 59 years old (55.3%), mixed-race (69.5%), with complete high school (38.2%), without private health coverage (89.3%), homeowners (68.7%) and belonging to families of up to 4 members (87.9%). The “Accessibility” component had the lowest score, 2.83, and the “Utilization” had the highest score, 8.06. Older age was associated with higher “Accessibility” scores (p = 0,018), while lower values of “Utilization” were associated with higher education (p = 0,004). The main problems observed were: low access for acute demand consultations, lack of access at nighttime and weekends, little access through non-personal ways, bureaucratic barriers and a long time for scheduling appointments. We conclude that, although there was an improvement in PHC coverage in the city over the years, mainly due to FHS, there is still a lot to improve to ensure timely access to health services. Key messages Users consider PHC as the usual source of care, demonstrated by the high score of 'Utilization', however, they are unable to use it when necessary, demonstrated by the low score of 'Accessibility'. Expanding forms of access is essential to contribute to the strengthening of PHC in Fortaleza, Brazil, facilitating the entry to its national Universal Health System.

scholarly journals 8.2. Prospects for the use of a comprehensive assessment of the resource potential of medical organizations

2020 ◽  
Author(s):  
С.С. Бударин ◽  
Ю.В. Эльбек
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Comprehensive Assessment ◽  
State Health ◽  
Resource Potential ◽  
Primary Health ◽  
Potential Use

Статья посвящена рассмотрению методики комплексной оценки ресурсного потенциала медицинских организаций, оказывающих населению первичную медико-санитарную помощь. Предложена система показателей оценки эффективности использования ресурсного потенциала по трем направлениям – экономичность, продуктивность, результативность, – сформированная с использованием элементов методологии аудита эффективности. На основании данных медицинских организаций государственной системы здравоохранения г. Москвы, выбранных для исследования, рассчитана комплексная оценка их ресурсного потенциала. The article is devoted to the method of complex assessment of the resource potential of medical organizations that provide primary health care to the population. A system of indicators for evaluating the effectiveness of resource potential use in three areas: Efficiency, Productivity, and Effectiveness, formed using elements of the efficiency audit methodology. A comprehensive assessment of their resource potential is calculated, based on the data of medical organizations of the Moscow state health system selected for the study.

Resolution And Continuity Of Primary Health Care: Reference And Counter-Reference In The Sus (Unified Health System)

2017 ◽  
Vol 04 (01) ◽  
Author(s):  
Maria Beatriz Rodrigues Criscuolo ◽  
Duane Ferreira Melo ◽  
Selma Maria da Fonseca Viegas
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Unified Health System ◽  
Primary Health

What are the roles of community health workers? Looking back at the philosophies of primary health care

2019 ◽  
Vol 27 (2) ◽  
pp. 117-120
Author(s):  
Marietou Niang
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Development ◽  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Primary Health ◽  
Looking Back

This commentary discusses the different roles of community health workers (CHWs), their challenges and limitations in a historical perspective of primary health care (PHC). We first try to show that the comprehensive philosophy of PHC promulgated in Alma-Ata proposed the role of CHWs as actors who work in community development. On the other hand, in the 1980s, with the emergence of the selective philosophy of PHC, CHWs’ role was more affiliated with the health system. We conclude our pitch about the balance that can exist between these different roles by suggesting that CHWs can work in continuity with the health system, but they should not be considered as affordable labor. Also, they must be supported in their activities to develop their communities, allowing them to participate effectively in programs and policies that concern them and their community.

The development of rural primary health care in China’s health system reform

2015 ◽  
Vol 8 (1) ◽  
pp. 88-101 ◽  
Author(s):  
Xiaoyun Liu ◽  
Shichao Zhao ◽  
Minmin Zhang ◽  
Dan Hu ◽  
Qingyue Meng
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
System Reform ◽  
Health System Reform ◽  
Primary Health

scholarly journals The Technical Feasibility of Integrating Primary Eye Care Into Primary Health Care Systems in Nigeria: Protocol for a Mixed Methods Cross-Sectional Study (Preprint)

2019 ◽  
Author(s):  
Ada Aghaji ◽  
Helen Burchett ◽  
Shaffa Hameed ◽  
Jayne Webster ◽  
Clare Gilbert
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Assessment Tools ◽  
Sub Saharan Africa ◽  
Eye Care ◽  
Technical Feasibility ◽  
Primary Eye Care ◽  
Primary Health ◽  
Sub Saharan

BACKGROUND Approximately 90% of the 253 million blind or visually impaired people worldwide live in low- and middle-income countries. Lack of access to eye care is why most people remain or become blind. The World Health Organization Regional Office for Africa (WHO-AFRO) recently launched a primary eye care (PEC) package for sub-Saharan Africa—the WHO-AFRO PEC package—for integration into the health system at the primary health care (PHC) level. This has the potential to increase access to eye care, but feasibility studies are needed to determine the extent to which the health system has the capacity to deliver the package in PHC facilities. OBJECTIVE Our objective is to assess the technical feasibility of integrating the WHO-AFRO PEC package in PHC facilities in Nigeria. METHODS This study has several components, which include (1) a literature review of PEC in sub-Saharan Africa, (2) a Delphi exercise to reach consensus among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it in PHC facilities, (3) development of PEC technical capacity assessment tools, and (4) data collection, including facility surveys and semistructured interviews with PHC staff and their supervisors and village health workers to determine the capacities available to deliver PEC in PHC facilities. Analysis will identify opportunities and the capacity gaps that need to be addressed to deliver PEC. RESULTS Consensus was reached among experts regarding the technical complexity of the WHO-AFRO PEC package and the capacities needed to deliver it as part of PHC. Quantitative tools (ie, structured questionnaires, in-depth interviews, and observation checklists) and topic guides based on agreed-upon technical capacities have been developed and relevant stakeholders have been identified. Surveys in 48 PHC facilities and interviews with health professionals and supervisors have been undertaken. Capacity gaps are being analyzed. CONCLUSIONS This study will determine the capacity of PHC centers to deliver the WHO-AFRO PEC package as an integral part of the health system in Nigeria, with identification of capacity gaps. Although capacity assessments have to be context specific, the tools and findings will assist policy makers and health planners in Nigeria and similar settings, who are considering implementing the package, in making informed choices. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/17263

scholarly journals The Concept of Gynecologic Oncology Services in Jakarta Related to Academic Health System

2017 ◽  
Author(s):  
Sigit Purbadi
Keyword(s):  
Health Care ◽  
Cervical Cancer ◽  
Primary Health Care ◽  
Health System ◽  
Gynecologic Oncology ◽  
Academic Health ◽  
Primary Health ◽  
Education Training ◽  
Precancer Lesion ◽  
Training Service

An Academic Health System (AHS) is a system in partnership among universities and health care providers that focuses on education, training, service, and research. The final outcome of this partnership is to improve health status. Numerous countries have been using this system, since this system is proven to lead to better sustainable outcome.The vision of Faculty of Medicine, University of Indonesia (FMUI) is "to create infinite experience for all through Academic Health System". The third mission of FMUI is to integrate the AHS to Dr. CiptoMangunkusumo Hospital and its other affiliated hospitals.The division of Oncology Department of Obstetrics and Gynecology is a part of Academic Health System that is responsible to create the Gynecologic Oncology services in this system. We create the gynecologiconcology services in preventive approach from primary to tertiary prevention.The sister hospitals of FMUI’s including Dr. Cipto Manungunkusumo, Persahabatan, Fatmawati, Karawang, and Tangerang General Hospital. Ideally, we should have health provider partners from primary, DistrictHospital (Rumah Sakit Umum Kecamatan/RSUK and Rumah Sakit Umum Daerah/RSUD). Another partner in collaborative project of AHS is Organization of Health Care Professions, such as Indonesian Medical Association, Indonesian Obstetrics and Gynecology Society, and Indonesian Gynecologic Oncology Society, and nongovernmental organization such as Female Cancer Program, Indonesian Cancer Foundation and others are part of partnership in AHS. When talking about public health status, it is also necessary to talk about the role of government as the policy maker and The Social Warranty Institution (Badan Penyelenggara Jaminan Sosial Kesehatan, BPJS) as the public health care insurance regulator. Primary health care should be included in the AHS’s partnership members because primary prevention strategy should be conducted in primary health care.The example of this project is Cervical Cancer Surveilance as a pilot project. We would prepare the project in collaborative meeting with all partners to make proposal in gynecologic oncology services in primary,secondary, and tertiary health care, and finally Dr. Cipto Mangunkusumo Hospital as the national referral Hospital. The proposal should talk about concepts of education, training, service, and research. Primary health care can promote cervical prevention and early detection via visual inspection using acetic acid and Pap test.Cervical precancer lesion can be treated using cryotherapy in primary health care. In secondary health care setting, cervical precancer lesion until microinvasive cervical cancer (stage 1A1) can be treated. Invasive cervical cancer should be managed in tertiary health care. We are preparing concepts where all services should follow the Clinical Practice Guideline. All medical patient database should be recorded digitally as long term cohort data. By applying this system, we’ll have a large number of patients’ data from primary to tertiary health care.This is crucial, considering that the process of education, training, and research of medical students, residents, and fellows is the backbone of AHS in improving health care status.

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