Implementing the district health system in the framework of primary health care in Pakistan: can the evolving reforms enhance the pace towards the Millennium Development Goals?

Background: Burnout among doctors negatively affects health systems and, ultimately,patient care.Aim: To determine the prevalence of burnout among doctors working in the district health system in the Overberg and Cape Winelands districts of the Western Cape Province and to compare the findings with those of previous South African studies.Setting: Rural district hospitals.Methods: During 2013, a validated questionnaire (Maslach Burnout Inventory) was sent to 42 doctors working in the district health system within the referral area of the Worcester Hospital, consisting of the Overberg health district and the eastern half of the Cape Winelands.Results: Response rate was 85.7%. Clinically significant burnout was found among 81% of respondents. High levels of burnout on all three subscales were present in 31% of participants.Burnout rates were similar to those of a previous study conducted among doctors working in the Cape Town Metropolitan Municipality primary health care facilities. Scores for emotional exhaustion (EE) and depersonalisation (DP) were greater than those of a national survey;however, the score for personal accomplishment (PA) was greater. EE and PA scores weresimilar to that of a study of junior doctors working in the Red Cross Children’s Hospital;however, EE was smaller.Conclusion: This study demonstrates high burnout rates among doctors working at district level hospitals, similar to the prevalence thereof in the Cape Town Metropolitan primary health care facilities. Health services planning should include strategies to address and prevent burnout of which adequate staffing and improved work environment are of prime importance.

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Health system capacity and readiness for delivery of integrated non-communicable disease services in primary health care: A qualitative analysis of the Ethiopian experience

PLOS Global Public Health ◽

10.1371/journal.pgph.0000026 ◽

2021 ◽

Vol 1 (10) ◽

pp. e0000026

Author(s):

Azeb Gebresilassie Tesema ◽

Seye Abimbola ◽

Afework Mulugeta ◽

Whenayon S. Ajisegiri ◽

Padmanesan Narasimhan ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Health System ◽

Communicable Disease ◽

Addis Ababa ◽

System Capacity ◽

World Health ◽

Political Commitment ◽

District Health ◽

Primary Health

Background Non-communicable diseases (NCDs) now account for about 71% and 32% of all the deaths globally and in Ethiopia. Primary health care (PHC) is a vital instrument to address the ever-increasing burden of NCDs and is the best strategy for delivering integrated and equitable NCD care. We explored the capacity and readiness of Ethiopia’s PHC system to deliver integrated, people-centred NCD services. Methods A qualitative study was conducted in two regions and Federal Ministry of Health, Addis Ababa, Ethiopia. We carried out twenty-two key informant interviews with national and regional policymakers, officials from a partner organisation, woreda/district health office managers and coordinators, and PHC workers. Data were coded and thematically analysed using the World Health Organization (WHO) Operational Framework for PHC. Results Although the rising NCD burden is well recognised in Ethiopia, and the country has NCD-specific strategies and some interventions in place, we identified critical gaps in several levers of the WHO Operational Framework. Many compared the under-investment in NCDs contrasted with Ethiopia’s successful PHC models established for maternal and child health and communicable disease programs. Insufficient political commitment and leadership required to integrate NCD services at the PHC level and weaknesses in governance structures, inter-sectoral coordination, and funding for NCDs were identified as significant barriers to strengthening PHC capacity to address NCDs. Among the operational-focussed levers, fragmented information management systems and inadequate equipment and medicines were identified as critical bottlenecks. The PHC workforce was also considered insufficiently skilled and supported to provide NCD services in PHC facilities. Conclusion Strengthening NCD prevention and control through PHC in Ethiopia requires greater political commitment and investment at all health system levels. Prior success strategies with other PHC programs could be adapted and applied to NCD policies and practice, giving due consideration for the unique nature of the NCD program.

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Management of pharmaceutical services in the Brazilian primary health care

Revista de Saúde Pública ◽

10.11606/s1518-8787.2017051007063 ◽

2017 ◽

Vol 51 (suppl.2) ◽

Cited By ~ 3

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

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A job analysis of selected health workers in a district health system in KwaZulu Natal - Part two: Job analysis of nurses in primary health care settings

Curationis ◽

10.4102/curationis.v26i3.829 ◽

2003 ◽

Vol 26 (3) ◽

Cited By ~ 8

Author(s):

S Mbambo

Keyword(s):

Health System ◽

Current Practice ◽

Health Workers ◽

Job Analysis ◽

District Health ◽

District Health System ◽

Primary Health ◽

Kwazulu Natal ◽

Descriptive Survey ◽

Primary Health Care Settings

The aim of this descriptive survey was to do a job analysis of different categories of nurses in a District Health System in order to clarify job expectations, describe current practice of nurses in hospitals and clinics and to make recommendations about skills mix in district services. This article deals with the clinics only.

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

Revista de Saúde Pública ◽

10.11606/s1518-8787.2017051007139 ◽

2017 ◽

Vol 51 ◽

pp. 20s ◽

Cited By ~ 3

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

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