Decentralised Delivery of Primary Healthcare Services in Urban Slums of Odisha, India

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

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

10.21203/rs.2.17010/v2 ◽

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.

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

10.21203/rs.2.17010/v4 ◽

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.

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

10.21203/rs.2.17010/v1 ◽

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.

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Funding models and expenditures with primary healthcare in Salvador, Bahia, Brazil metropolitan area

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.551 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

T Vivas ◽

M Duarte ◽

A Pitta ◽

B Christovam

Keyword(s):

Public Health ◽

Metropolitan Area ◽

Primary Healthcare ◽

Healthcare Services ◽

Ministry Of Health ◽

Healthcare Budget ◽

Health Budget ◽

The Public ◽

Before And After ◽

The Government

Abstract Background The government investments in quality primary healthcare are the basis to strengthening the health systems and monitoring the public expenditure in this area is a way to assess the effectiveness and efficiency of the public health policies. The Brazil Ministry of Health changed, in 2017, the method of onlending federal resources to states and cities seeking to make the public funds management more flexible. This change, however, suppressed mandatory investments in primary healthcare. This research aims to determine the difference of expenditures on primary healthcare in Salvador, Bahia, Brazil metropolitan area before and after this funding reform, seeking to verify how it can impact the quality of primary healthcare services and programs. Methods This is an ecological time-series study that used data obtained in the Brazil Ministry of Health budget reports. The median and interquartile range of expenditures on primary healthcare (set as the percentage of total public health budget applied in primary care services and programs) of the 13 cities in the Salvador metropolitan area were compared two years before and after the reform. Results The median of expenditures on primary healthcare in Salvador metropolitan area was 25.5% (13,9% - 32,2%) of total public health budget before and 24.8% (20.8% - 30.0%) of total public health budget after the reform (-0.7% difference). Seven cities decreased the expenditures on primary healthcare after the reform, ranging from 1.2% to 10.8% reduction in the primary healthcare budget in five years. Conclusions Expenditures on primary healthcare in Salvador metropolitan area decreased after the 2017 funding reform. Seven of 13 cities reduced the government investments on primary healthcare services and programs in this scenario. Although the overall difference was -0.7%, the budget cuts ranged from 1.2% to 10.8% in the analyzed period and sample. More studies should assess these events in wide areas and with long time ranges. Key messages Public health funding models can impact the primary healthcare settings regardless of the health policy. Reforms in the funding models should consider the possible benefits before implementation. Funding models and methods that require mandatory investments in primary healthcare may be considered over more flexible ones.

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Effective supervision model for improved primary healthcare services: case of Egypt

The International Journal of Health Planning and Management ◽

10.1002/hpm.3098 ◽

2020 ◽

Author(s):

Madiha Said Abdel‐Razik ◽

Fayrouz El‐Aguizy ◽

Ghada Wahby ◽

Ahmed Samir Elsayad ◽

Eman Moawad Elhabashi

Keyword(s):

Primary Healthcare ◽

Healthcare Services ◽

Supervision Model ◽

Effective Supervision

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What was the impact of a participatory research project in Australian Indigenous primary healthcare services? Applying a comprehensive framework for assessing translational health research to Lessons for the Best

BMJ Open ◽

10.1136/bmjopen-2020-040749 ◽

2021 ◽

Vol 11 (2) ◽

pp. e040749

Author(s):

Shanthi Ann Ramanathan ◽

Sarah Larkins ◽

Karen Carlisle ◽

Nalita Turner ◽

Ross Stewart Bailie ◽

...

Keyword(s):

Learning Community ◽

Primary Healthcare ◽

Health Research ◽

Return On Investment ◽

Health Centre ◽

Healthcare Services ◽

Secondary Outcome ◽

Cost Consequence ◽

Comprehensive Framework ◽

The Impact

ObjectivesTo (1) apply the Framework to Assess the Impact from Translational health research (FAIT) to Lessons from the Best to Better the Rest (LFTB), (2) report on impacts from LFTB and (3) assess the feasibility and outcomes from a retrospective application of FAIT.SettingThree Indigenous primary healthcare (PHC) centres in the Northern Territory, Australia; project coordinating centre distributed between Townsville, Darwin and Cairns and the broader LFTB learning community across Australia.ParticipantsLFTB research team and one representative from each PHC centre.Primary and secondary outcome measuresImpact reported as (1) quantitative metrics within domains of benefit using a modified Payback Framework, (2) a cost-consequence analysis given a return on investment was not appropriate and (3) a narrative incorporating qualitative evidence of impact. Data were gathered through in-depth stakeholder interviews and a review of project documentation, outputs and relevant websites.ResultsLFTB contributed to knowledge advancement in Indigenous PHC service delivery; enhanced existing capacity of health centre staff, researchers and health service users; enhanced supportive networks for quality improvement; and used a strengths-based approach highly valued by health centres. LFTB also leveraged between $A1.4 and $A1.6 million for the subsequent Leveraging Effective Ambulatory Practice (LEAP) Project to apply LFTB learnings to resource development and creation of a learning community to empower striving PHC centres.ConclusionRetrospective application of FAIT to LFTB, although not ideal, was feasible. Prospective application would have allowed Indigenous community perspectives to be included. Greater appreciation of the full benefit of LFTB including a measure of return on investment will be possible when LEAP is complete. Future assessments of impact need to account for the limitations of fully capturing impact when intermediate/final impacts have not yet been realised and captured.

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Primary healthcare services and maternal mortality in Ugep

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2021.102691 ◽

2021 ◽

pp. 102691

Author(s):

Ogadimma Arisukwu ◽

Stephen Akinfenwa ◽

Chisaa Igbolekwu

Keyword(s):

Maternal Mortality ◽

Primary Healthcare ◽

Healthcare Services

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Views and experiences of family physicians about Syrian refugee patients in Turkey: a qualitative research

Primary Health Care Research & Development ◽

10.1017/s1463423621000190 ◽

2021 ◽

Vol 22 ◽

Author(s):

Duygu Ayhan Baser ◽

Özge Mıhcı ◽

Meltem Tugce Direk ◽

Mustafa Cankurtaran

Keyword(s):

Primary Healthcare ◽

Asylum Seekers ◽

Health Care Services ◽

Qualitative Methodology ◽

Healthcare Delivery ◽

Family Physicians ◽

Healthcare Services ◽

Free Access ◽

Structured Interviews ◽

Syrian Refugee

Abstract Aim: The aim of this study was to describe the attitudes, views and solution proposals of family physicians (FPs) about primary healthcare problems of Syrian refugee patients. This study would be the very first study for Turkey that evaluates the attitudes, views and solution proposals of FPs about primary healthcare problems of Syrian refugee patients. Background: Following the anti-regime demonstrations that started in March 2011, the developments in Syria created one of the biggest humanitarian crises in the world and the largest number of asylum seekers continue to be hosted in Turkey. There are some studies evaluating asylum seekers’ access to healthcare services in Europe, and the common result is that refugees have free access to primary healthcare services in most countries; however, they face many obstacles when accessing primary healthcare services. While there are studies in the literature evaluating the situation of access to primary healthcare services from the perspective of asylum seekers; there are few studies evaluating the opinions/views of FPs. Methods: A qualitative methodology informed by the grounded theory was used to guide the research. A total of 20 FPs were interviewed face to face through semi-structured interviews, using 12 questions about their lived experience and views caring of refugee population. Interviews were analysed thematically. Finding: The following themes were revealed: Benefiting from Primary Health Care Services, Benefiting from Rights, Differences Between the Approach/Attitudes of Turkish Citizens and Refugees, Barriers to Healthcare Delivery, Training Needs of Physicians, Solution proposals. FPs reported that there is a need for support in primary care and a need for training them and refugees in this regard and they specified refugee healthcare centres are the best healthcare centres for refugees; however, the number of these and provided services should be increased.

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