Requirements for Creating a Position for Community Health Nursing Within the Iranian Primary Health Care System: A SWOT Analysis

Background: Accepting community health nursing in the primary care system of each country and focusing on creating a position for community health nurses is of significant importance. The aim of this study was to examine the stakeholders' perception of the requirements for establishing a position for community health nursing in the Iranian primary health care system.Methods: This qualitative study was done using 24 semi-structured interviews conducted from May 2020 to February 2021 in Iran. The participants were selected through purposive sampling and consisted of nursing policy makers, the policy makers of the Health Deputy of Ministry of Health, the managers and the authorities of universities of medical sciences all across the country, community health nursing faculty members, and community health nurses working in health care centers. After recording and transcribing the data, data analysis was performed in MAXQDA10 software, using Elo and Kyngas's directed content analysis approach and based on WHO's community health nursing role enhancement model. The statements for each main category were summarized in SWOT classification. To examine the trustworthiness of the data, Lincoln & Guba's criteria were used.Results: By analyzing the interviews 6 main categories identified consist of creating a transparent framework for community health nursing practice, enhancing community health nursing education and training for practice in the primary health care system and community settings, seeking support, strengthening the cooperation and engagement among the key stakeholders of the primary health care system, changing the policies and the structure of the health system, and focusing on the deficiencies of the health system. Each main categories including the subcategories strengths, weaknesses, opportunities and threats (SWOT).Conclusions: Based on the participants' opinions, focusing on the aforementioned dimensions is one of the requirements of developing a position for community health nursing within the Iranian PHC system. It seems that correct and proper implementation of these strategies in regard with the cultural context of society can help policymakers manage challenges that prevent the performance of community health nursing in the health system.

Recent Advances of the Medicinal Plant Compound for Combating Pneumonia Disease: A Review

Bacteria, influenza, parasites and fungi are pathogenic microorganisms that cause infectious diseases. Diseases can spread from one individual to another, either directly or indirectly. Infectious diseases are world’s second most common cause of death. Rainforest plants provide about quarter of drugs we need. Scientific research has been carried out on few medicinal plants, but only to small degree. Bacterial susceptibility to currently active antibiotics has necessitated discovery of new antibacterial agents. Several plants are widely used as herbal medicine for treatment of infectious diseases in rural and backward areas of India. This chapter looks over the publications on medicinal plants that are used to cure diseases like malaria, pneumonia. Traditional medicine is preferred primary health care system in many rural areas for variety of reasons, including its affordability and efficacy. The current study focused on existing medicinal plant literature, with ethnobotany, phytochemistry and pharmacology details being highlighted. All of examined plants showed potent action, supporting their conventional uses as well as their ability to cure common diseases. Curcuma longa L., Punica granatum L. and Justicia adhatoda L. were most widely used plant families for pneumonia therapy in research area (each with seven plants); of these, Curcuma longa L., Punica granatum L. and Justicia adhatoda L. had most inhibiting ability against Staphylococcus aureus and Streptococcus pneumoniae. Ascorbic acid, curcumin, vasicine, piperine, quercetin, myricetin and gallic acid have all been derived from these plants and are said to have antibacterial properties. Although Himalayan region has wide range of ethnomedicinal plants used to treat pneumonia, research on in-vivo activity, toxicology, and mechanism of action is minimal. As result, in order to produce novel antibacterial drugs from studied plant species, thorough study of these aspects is needed.

Evolution of Non-communicable Disease Programs in Kerala: Lessons Learnt and the Way Forward

Addressing the double burden of disease in a country like India is a massive challenge, especially when the system is tuned to do monitoring and surveillance of mainly communicable diseases. Achieving the sustainable development goal target 3.4 to bring down the premature mortality from non-communicable diseases (NCDs) to one-third will need to consider the requirement of robust indicators at the national level to keep track of the prevalence of NCD and its risk factors among its population. The state of Kerala in contrast has a strong primary health care system that it can build on to address the rising NCD burden.

Funding Populations and Paying Providers: The Role of Financial Risk in the New Zealand Primary Health Care Strategy

<p>This thesis examines how funding changes in the New Zealand Primary Health Care Strategy (NZPHCS), introduced in 2002, altered the magnitude, locus and management of financial risk in the New Zealand primary health care sector, and the consequences for cost, equity and care delivery objectives. A simplified model of a primary health care system is developed to explore how the funding changes influenced, and were influenced by, existing institutions and arrangements in the New Zealand sector. Drawing on industrial organisation, transaction cost economics, health economics and health care policy literatures and analysis, financial risk sharing between the government and private entities before and after the NZPHCS implementation is assessed. The effects of the policy on a range of indicators assessing the relative, theoretically-expected changes in costs and equitable allocation of financial and health care resources are identified. The NZPHCS was intended to reduce service user fees, foster an integrated multidisciplinary approach to primary care delivery, reduce health inequalities and encourage the promotion and maintenance of healthy populations. Progress towards thesem objectives was disappointing. The government abrogated responsibility for managing financial risks associated with uncertainty about funded individuals’ future care needs when replacing fee-for-service funding with capitation funding of individuals within a population. Very small, risk-averse care providers became the primary risk pool managers. Via legacy balance-billing arrangements, much higher risk management costs have likely been passed on to service users in either or both of higher-than-expected fees and more variable care quality. Those with the greatest needs for primary care, and those whose fees the government intended to reduce most, have most probably borne a disproportionately higher share of the additional financial risk management costs. If the New Zealand primary health care system is to evolve towards the one envisaged by the NZPHCS, the government should assume a share of responsibility for managing financial risks associated with utilisation uncertainty. A mixed funding model, proposed and evaluated against the NZPHCS and three other policy options, provides risk management arrangements most likely to be conducive to delivering the desired cost and equity objectives. At the same time it provides a more stable path towards a fully government-funded New Zealand primary health care sector than the current arrangements. The findings specifically address the New Zealand context. However, the model and analytical framework developed are applicable to a wide range of primary health care policies, notably where partial private funding is either utilised or contemplated, and changes from service-based to population-based funding are being considered.</p>

Funding Populations and Paying Providers: The Role of Financial Risk in the New Zealand Primary Health Care Strategy

<p>This thesis examines how funding changes in the New Zealand Primary Health Care Strategy (NZPHCS), introduced in 2002, altered the magnitude, locus and management of financial risk in the New Zealand primary health care sector, and the consequences for cost, equity and care delivery objectives. A simplified model of a primary health care system is developed to explore how the funding changes influenced, and were influenced by, existing institutions and arrangements in the New Zealand sector. Drawing on industrial organisation, transaction cost economics, health economics and health care policy literatures and analysis, financial risk sharing between the government and private entities before and after the NZPHCS implementation is assessed. The effects of the policy on a range of indicators assessing the relative, theoretically-expected changes in costs and equitable allocation of financial and health care resources are identified. The NZPHCS was intended to reduce service user fees, foster an integrated multidisciplinary approach to primary care delivery, reduce health inequalities and encourage the promotion and maintenance of healthy populations. Progress towards thesem objectives was disappointing. The government abrogated responsibility for managing financial risks associated with uncertainty about funded individuals’ future care needs when replacing fee-for-service funding with capitation funding of individuals within a population. Very small, risk-averse care providers became the primary risk pool managers. Via legacy balance-billing arrangements, much higher risk management costs have likely been passed on to service users in either or both of higher-than-expected fees and more variable care quality. Those with the greatest needs for primary care, and those whose fees the government intended to reduce most, have most probably borne a disproportionately higher share of the additional financial risk management costs. If the New Zealand primary health care system is to evolve towards the one envisaged by the NZPHCS, the government should assume a share of responsibility for managing financial risks associated with utilisation uncertainty. A mixed funding model, proposed and evaluated against the NZPHCS and three other policy options, provides risk management arrangements most likely to be conducive to delivering the desired cost and equity objectives. At the same time it provides a more stable path towards a fully government-funded New Zealand primary health care sector than the current arrangements. The findings specifically address the New Zealand context. However, the model and analytical framework developed are applicable to a wide range of primary health care policies, notably where partial private funding is either utilised or contemplated, and changes from service-based to population-based funding are being considered.</p>

Risk factors and mortality profile of post neonatal deaths; 1 month to 1 year, in a rural medical college hospital, South India

Background: Infant mortality is the most important indicator which reflect country growth standards and development. This study was aimed to assess the risk factors and clinical profile of post neonatal deaths, admitted in PICU, government Villupuram medical college.Methods: A retrospective analysis was done on post neonatal mortality data by pediatric department of government Villupuram medical college, Mundiyambakkam from January 2019 to December 2020, referral and LAMA patients were excluded from study. Data was analyzed using SPSS 18.0Results: Overall post neonatal mortality was 7.3%. Mortality amongst boys were 28 (41.1%) and girls were 40 (58.8%). Mortality of female babies were higher than male babies.Among the 68 post neonatal deaths, maximum number of mortalities was seen in 1-3 months (61.9%), maximum within 24 hours of hospital stay (54.4%), 37 cases (54.4%) were referred from GHPHC and private practitioners of the nearby districts, 28 babies (41.1%) had previous admissions, 22 babies had SNCU admissions and 6 babies had pediatric admissions. Three most common causes of mortality were bronchopneumonia, sepsis and acute CNS infections. Congenital malformations and heart disease along with failure to thrive are other causes of morbidity.Conclusions: Analysis reflects the disease occurrence, treatment modalities and quality of treatment available. Treatment at primary level can prevent postnatal deaths from infections. The preventive and primary health care system should be strengthened. All special newborn care units (SNCU) discharged babies should have both community and district early intervention centre (DEIC) follow up, immunization practices, explaining danger signs to the parents, improving the quality of life has got great impact on the post neonatal outcome.

The CombiConsultation: a new concept of sequential consultation with the pharmacist and practice nurse/general practitioner for patients with a chronic condition.

The primary health care system is generally well organized for dealing with chronic diseases, but comprehensive medication management is still a challenge. Studies suggest that pharmacists can contribute to effective and safe drug therapy by providing services like a clinical medication review (CMR). However, several factors limit the potential impact of a CMR. Therefore, we propose a new pharmaceutical care service for patients with a chronic condition: the CombiConsultation. The CombiConsultation is a medication evaluation service conducted by the (community) pharmacist and either the practice nurse or general practitioner. It consists of 3 steps: medication check, implementation and follow-up. The pharmacist primarily focusses on setting treatment goals for 1 or 2 drug-related problems in relation to a specific chronic condition. In this manuscript we describe the process and characteristics of the CombiConsultation. We compare the CombiConsultation with the CMR and explain the choices made and the implications for implementation.

The impact of electronic medical records in the modern primary health care system on the interaction between doctor and patient in Moscow

Introduction. Digital technologies are an essential condition for the development of modern health care. New forms of interaction between the supplier and the consumer of medical services determine the need to understand the attitude of the doctor and the patient to this employment operation. Purpose. Assess the change in the quality of communications between the doctor and the patient with the widespread introduction of electronic medical records. Material and methods. Within the framework of the project, a content analysis of media materials was held. Mass (questionnaire) survey of doctors and patients in November-December 2020 was executed. The comprehensive survey had 482 respondents, including 168 doctors and 314 patients. Results. Most (61.5%) of medical professionals indicate a decrease in time costs during the patient’s reception, an increase in time to work with patients is noted in 47.4% of respondents. 55% of doctors report that the service helps better focus on the provision of medical care, and 47.6% of respondents believe that the conduct of medical documentation in electronic form allows reducing the frequency of passing a significant pathology. Among patients, 52.2% believe that introducing electronic medical records will enable you to increase the time that the doctor pays to the patient during the reception. 68.9% of patients indicate an improvement in the interaction between doctors and patients. Conclusion. High-quality results can be achieved only if there is a medical staff with the skills of using modern digital technologies and new communication skills with a patient when using electronic medical records.

Dimensions of Accountability: Voices from New Zealand Primary Health Organisations

<p>Cooperative activity necessitates participants acknowledging joint goals, often delegating resources, consequent performance, tailored accountability reporting and feedback (Levaggi, 1995). Thus, accountability is a process reflecting the interdependence of social relationships (Roberts, 1991). Such interdependence is evident in publicly funded health care systems where governments contract with autonomous providers, as occurs in the New Zealand primary health care system. Primary health care (as patients' first point of contact with the health system) was reformed significantly with the launch of the Primary Health Care Strategy [(Minister of Health, 2001) effective from May, 2002]. Increased government funding became available to Primary Health Organisations (PHOs), new entities that were to act as intermediaries between the government on the one hand, and primary health care practitioners on the other. PHOs became responsible for designing and contracting for the delivery of primary health programmes so as to improve their communities' health (Minister of Health, 2001). Consequent upon increased public funding distributed through these organisations, the government requires all PHOs to be 'fully and openly accountable' for all public funds they receive. O'Dwyer and Unerman (2006) term this 'holistic' accountability. Further, PHOs must be private not-for-profit organisations, reducing the likelihood that public funds will be diverted to shareholder dividends paid out by profit-oriented providers (Minister of Health, 2001). Despite the promise of accountability, the challenges of meeting the expectations of multiple stakeholders and choosing effective accountability mechanisms potentially mitigate against PHOs discharging accountability adequately. Accordingly, this research is an interpretive study into the understanding of PHOs and their stakeholders of 'to whom', 'for what', 'why' and 'how' accountability is discharged and how these challenges are mana ged. Four PHOs consented to be included as case studies during the 2006 and 2007 financial years. This ethnographic research collected financial and non-financial data, observed community meetings, interviewed key stakeholders and integrated research participants' feedback to reflect on current theory. It was found that stakeholders expect PHOs to prioritise either community or their funding and service providers, giving rise to possible conflicting demands. PHOs appear to manage this conflict internally, although the manner in which they do so evokes particular external images. Some District Health Boards (DHBs), as PHOs' funders, seek to manage PHOs' prioritisation by positing themselves as the arbiters of community needs. Further, while the Primary Health Care Strategy appears to require accountability to counter-balance control of PHOs with enhancing trust in DHB/PHO relationships, in this research it was found that PHOs subjected to strong funder control experience reduced autonomy and, by extension, fewer opportunities to learn. A further finding of this research was that 'mapping' the observations of stakeholders' expectations and the operation of control and/or trust against each other enables the identification of deficits in the process of holistic accountability. Accordingly, suggestions for mechanisms that will enable PHOs to balance multiple stakeholders and discharge holistic accountability are derived.</p>

Dimensions of Accountability: Voices from New Zealand Primary Health Organisations

<p>Cooperative activity necessitates participants acknowledging joint goals, often delegating resources, consequent performance, tailored accountability reporting and feedback (Levaggi, 1995). Thus, accountability is a process reflecting the interdependence of social relationships (Roberts, 1991). Such interdependence is evident in publicly funded health care systems where governments contract with autonomous providers, as occurs in the New Zealand primary health care system. Primary health care (as patients' first point of contact with the health system) was reformed significantly with the launch of the Primary Health Care Strategy [(Minister of Health, 2001) effective from May, 2002]. Increased government funding became available to Primary Health Organisations (PHOs), new entities that were to act as intermediaries between the government on the one hand, and primary health care practitioners on the other. PHOs became responsible for designing and contracting for the delivery of primary health programmes so as to improve their communities' health (Minister of Health, 2001). Consequent upon increased public funding distributed through these organisations, the government requires all PHOs to be 'fully and openly accountable' for all public funds they receive. O'Dwyer and Unerman (2006) term this 'holistic' accountability. Further, PHOs must be private not-for-profit organisations, reducing the likelihood that public funds will be diverted to shareholder dividends paid out by profit-oriented providers (Minister of Health, 2001). Despite the promise of accountability, the challenges of meeting the expectations of multiple stakeholders and choosing effective accountability mechanisms potentially mitigate against PHOs discharging accountability adequately. Accordingly, this research is an interpretive study into the understanding of PHOs and their stakeholders of 'to whom', 'for what', 'why' and 'how' accountability is discharged and how these challenges are mana ged. Four PHOs consented to be included as case studies during the 2006 and 2007 financial years. This ethnographic research collected financial and non-financial data, observed community meetings, interviewed key stakeholders and integrated research participants' feedback to reflect on current theory. It was found that stakeholders expect PHOs to prioritise either community or their funding and service providers, giving rise to possible conflicting demands. PHOs appear to manage this conflict internally, although the manner in which they do so evokes particular external images. Some District Health Boards (DHBs), as PHOs' funders, seek to manage PHOs' prioritisation by positing themselves as the arbiters of community needs. Further, while the Primary Health Care Strategy appears to require accountability to counter-balance control of PHOs with enhancing trust in DHB/PHO relationships, in this research it was found that PHOs subjected to strong funder control experience reduced autonomy and, by extension, fewer opportunities to learn. A further finding of this research was that 'mapping' the observations of stakeholders' expectations and the operation of control and/or trust against each other enables the identification of deficits in the process of holistic accountability. Accordingly, suggestions for mechanisms that will enable PHOs to balance multiple stakeholders and discharge holistic accountability are derived.</p>