Reiterating The Importance of Publicly Funded and Provided Primary Health Care for Non-Communicable Diseases: The Case of India; Comment on "Universal Health Coverage for Non-Communicable Diseases and Health Equity: Lessons From Australian Primary Healthcare"

India has established Health and Wellness Centres (HWCs) and appointed Mid-level Healthcare Providers (Community Health Officers) to provide free and comprehensive primary health care, through screening, prevention, control, management and treatment for non-communicable diseases (NCDs), in addition to existing services for communicable diseases, and reproductive and child health. The range of services being provided and the number of people accessing ambulatory care in these government centres have increased, leading to more equitable healthcare access and financial protection. In policy debates, contestations exist prioritising between primary health care or hospital services, and between publicly-provided healthcare or privatised and "purchased" services. Nationally and globally the influence of industries and corporations in health governance has weakened the response against NCDs. Primary health care initiatives for NCDs must be publicly funded and provided, located within communities, and necessitate action on the determinants of health. The experiences from Australia (a High-Income Country) and India (a Low-and Middle-Income Country) amply illustrate this.

Association of Cognitive Impairment With Migrant Status Among Older Adults in India: A Cross-Sectional Study

Introduction Among various health implications for older adult, cognitive impairment and related dementias are significant public health concern in many low and middle income countries, including India and lack due attention in policy arena. Socio-economic and health vulnerability are associated with cognitive impairment among older adults. Therefore the present study explores the prevalence and determinants of cognitive impairment among older adults in India with special reference to migrant status of older adults. MethodsData for this study was utilized from recent release of Longitudinal Ageing Study in India (LASI) wave 1 2017-19. The LASI is a nationally representative survey over 72000 older adults age 45 and above across all states and union territories of India. The present study is conducted on the eligible respondent’s age 60 years and above. The total sample size for the present study is 31,464 older adults aged 60 years and above (Male-15,068; Female-16,366). Descriptive and logistic regression analysis carried to fulfil the objective of the study. ResultsOverall, the prevalence of cognitive impairment among male older adults was 6.4% and female older adults 19.8%. Non-migrant status (6.8%) was more likely to face cognitive impairment than migrant status (5.7%) among older adults. The high prevalence of cognitive impairment were found with increasing socio-economic, demographic and multi-morbidities among older adults. Older adults (male 6.7% vs. female 20.2%) with no social participation were more likely to be face cognitive impairment. The result of logistic regression of our study is supported the bivariate analysis. Older adults with migrant status were more likely to be suffered from the cognitive impairment with unadjusted [UOR; 1.57, CI: 1.45-1.70] & after adjusting with covariates [AOR; 1.14, CI: 1.03-1.26] as compared to non-migrant status. Among the individual factors, odds of impairment was very high for the oldest-older adults age group [AOR: 2.95, CI: 2.59-3.36] as compared to young-older adults and further, female older adults were more likelihood to be cognitive impairment [AOR: 1.99, CI: 1.77-2.24] than their counterparts. Similar findings were also found with socio-economic and health vulnerability among older adults.Conclusion The study demonstrates that female older adults need more care and support from community and government as they face higher cognitive impairment. Further, the results significantly varied across different socio-economically, demographically, regionally in cognitive impairment and those who were suffering with co-morbidities. Comprehensive primary health care with community health approach may improve the health status of older adults in later period of life.

Bibliometric Analysis of Publications from Pubmed on Non Communicable Disease and Ayushman Bharat Health and Wellness Center

Background: Increase in Non-communicable diseases in spite of many steps taken for prevention and control is challenge for all over world, these epidemiological transition leas to need of health care services at community level with quality health care services. Under Ayushman Bharat Programme transformation of existing health facilities in Health and Wellness center to deliver universal and free comprehensive primary health care. Delivering Non communicable disease health services is one of major component of HWCs. Objectives:.Study was conducted to conduct analysis of Publication on Non communicable disease and Ayushman Bharat Health and Wellness Center. Methodology: Retrospective observational study was conducted On 30.01.2021, the Pubmed was accessed to collect publication on Non communicable disease and Ayushman Bharat, Health and Wellness Centre. Bibliometric analysis was conducted with quantity indicators for measuring productivity and quality indicators for measurement of output. Structural indicator for measured inter linkage between authors, publication Information on PubMed was used for analysis with the help of R Studio. Results: The PubMed search filtered for annual scientific production including journal ,book , document etc from 1978 to 2021 are found total publication are 2377.Out of Total publication after analysing most relevant sources include PLOS One was found most relevant source around 91.In Correspondence Authors from various countries India is on 3rd number which is around 114 authors. Conclusion: There are many publications on this key words and most publication are published in recent 10 years. Indian contribution in this area in on 3rd no in all over world.

Steps towards Universal Health Coverage through Health and Wellness Center under Ayushman Bharat Programme Delivering Comprehensive Primary Health Care in Bhandara District

Background: In 2018-19 as recommended by National Health Policy an Ambitious health care scheme as Ayushman Bharat programme was started by Government of India steps toward the Universal health coverage. Ayushman Bharat is also known as Healthy India having two major component. Creation of Health and Wellness Centres and Pradhan Mantri Jan Arogya Yojana (PM-JAY). Comprehensive primary health care services will be delivered up gradation of existing health facility in various 10 core area and 13 different types of health services will be delivered at HWC health facility. Progress in Health and Wellness under Ayushman Bharat Programme: First HWC was inaugurated by GOI in state of Chhattisgarh within Bijapur district at jangla village of Bhairamgarh Taluka on On 18th April 2018. Till 06th Feb 2021 total 58961 Health and wellness cneters are operational in India and In Maharashtra total 8423 Health and wellness cneters are operational where in Bhandara district total 177 Health and wellness cneters are operational which include 143 SHC Health and wellness center, 33 PHC Health and wellness center and 1 UPHC Health and wellness center. Achievements in Health and Wellness Center: In Bhandara district 98% of Medical Officer, 90% of Staff Nurse, 93% of MPW Female, 88% of MPW Male and 99% of ASHA trained NPCDCS Programme. Where 10,69,219 screening test for Hypertension and 10,81,901 screening test for Diabetes conducted in HWC health facility. Total 4097 Yoga sessions conducted at HWC health facility. Conclusion: 13 different types of health services which are delivered at Health and Wellness Centres health facility under Ayushman Bharat is step towards the Unvarsal health coverage provision in rural area of bhandara district.

Analysis of General Practitioners’ Attitudes and Beliefs about Psychological Intervention and the Medicine–Psychology Relationship in Primary Care: Toward a New Comprehensive Approach to Primary Health Care

The biopsychosocial paradigm is a model of care that has been proposed in order to improve the effectiveness of health care by promoting collaboration between different professions and disciplines. However, its application still faces several issues. A quantitative–qualitative survey was conducted on a sample of general practitioners (GPs) from Milan, Italy, to investigate their attitudes and beliefs regarding the role of the psychologist, the approach adopted to manage psychological diseases, and their experiences of collaboration with psychologists. The results show a partial view of the psychologist’s profession that limits the potential of integration between medicine and psychology in primary care. GPs recognized that many patients (66%) would often benefit from psychological intervention, but only in a few cases (9%) were these patients regularly referred to a psychologist. Furthermore, the referral represents an almost exclusive form of collaboration present in the opinions of GPs. Only 8% of GPs would consider the joint and integrated work of the psychologist and doctor useful within the primary health care setting. This vision of the role of psychologists among GPs represents a constraint in implementing a comprehensive primary health care approach, as advocated by the World Health Organization.

Mergers may enhance the legitimacy of community health organisations in neoliberal environments

PurposeComprehensive primary health care (PHC) models are seldom implemented in high income countries, in part due to their contested legitimacy in neoliberal policy environments. This article explores how merging affected the perceived legitimacy of independent community health organisations in Victoria, Australia, in providing comprehensive PHC services.Design/methodology/approachA longitudinal follow-up study (2–3 years post-merger) of two amalgamations among independent community health organisations from the state of Victoria, Australia, was conducted. This article explores the perceived effects of merging on (1) the pragmatic, normative and cognitive legitimacy of studied organisations and (2) the collective legitimacy of these organisations in Victoria's health care system. Data were collected through 19 semi-structured interviews with key informants and subjected to template and thematic analyses.FindingsMerging enabled individual organisations to gain greater overall legitimacy as regional providers of comprehensive PHC services and thus retain some capacity to operationalise a social model of health. Normative legitimacy was most enhanced by merging, through acquisition of a large organisational size and adoption of business practices favoured by neoliberal norms. However, mergers may have destabilised the already contested cognitive legitimacy of community health services as a group of organisations and as a comprehensible state-wide platform of service delivery.Practical implicationsOver-reliance on individual organisational behaviour to maintain the legitimacy of comprehensive PHC as a model of organising health and social care could lead to inequities in access to such models across communities.Originality/valueThis study shows that organisations can manage their perceived legitimacy in order to ensure the survival of their preferred model of service delivery.

Preparing Graduates for Interprofessional Practice in South Africa: The Dissonance Between Learning and Practice

With South Africa's tumultuous history and resulting burden of disease and disability persisting post-democracy in 1994, a proposed decentralization of heath care with an urgent focus on disease prevention strategies ensued in 2010. Subsequently a nationwide call by students to adapt teaching and learning to an African context spoke to the need for responsive health professions training. Institutions of higher education are therefore encouraged to commit to person-centered comprehensive primary health care (PHC) education which equates to distributed training along the continuum of care. To cope with the complexity of patient care and health care systems, interprofessional education and collaborative practice has been recommended in undergraduate clinical training. Stellenbosch University, South Africa, introduced interprofessional home visits as part of the students' contextual PHC exposure in a rural community in 2012. This interprofessional approach to patient assessment and management in an under-resourced setting challenges students to collaboratively find local solutions to the complex problems identified. This paper reports on an explorative pilot study investigating students' and graduates' perceived value of their interprofessional home visit exposure in preparing them for working in South Africa. Qualitative semi-structured individual and focus group interviews with students and graduates from five different health sciences programmes were conducted. Primary and secondary data sources were analyzed using an inductive approach. Thematic analysis was conducted independently by two researchers and revealed insights into effective patient management requiring an interprofessional team approach. Understanding social determinants of health, other professions' roles, as well as scope and limitations of practice in a resource constrained environment can act as a precursor for collaborative patient care. The continuity of an interprofessional approach to patient care after graduation was perceived to be largely dependent on relationships and professional hierarchy in the workplace. Issues of hierarchy, which are often systemic, affect a sense of professional value, efficacy in patient management and job satisfaction. Limitations to using secondary data for analysis are discussed, noting the need for a larger more comprehensive study. Recommendations for rural training pathways include interprofessional teamwork and health care worker advocacy to facilitate collaborative care in practice.

Community midwifery: a primary health care approach to care during pregnancy for Aboriginal and Torres Strait Islander women

Comprehensive primary health care is integral to meaningful client-centred care, with nurses and midwives central to partnership approaches with individuals, families and communities. A primary health model of antenatal care is needed for Aboriginal and Torres Strait Islander women in rural and remote areas, where complex social determinants of health impact on pregnancy outcomes, early years and lifelong health. Staff experiences from a community midwifery-led antenatal program in a remote Western Australian setting were explored, with the aim of investigating program impacts from health service providers’ perspectives. Interviews with 19 providers, including community midwives, child health nurses, program managers, a liaison officer, doctors and community agency staff, examined elements comprising a culturally safe community antenatal program for Aboriginal and Torres Strait Islander women, exploring program benefits and challenges. Thematic analysis derived five themes: Organisational and Accessibility Factors; Culturally Appropriate Support; Staff Availability and Competencies; Collaboration; and Sustainability. The ability of program staff to work in culturally safe partnerships with clients in collaboration with community agencies was essential to building meaningful and sustainable antenatal strategies. Midwifery primary health care competencies were viewed as a strong enabling factor, with potential to reduce health disparities in accordance with Australian Government and research recommendations.

Assessment of functioning of Health and Wellness Centers in a district of Western Gujarat

Introduction: Ayushman Bharat is an attempt to move from a selective approach to health care to deliver comprehensive range of services spanning preventive, promotive, curative, rehabilitative and palliative care. To ensure delivery of Comprehensive Primary Health Care services, existing Sub Health Centers and Primary Health Centers are converted to Health and Wellness Centers (HWC).Objective: The main objective of our study is to assess functionality of HWCs in various blocks of Jamnagar district and to determine prevalence of non-communicable diseases in the community. It is a cross sectional study conducted between August-December 2019. A semi-structured proforma containing questionnaires was used for data collection. Data were entered and analyzed in Microsoft Excel version 2007.There are 58 health and wellness centers in Jamnagar, of which, we randomly select 50% of centers from each taluka, so total of 29 HWCs selected, four among them could not be assessed, so our final sample size would be 25. Result: Our study observed satisfactory performance of health and wellness centres except barring a few indicators. Community health officers and multipurpose workers are available in about majority of centers. The study found that the prevalence of hypertension, diabetes mellitus, oral Cancer, breast cancer, and cervical Cancer was 20.44%, 11.03%, 0.73% 0.45% and 1.02% respectively. Staff at the centers was in need of vital training like Techo, refresher training etc. Conclusion: Majority of health and wellness centers are functioning as per the guidelines laid down by the Government barring a few services like laughing club, music therapy, meditation etc.