Assessing equity of the spatial distribution of primary health care facilities in Fuzhou City, China: A comprehensive method

Background It is well known that equity assessment of the spatial distribution of primary health care facilities (PHCFs) is significant to optimize the allocation of health care resources and enhance the ability to react to public health emergencies, yet there is much discussion about the poor effectiveness of assessment for many cities due to the limitations of the insufficient ability of traditional data to reflect residents’ demands, etc. In many cities where PHCFs are inequity distributed, this is urgently needed for the government. Methods Using Fuzhou City, China as a case study, we propose a comprehensive method for assessing the equity that consisting of two frameworks based on the Geographic Information System. The first framework is assessing resident demand based on daily demand and potential demand, and the second is assessing PHCFs supply based on road impedance. This method combines an index system based on multi-source data and a spatial matching analysis between resident demand and PHCFs supply based on the supply-demand disparity index. Results The demand degree for the PHCFs and the supply degree of accessing the PHCFs of different residential areas differ to great extents. The equity of the spatial distribution of PHCFs shows well overall, but there is still a lack of equity in local areas. The number of the residential areas with the lowest equity, insufficient supply and oversupply accounted for 10.31% and 39.00% respectively; the former is mainly gathered in a concentrated form at the edge and in a scattered form inside, and the latter is distributed in the interior mostly in a concentrated manner. Conclusion The key findings highlight several aspects of improving the layout of PHCFs such as strengthen an in-depth analysis on residents’ demand. This study contributes to a more accurate equity assessment, and further improves the layout of health care facilities.

Towards quality primary health care: the dilemma of Community-Based Health Planning and Services (CHPS) in health service provision in Ghana

PurposeOver the past two decades, Community-Based Health Planning and Services (CHPS) has been a pragmatic strategy towards universal Primary Health Care (PHC) in Ghana. However, the ability and capacity of these facilities to deliver quality primary health care remain an illusion as they are still crumbling in myriad challenges. These challenges are translated to the poor-quality services provision and low community utilization of CHPS facilities. The study presents a comparative analysis of three communities in the Kassena-Nankana East Municipality, Ghana.Design/methodology/approachUsing a mixed-method research design, the study gathered and analysed data from 110 households, three community health officers (CHOs) and three community leaders using semi-structured questionnaires and interview guides.FindingsThe findings indicated that the facilities do not have the requisite inputs such as drugs and supplies, logistics, appropriate health personnel, good infrastructure, funding support necessary to deliver quality and appropriate healthcare services that meet the health needs of the communities. For the CHPS to realize their full potentials as PHC facilities, it is required that the needed inputs such as logistics, drugs and appropriate staff are in place to facilitate the activities of CHOs.Research limitations/implicationsDue to the limited number of participants and selection of the study communities, the results may generalization. Also, the researchers acknowledged the inability to interview the district level health officials and the Kassena-Nankana Municipal Assembly during the field visits. This could have provided in-depth knowledge on the findings of this research as well as the validation of the results from the communities' perspective. Several attempts were made to contact and interview district-level authorities which proven futile due to the unavailability of targeted respondents. This resulted in limiting the studies at the community level. However, this limitation does not disprove the findings of this study.Practical implicationsThe article implications for planning primary health care strategies include a keen assessment of community health needs and institutional management of primary health care facilities, equip PHC facilities with adequate resources such as drugs and appropriate staffing to provide the health needs of the communities.Originality/valueThe paper fulfils the gap in the literature by providing empirical data on how the challenges of primary health care facilities affected the provision of high quality service and how this can affect community’s use of the facilities.

Characteristics of the Relations of Local Government Bodies with Primary Health Care Facilities

At the current stage of the development of health care systems, it is believed that local governments should be included in any reform plans. The World Health Organisation emphasizes the important role of local governments in reforming primary care while maintaining the primary responsibility for building national central government health systems. The purpose of the study is to characterize the relations of primary health care facilities with local governments by the heads in the context of reforming the health care system in Ukraine and identifying problem areas in them that require improvement. Materials and methods. The study was carried out in two stages: focusing interviewing heads of primary health care facilities with a high level of competence to determine the set of characteristics that form the relationship between of the local governments and primary health care facilities; a survey of 100 heads of primary care facilities using a questionnaire drawn up based on the results of the first stage of the study. Statistical analysis was carried out using descriptive and analytical statistics. Results and discussion. Comprehensive reform of local self-government and primary health care in Ukraine faces certain difficulties and requires coordination of relations between the local governments and primary health care facilities. Twelve main characteristics of the relationship between local governments and primary health care system of the community were identified. Of the total number of respondents, 72% did not give a satisfactory assessment of the competence of the representatives of local governments in the organization of medical services; 36% – the attitude of local governments to primary care facilities; 32% – response of local governments to the needs of primary health care facilities; 78% – understanding by the owner of the contribution of the primary health care to the prosperity of the community; 52% – priority of health development for community; 12% of the respondents noted that their facilities did not receive additional funding from local budgets for the development of the institution and improvement of the quality of medical care. In general, 68% of the surveyed primary health care managers assessed positively the relationship with the owner; 19% – negatively. Conclusion. The study identified problems in the relationship between the local governments and primary care facilities during the reform of the health care system, which need to be addressed. It was revealed that the main problem is the lack of awareness of the local governments of the importance of primary health care for the community, which is primarily due to the low competence of representatives of local authorities on health issues

Measuring Physical access to primary health care facilities in Gambella Region (Western Ethiopia)

As part of the project “More equity and quality of health services in Gambella, Gambella Region”, financed by the Italian Agency for Development Cooperation (AICS) and implemented by the Italian NGO Doctors with Africa CUAMM (Padua, Italy) a geographic database of the distribution of health facilities of Gambella Region (western Ethiopia) was created. This data collection was carried out in two missions carried out in February 2018 and November-December 2019. It allowed a mapping of the access roads and the location of health facilities using Geomatic Approaches and related technologies (Remote Survey, Field Survey, GPS, GIS). The field work has allowed the investigation in 11 Waredas (i.e. districts) with the census of 3 primary hospitals, 26 health centres and 121 HPs and related road access by car or, in case of inaccessibility of vehicles, by foot or boat.The final result of this work is the availability of a detailed cartographic picture of the geographical distribution of Health Facilities (HFs) in order to support the modern decision-making tools to be adopted for the distribution of human and instrumental resources. As an example we describe a network analysis performed by ESRI™ Network Analyst which showed the importance of this approach to remodel a more efficient referral system.

Factors affecting glycemic control among Egyptian people with diabetes attending primary health care facilities in Mansoura District

Background Diabetes is a rapidly growing health problem worldwide. In 2019, the International Diabetes Federation (IDF) estimates that Egypt is the 9th country worldwide with about 8,850,400 cases and a prevalence of 15.2% in adults. By 2045, Egypt is expected to be the 7th country worldwide. Several factors affecting glycemic control are related to patients, physicians, and the infrastructure of primary health care facilities (PHCFs). The effect of health care infrastructure and resources is not well studied. This cross-sectional study aims to explore factors affecting glycemic control among subjects with diabetes visiting PHCFs in the Mansoura District. A questionnaire was done to assess these factors among subjects with diabetes, primary care physicians (PCPs), and PHCFs infrastructure and resources. Three hundred and two subjects with diabetes attending PHCFs in the Mansoura District underwent a detailed clinical history. Also, HbA1c was obtained. Results Factors in patients that affect diabetic control include patient’s education and occupation and their smoking status. Practicing physical exercise is important for diabetes control. Physicians can affect diabetes control by their rural residence, older age, participation in diabetes training, early graduation year, longer durations since started dealing with subjects with diabetes, and following guidelines. Resources of infrastructure have a role in diabetes control. Metformin and investigation availability has a positive association with diabetes control. Conclusion Patients, physicians, and resources of infrastructure have a role in diabetes control.

Compliance of Private Primary Health Care Facilities Towards Requirements of Labelling of Dispensed Medicine in Sarawak

Background: Compliance towards the requirements of labelling of dispensed medicine (LDM) among private primary health care facilities ensures appropriate use of medicines. Aim: This study aimed to examine the rate of compliance towards the requirements of LDM among retail pharmacies (RPs) and private medical clinics (PMCs). Methods: A cross-sectional study was conducted from April 2019 to January 2020 across all inspected premises in Sarawak. Publics who attended RPs and PMCs and having medicines dispensed, have their medicine labels examined for compliance towards the requirements of LDM upon exiting the premises. Their verbal consents were obtained and the compliance score were recorded into self-developed data collection forms. Compliance rate was the percentage of requirements on the examined medicine labels that fulfil the requirements under Regulation 12 of Poisons Regulations 1952. Results: A total of 414 LDM were examined, with 135 from RPs and 279 from PMCs. The full compliance towards the requirements of LDM among RPs and PMCs were 23.7% and 41.6%, respectively. The median compliance score of PMCs (0.83) was significantly higher (P<0.001) than RPs (0.67). The requirements of LDM with the lowest compliance was name of medicine (53.1%), followed by name of patient (31.9%) and date of dispensing (25.6%). Conclusion: The full compliance rate on the requirements of LDM among RPs and PMCs were low. More stringent enforcement and public education on their rights for fully compliant medicine labels could improve the compliance.

Health System Responsiveness and Its Associated Factors Among Outpatients in Primary Health Care Facilities, Asagirt District, NorthShewa Zone, Ethiopia, 2021: Cross Sectional Study Design

Background: Health system responsiveness is defined as the outcome of designing health facility relationships in such a way that they are familiar and respond appropriately to patients’ universally legitimate expectations. Even though different strategies have been implemented to measure responsiveness, only scanty evidence exists in Sub-Saharan Africa. In Ethiopia information about the level of health system responsiveness among outpatients is scant. Assessing responsiveness could help facilities in improving service delivery based on patient expectations. Objective: The study aimed to assess health system responsiveness and associated factors among outpatients in primary health care facilities, Asagirt District, North Shewa Zone, Ethiopia, 2021. Methods: Facility-based cross-sectional quantitative study was implemented between 30th March and April 30/2021. A systematic random sampling technique was employed to select 423 participants, and interviewer-administered data were collected using a structured and pretested questionnaires. Both bivariable and multivariable logistic regressions were employed to identify factors that have an association with health system responsiveness. Adjusted Odds Ratio with their corresponding 95% CI was used to declare factors associated with health system responsiveness. A p-value less than 0.05 was used to declare statistical significance in this study. Results: The overall health system responsiveness was 66.2% (95% CI: 61.4% - 70.7%). Confidentiality and dignity domains were the highest responsiveness score. Health system responsiveness was higher among satisfied outpatients (AOR: 9.9, 95% CI: 5.11-19.46), utilized private clinics (AOR: 8.8, 95% CI: 4.32-18.25), and no transport cost (AOR: 1.7, 95% CI: 1.03-2.92) in the study setting. Conclusion: Overall health system responsiveness was higher as compared to other case-specific study in Ethiopia. The domains of Autonomy, Waiting time, Basic amenities, and Choice were identified as vital areas needing the effort to raise responsiveness of health care service in the District. HSR was higher in private than public healthcare facilities, among satisfied clients and those who didn’t pay for transport on their way to the health facility than their counterparts. Thus, enhancing patient satisfaction, using input from service users, Collaboration, and experience exchange between public and private facilities will be important interventions to improve HSR.

Compliance of Professional Nurses at Primary Health Care Facilities to the South African Cervical Cancer Screening Guidelines

Despite the availability of the South African cervical cancer screening guidelines at clinics, women still present in district hospitals of Thulamela Municipality with no cervical cancer screening results. Thus, many cervical cancer screenings done at the hospitals often come back positive for cervical cancer at advanced stages. This study was conducted to investigate the compliance of professional nurses at primary health care facilities (PHCs) in Thulamela Municipality to the South African cervical cancer screening guidelines. The study adopted a qualitative approach. Purposive, non-probability sampling method was used to select PHCs and recruit eligible participants. Sample size was determined by data saturation. A digital recorder was used to log individual responses during interview sessions. Data from the digital recordings were transcribed verbatim. Results were analysed and interpreted in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist. This study established that clinic professional nurses are non-compliant to the South African cervical cancer screening guidelines owing to several challenges they face, such as inadequate knowledge of the cervical cancer screening guidelines, shortage of resources, shortage of staff and patients’ factors. We recommend a strengthening of the South African cervical cancer screening guideline, in-service trainings and workshops on cervical cancer and cervical cancer screening guideline as well as improvement on patients’ education.

A Descriptive Cross-Sectional Assessment of Caregivers’ Knowledge and Practices Regarding the Prevention and Management of Diarrhea among Children under the Age of Five in Thulamela B Clinics, South Africa

Diarrhea is a common cause of child-related hospitalization and mortality among children under the age of five in South Africa. This study was conducted to assess the knowledge and practices of caregivers regarding prevention and management of diarrhea among children under the age of five in the Thulamela Municipality of South Africa. A quantitative approach using a descriptive cross-sectional survey was used. A questionnaire was adopted to collect data from caregivers at thirty primary health-care facilities using convenient sampling. Statistical Package for Social Sciences (SPSS) version 24.0 was used to analyze data. Most of the respondents have fair knowledge about diarrhea, oral rehydration therapy/salt sugar solution and its usage during diarrheal episodes. However, most of them (81.7%) do not use the salt sugar solution when their children have diarrhea. Almost all the respondents practice a hand washing hygiene for themselves and their children; 97.2% do not reheat cooked food before feeding their children; 95.5% do not drink untreated water as their source of drinking water is the municipal supply. The practices of these respondents do not reflect their knowledge in terms of the use of oral rehydration solution/salt and sugar solution. Further efforts should be made to educate caregivers on the mode of transmission of diarrheal pathogens.