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Yanful B, Kirubarajan A, Bhatia D, Mishra S, Allin S, Di Ruggiero E. Quality of care in the context of universal health coverage: a scoping review. Health Res Policy Syst 2023; 21:21. [PMID: 36959608 PMCID: PMC10035485 DOI: 10.1186/s12961-022-00957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/28/2022] [Indexed: 03/25/2023] Open
Abstract
INTRODUCTION Universal health coverage (UHC) is an emerging priority of health systems worldwide and central to Sustainable Development Goal 3 (target 3.8). Critical to the achievement of UHC, is quality of care. However, current evidence suggests that quality of care is suboptimal, particularly in low- and middle-income countries. The primary objective of this scoping review was to summarize the existing conceptual and empirical literature on quality of care within the context of UHC and identify knowledge gaps. METHODS We conducted a scoping review using the Arksey and O'Malley framework and further elaborated by Levac et al. and applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews reporting guidelines. We systematically searched MEDLINE, EMBASE, CINAHL-Plus, PAIS Index, ProQuest and PsycINFO for reviews published between 1 January 1995 and 27 September 2021. Reviews were eligible for inclusion if the article had a central focus on UHC and discussed quality of care. We did not apply any country-based restrictions. All screening, data extraction and analyses were completed by two reviewers. RESULTS Of the 4128 database results, we included 45 studies that met the eligibility criteria, spanning multiple geographic regions. We synthesized and analysed our findings according to Kruk et al.'s conceptual framework for high-quality systems, including foundations, processes of care and quality impacts. Discussions of governance in relation to quality of care were discussed in a high number of studies. Studies that explored the efficiency of health systems and services were also highly represented in the included reviews. In contrast, we found that limited information was reported on health outcomes in relation to quality of care within the context of UHC. In addition, there was a global lack of evidence on measures of quality of care related to UHC, particularly country-specific measures and measures related to equity. CONCLUSION There is growing evidence on the relationship between quality of care and UHC, especially related to the governance and efficiency of healthcare services and systems. However, several knowledge gaps remain, particularly related to monitoring and evaluation, including of equity. Further research, evaluation and monitoring frameworks are required to strengthen the existing evidence base to improve UHC.
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Affiliation(s)
- Bernice Yanful
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Abirami Kirubarajan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Dominika Bhatia
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sujata Mishra
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Erica Di Ruggiero
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Wang Z, Jamal A, Wang R, Dan S, Kappagoda S, Kim G, Palaniappan L, Long J, Singh J, Srinivasan M. Disparities and Trends in Routine Adult Vaccination Rates Among Disaggregated Asian American Subgroups, National Health Interview Survey 2006-2018. AJPM FOCUS 2023; 2:100044. [PMID: 37789943 PMCID: PMC10546520 DOI: 10.1016/j.focus.2022.100044] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Vaccination rates may be improved through culturally tailored messages, but little is known about them among disaggregated Asian American subgroups. We assessed the vaccination rates for key vaccines among these subgroups. Methods Using the National Health Interview Survey, we analyzed recent vaccination rates (2015-2018, n=188,250) and trends (2006-2018) among Asians (Chinese [n=3,165], Asian Indian [n=3,525], Filipino [n=3,656], other Asian [n=5,819]) and non-Hispanic White adults (n=172,085) for 6 vaccines (the human papillomavirus, hepatitis B, pneumococcal, influenza, tetanus-diphtheria [tetanus], and shingles vaccines). We controlled demographic, socioeconomic, and health-related variables in multivariable logistic regression and predicted marginal modeling analyses. We also computed vaccination rates among Asian American subgroups on the 2015-2018 National Health Interview Survey data stratified by foreign-born and U.S.-born status. We used Joinpoint regression to analyze trends in vaccination rates. All analyses were conducted in 2021 and 2022. Results Among Asians, shingles (29.2%; 95% CI=26.6, 32.0), tetanus (53.7%; 95% CI=51.8, 55.6), and pneumococcal (53.8%; 95% CI=50.1, 57.4) vaccination rates were lower than among non-Hispanic Whites. Influenza (47.9%; 95% CI=46.2, 49.6) and hepatitis B (40.5%; 95% CI=39.0, 42.7) vaccination rates were similar or higher than among non-Hispanic Whites (48.4%; 95% CI=47.9, 48.9 and 30.7%; 95% CI=30.1, 31.3, respectively). Among Asians, we found substantial variations in vaccination rates and trends. For example, Asian Indian women had lower human papillomavirus vaccination rates (12.9%; 95% CI=9.1, 18.0) than all other Asian subgroups (Chinese: 37.9%; 95% CI=31.1, 45.2; Filipinos: 38.7%; 95% CI=29.9, 48.3; other Asians: 30.4%; 95% CI=24.8, 36.7) and non-Hispanic Whites (36.1%; 95% CI=34.8, 37.5). Being male, having lower educational attainment and income, having no health insurance or covered by public health insurance only, and lower frequency of doctor visits were generally associated with lower vaccine uptakes. Foreign-born Asian aggregate had lower vaccination rates than U.S.-born Asian aggregate for all vaccines except for influenza. We also found subgroup-level differences in vaccination rates between foreign-born and U.S.-born Asians. We found that (1) foreign-born Chinese, Asian Indians, and other Asians had lower human papillomavirus and hepatitis B vaccination rates; (2) foreign-born Chinese and Filipinos had lower pneumococcal vaccination rates; (3) foreign-born Chinese and Asian Indians had lower influenza vaccination rates; and (4) all foreign-born Asian subgroups had lower tetanus vaccination rates. Conclusions Vaccination rates and trends differed among Asian American subgroups. Culturally tailored messaging and interventions may improve vaccine uptakes.
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Affiliation(s)
- Ziqing Wang
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Statistics and Data Science, Cornell University, Ithaca, New York
| | - Armaan Jamal
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ryan Wang
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of BioSciences, Rice University, Houston, Texas
- Department of Computer Science, Rice University, Houston, Texas
| | - Shozen Dan
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Mathematics, Imperial College London, London, United Kingdom
- Department of Statistics, Imperial College London, London, United Kingdom
| | - Shanthi Kappagoda
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Infectious Diseases & Geographic Medicine, Stanford University School of Medicine, Stanford, California
| | - Gloria Kim
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California
| | - Latha Palaniappan
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jaiveer Singh
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Department of Molecular Biochemistry and Biophysics, Yale University, New Heaven, Connecticut
| | - Malathi Srinivasan
- The Stanford Center for Asian Health Research and Education (CARE), Stanford University School of Medicine, Stanford, California
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Terry AL, Stewart M, Ashcroft R, Brown JB, Burge F, Haggerty J, McWilliam C, Meredith L, Reid GJ, Thomas R, Wong ST. Complex skills are required for new primary health care researchers: a training program responds. BMC MEDICAL EDUCATION 2022; 22:565. [PMID: 35869518 PMCID: PMC9306239 DOI: 10.1186/s12909-022-03620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders - require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research. MAIN BODY In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program's goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context - a context that requires researchers who are able to respond to multiple challenges. CONCLUSION We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.
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Affiliation(s)
- Amanda L. Terry
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, The University of Western Ontario, Western Centre for Public Health and Family Medicine, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Québec Canada
| | - Carol McWilliam
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Ontario Canada
| | - Leslie Meredith
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Graham J. Reid
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Psychology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Sabrina T. Wong
- School of Nursing, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia Canada
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Asgari-Jirhandeh N, Zapata T, Jhalani M. Strengthening Primary Health Care as a Means to Achieve Universal Health Coverage: Experience from India. JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/0972063421995004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Compared to its peers, India has always spent far less on health. This is slowly changing as are the drivers that are forcing some of these changes. Demographical and epidemiological changes have moved the disease burden away from communicable and maternal and childhood diseases to non-communicable diseases. More people are city dwellers and achieving UHC is one of Sustainable Development Goals. To tackle these commitments and shifting demands, in 2017, there was a committed move towards improving primary health care by introducing comprehensive PHC through health and wellness centres. These centres are close to the community and by improving the quality of care given and increasing the range of services that they provide, there should be an increase in access to health. However, much needs to be done to ensure that these centres will provide high quality care to the local populations. Training the healthcare workers needed to staff these HWCs will take time. Keeping the required funding to expand the programme will be challenging in the current fiscal space. There is a need to integrate care and flow of funds between primary and secondary care and empowering local populations to engage in governance of the HWCs will take time.
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Affiliation(s)
| | - Tomas Zapata
- World Health Organization, Regional Office for South East Asia, New Delhi, India
| | - Manoj Jhalani
- Director, Health Systems Department, World Health Organization, South East Asia Regional Office
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Feng XL, Wen C. Evaluation of a pilot program that integrated prenatal screening into routine antenatal care in western rural China: an interrupted time-series study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 6:100075. [PMID: 34327408 PMCID: PMC8315490 DOI: 10.1016/j.lanwpc.2020.100075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
Background We evaluated a large-scale pilot program in Shaanxi Province, western rural China, which integrated prenatal screening interventions for congenital abnormalities into routine antenatal programs. Methods We surveyed 1,597 mothers who gave birth between 2009 and 2016. Adopting the interrupted time-series design, we evaluated the program's impact on awareness, coverage, and cost, by comparing two counties with only supply-side policies, and two counties from the neighbouring province with no policies; and among the two counties with both supply- and demand-side policies and the two counties with only supply-side policies. We adjusted the sampling procedure and women's background characteristics. We conducted subgroup analyses by women's education. Findings After one year of implementation, the coverage of prenatal foetal aneuploidies and B-ultrasound screening rose by 25.0% and 23.5%. The program's supply-side policies attributed to 17.2 percentage points (90%CI 7.8–26.6%) and 27.3 percentage points (90%CI 16.2–38.5%) in coverage, and contributed to a higher median cost of 796.5RMB (90%CI 595.5–997.5). These significantly affected women with secondary education and above. However, the program's demand-side measures, that is, vouchers, seemed to be effective only in the mountainous regions, which raised awareness, and increased coverage of prenatal foetal aneuploidies screening by 28.6 percentage points (90%CI 13.4–43.8%), while not increasing costs. These significantly affected women with primary education and below. Education-related inequalities widened post-program in counties with only supply-side policies, but no inequalities existed in counties with demand-side policies. Interpretation Shaanxi's program made a pilot study to other provinces of China to integrate antenatal services. Government subsidies might be more effective in targeting specific geographic locations and people with primary education and lower.
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Affiliation(s)
- Xing Lin Feng
- Department of Health Policy and Management, School of Public Health, Peking University, China
| | - Chunmei Wen
- Department head, Department of Maternal and Child Health, Health Commission of the Shaanxi Province, China
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Cohen O, Mahagna A, Shamia A, Slobodin O. Health-Care Services as a Platform for Building Community Resilience among Minority Communities: An Israeli Pilot Study during the COVID-19 Outbreak. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207523. [PMID: 33081120 PMCID: PMC7602759 DOI: 10.3390/ijerph17207523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022]
Abstract
Background: Previous studies of minority groups in times of emergency have tended to focus on risk reduction or on individual resilience, overlooking the community factors that could be bolstered to promote better health and safety outcomes. The current study aimed to examine the role of health-care services in the perceived community resilience of urban and suburban Arab communities in Israel during the COVID-19 outbreak. Method: The study included 196 adults age 17–76 years, who filled out on-line questionnaires in May 2020; 112 participants lived in an urban community and 84 lived in a suburban community. Community resilience was evaluated using the Conjoint Community Resiliency Assessment Measure (CCRAM), a validated five-factor multidimensional instrument. Results: Residents of the suburban community reported higher community resilience than residents of the urban community. This difference was related to increased preparedness levels and strength of place attachment in the suburban community. Residents of suburban communities were also more satisfied and confident in health-care services than those of urban communities. Regression analysis showed that the satisfaction with primary health-care services, and not community type, significantly predicted community resilience. Conclusions: Our results support the pivotal role of primary health care in building community resilience of minority communities in times of emergency and routine.
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Affiliation(s)
- Odeya Cohen
- Nursing Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel or (A.M.); (A.S.)
- Correspondence: ; Tel.: +972-86477599
| | - Alaa Mahagna
- Nursing Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel or (A.M.); (A.S.)
| | - Asmaa Shamia
- Nursing Department, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel or (A.M.); (A.S.)
| | - Ortal Slobodin
- Education Department, Ben-Gurion University of the Negev, P.O. Box 653, Beer-Sheva 84105, Israel;
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Nambiar D, Sankar D. H, Negi J, Nair A, Sadanandan R. Monitoring Universal Health Coverage reforms in primary health care facilities: Creating a framework, selecting and field-testing indicators in Kerala, India. PLoS One 2020; 15:e0236169. [PMID: 32745081 PMCID: PMC7398520 DOI: 10.1371/journal.pone.0236169] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022] Open
Abstract
In line with the Sustainable Development Goals (SDGs) and the target for achieving Universal Health Coverage (UHC), state level initiatives to promote health with "no-one left behind" are underway in India. In Kerala, reforms under the flagship Aardram mission include upgradation of Primary Health Centres (PHCs) to Family Health Centres (FHCs, similar to the national model of health and wellness centres (HWCs)), with the proactive provision of a package of primary care services for the population in an administrative area. We report on a component of Aardram's monitoring and evaluation framework for primary health care, where tracer input, output, and outcome indicators were selected using a modified Delphi process and field tested. A conceptual framework and indicator inventory were developed drawing upon literature review and stakeholder consultations, followed by mapping of manual registers currently used in PHCs to identify sources of data and processes of monitoring. The indicator inventory was reduced to a list using a modified Delphi method, followed by facility-level field testing across three districts. The modified Delphi comprised 25 participants in two rounds, who brought the list down to 23 approved and 12 recommended indicators. Three types of challenges in monitoring indicators were identified: appropriateness of indicators relative to local use, lack of clarity or procedural differences among those doing the reporting, and validity of data. Further field-testing of indicators, as well as the revision or removal of some may be required to support ongoing health systems reform, learning, monitoring and evaluation.
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Affiliation(s)
- Devaki Nambiar
- The George Institute for Global Health India, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Karnataka, India
| | - Hari Sankar D.
- The George Institute for Global Health India, New Delhi, India
| | - Jyotsna Negi
- Independent Consultant, Baltimore, MD, United States of America
| | - Arun Nair
- ACCESS Health International Inc, New Delhi, India
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Liu H, Huffman MD, Trieu K. The role of contextualisation in enhancing non-communicable disease programmes and policy implementation to achieve health for all. Health Res Policy Syst 2020; 18:38. [PMID: 32303249 PMCID: PMC7164194 DOI: 10.1186/s12961-020-00553-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/23/2020] [Indexed: 11/21/2022] Open
Abstract
The September 2019 United Nations’ High-Level Meeting renewed political commitments to invest in universal health coverage by strengthening health systems, programmes and policies to achieve ‘health for all’. This Political Declaration is relevant to addressing the increasing global burden of non-communicable diseases, but how can evidence-based programmes and policies be meaningfully implemented and integrated into local contexts? In this Commentary, we describe how the process of contextualisation and associated tools, such as ecological frameworks, implementation research frameworks, health system indicators, effective system strengthening strategies and evidence mapping databases with priority-setting, can enhance the implementation and integration of non-communicable disease prevention and control policies and programmes. Examples across health platforms include (1) population approaches to reducing excess sodium intake, (2) fixed-dose combination therapy for cardiovascular disease prevention and control, and (3) health systems strengthening for improving the quality and safety of cardiovascular care. Contextualisation is needed to transfer evidence into locally relevant and impactful policies and programmes. The systematic and comprehensive use of contextualisation tools leverages key implementation research principles to achieve ‘health for all’.
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Affiliation(s)
- Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
| | - Mark D Huffman
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Department of Preventive Medicine and Center for Global Cardiovascular Health, Northwestern University's Feinberg School of Medicine, Chicago, United States of America
| | - Kathy Trieu
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Lahariya C, Sundararaman T, Ved RR, Adithyan GS, De Graeve H, Jhalani M, Bekedam H. What makes primary healthcare facilities functional, and increases the utilization? Learnings from 12 case studies. J Family Med Prim Care 2020; 9:539-546. [PMID: 32318378 PMCID: PMC7114016 DOI: 10.4103/jfmpc.jfmpc_1240_19] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/11/2020] [Indexed: 11/04/2022] Open
Abstract
Background The last few decades have witnessed a number of innovative approaches and initiatives to deliver primary healthcare (PHC) services in different parts of India. The lessons from these initiatives can be useful as India aims to strengthen the PHC system through Health and Wellness Centers (HWCs) component under Ayushman Bharat Program, launched in early 2018. Materials and Methods Comparative case study method was adopted to systematically document a few identified initiatives/models delivering the PHC services in India. Desk review was followed by field visits and key informant interviews. Twelve PHC case studies from 14 Indian states, with a focus on equity and "potentially replicable designs" were included from the government as well as the "not-for-profit" sector. The cases studies comprised of initiatives/models having the provision of PHC services, whether exclusively or as part of broader hospital services. The data was collected from May 2016 to March 2017. Results The "political will" for government facilities and "leadership and motivation" for "not-for-profit" facilities adjudged to contribute towards improved functioning. A comprehensive package of services, functional 'continuity of care' across levels, efforts to meet one or more type of quality standards and limited "intention to availability" gap (or assured provision of promised services) were considered to be associated with increased utilization. A total of 10 lessons and learnings derived from the analysis of these case studies have been summarised. Conclusions The case studies in this article highlights the components which makes PHC facilities functional and have potential for increased utilization. The article underscores the need for institutional mechanisms for health system research and innovation hubs at both national and state level in India, for the rapid scale of comprehensive primary healthcare. Lessons can be applied to other low- and middle-income countries intending to deliver comprehensive PHC services to advance towards universal health coverage.
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Affiliation(s)
- Chandrakant Lahariya
- Department of Health Systems, World Health Organization (WHO) Country Office for India, New Delhi, India
| | - T Sundararaman
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Rajani R Ved
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, Govt of India, New Delhi, India
| | - G S Adithyan
- National Health Mission, Department of Health and Family Welfare, Govt of Tamil Nadu, Chennai, India
| | - Hilde De Graeve
- Department of Health Systems, World Health Organization (WHO) Country Office for India, New Delhi, India
| | - Manoj Jhalani
- National Health Mission, Ministry of Health and Family Welfare, Govt of India, New Delhi, India
| | - Henk Bekedam
- World Health Organization (WHO) Country Office for India, New Delhi, India
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Rifkin SB. Paradigms, policies and people: the future of primary health care. BMJ Glob Health 2020; 5:e002254. [PMID: 32133199 PMCID: PMC7042568 DOI: 10.1136/bmjgh-2019-002254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 01/16/2023] Open
Affiliation(s)
- Susan B Rifkin
- Distance Learning, London School of Hygiene and Tropical Medicine, London, UK.,Health Systems, Management and Policy, Colorado School of Public Health, Aurora, Colorado, USA
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Angell B, Dodd R, Palagyi A, Gadsden T, Abimbola S, Prinja S, Jan S, Peiris D. Primary health care financing interventions: a systematic review and stakeholder-driven research agenda for the Asia-Pacific region. BMJ Glob Health 2019; 4:e001481. [PMID: 31478024 PMCID: PMC6703289 DOI: 10.1136/bmjgh-2019-001481] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/27/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Interventions targeting the financing of primary health care (PHC) systems could accelerate progress towards universal health coverage; however, there is limited evidence to guide best-practice implementation of these interventions. This study aimed to generate a stakeholder-led research agenda in the area of PHC financing interventions in the Asia-Pacific region. METHODS We adopted a two-stage process: (1) a systematic review of financing interventions targeting PHC service delivery in the Asia-Pacific region was conducted to develop an evidence gap map and (2) an electronic-Delphi (e-Delphi) exercise with key national PHC stakeholders was undertaken to prioritise these evidence needs. RESULTS Thirty-one peer-reviewed articles (including 10 systematic reviews) and 10 grey literature reports were included in the review. There was limited consistency in results across studies but there was evidence that some interventions (removal of user fees, ownership models of providers and contracting arrangements) could impact PHC service access, efficiency and out-of-pocket cost outcomes. The e-Delphi exercise highlighted the importance of contextual factors and prioritised research in the areas of: (1) interventions to limit out-of-pocket costs; (2) financing models to enhance health system performance and maintain PHC budgets; (3) the design of incentives to promote optimal care without unintended consequences and (4) the comparative effectiveness of different PHC service delivery strategies using local data. CONCLUSION The research questions which were deemed most important by stakeholders are not addressed in the literature. There is a need for more research on how financing interventions can be implemented at scale across health systems. Such research needs to be pragmatic and balance academic rigour with practical considerations.
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Affiliation(s)
- Blake Angell
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Dodd
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
| | - Thomas Gadsden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Seye Abimbola
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Dodd R, Palagyi A, Jan S, Abdel-All M, Nambiar D, Madhira P, Balane C, Tian M, Joshi R, Abimbola S, Peiris D. Organisation of primary health care systems in low- and middle-income countries: review of evidence on what works and why in the Asia-Pacific region. BMJ Glob Health 2019; 4:e001487. [PMID: 31478026 PMCID: PMC6703302 DOI: 10.1136/bmjgh-2019-001487] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/15/2019] [Accepted: 06/23/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION This paper synthesises evidence on the organisation of primary health care (PHC) service delivery in low-income and middle-income countries (LMICs) in the Asia Pacific and identifies evidence of effective approaches and pathways of impact in this region. METHODS We developed a conceptual framework describing key inputs and outcomes of PHC as the basis of a systematic review. We searched exclusively for intervention studies from LMICs of the Asia-Pacific region in an effort to identify 'what works' to improve the coverage, quality, efficiency, equity and responsiveness of PHC. We conducted a narrative synthesis to identify key characteristics of successful interventions. RESULTS From an initial list of 3001 articles, we selected 153 for full-text review and included 111. We found evidence on the impact of non-physician health workers (NPHWs) on coverage and quality of care, though better integration with other PHC services is needed. Community-based services are most effective when well integrated through functional referral systems and supportive supervision arrangements, and have a reliable supply of medicines. Many studies point to the importance of community engagement in improving service demand. Few studies adopted a 'systems' lens or adequately considered long-term costs or implementation challenges. CONCLUSION Based on our findings, we suggest five areas where more practical knowledge and guidance is needed to support PHC systems strengthening: (1) NPHW workforce development; (2) integrating non-communicable disease prevention and control into the basic package of care; (3) building managerial capacity; (4) institutionalising community engagement; (5) modernising PHC information systems.
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Affiliation(s)
- Rebecca Dodd
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Marwa Abdel-All
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
| | | | - Christine Balane
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Maoyi Tian
- The George Institute for Global Health, Beijing, China
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- The George Institute for Global Health, New Delhi, India
| | - Seye Abimbola
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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