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Mash R, Hirschhorn LR, Kakar IS, John R, Sharma M, Praveen D. Global lessons on delivery of primary healthcare services for people with non-communicable diseases: convergent mixed methods. Fam Med Community Health 2024; 12:e002553. [PMID: 39097405 DOI: 10.1136/fmch-2023-002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2024] Open
Abstract
OBJECTIVE To extract key lessons on primary healthcare (PHC) service delivery strategies for non-communicable diseases (NCD) from the work of researchers funded by the Global Alliance for Chronic Diseases (GACD). DESIGN A convergent mixed methods study that extracted data using a standardised template from research projects funded by the GACD that focused on PHC. The strategies implemented in these studies were mapped onto the PHC Performance Initiative framework. Semistructured qualitative interviews were conducted with researchers from purposefully selected projects to understand the strategies and contextual factors in more depth. SETTING PHC contexts from low or middle-income countries (LMIC) as well as vulnerable groups within high-income countries. Projects came from all regions of the world, particularly East Asia and Pacific, sub-Saharan Africa, South Asia, Latin America and Caribbean. PARTICIPANTS The study extracted data on 84 research projects and interviewed researchers from 16 research projects. RESULTS Research projects came from all regions of the world, and mainly focused on diabetes (35.3%), hypertension (28.3%) and mental health (27.6%). Mapped onto the PHC Performance Initiative framework: 49.4% focused on high-quality PHC (particularly the comprehensiveness of NCD care, 41.2%); 41.2% on the availability of PHC services (particularly the competence of healthcare workers, 36.5%); 35.3% on population health management (particularly community-based services, 35.3%); 34.1% on facility organisation and management (particularly team-based care, 20.0%) and 31.8% on access (particularly digital technology, 23.5%). Most common strategies were task shifting and training to improve the comprehensiveness of NCD care through community-based services. Contextual factors related to inputs: infrastructure, equipment and medication, workforce (particularly community health workers), finances, health information systems and digital technology. CONCLUSION Key strategies and contextual factors to improve PHC service delivery for NCDs in LMICs were identified. These strategies should combine with other strategies to strengthen the PHC system as a whole, while improving care for NCDs.
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Affiliation(s)
- Robert Mash
- Stellenbosch University, Stellenbosch, South Africa
| | | | | | - Renu John
- The George Institute for Global Health, Hyderabad, India
| | - Manushi Sharma
- The George Institute for Global Health, New Delhi, India
| | - Devarsetty Praveen
- The George Institute for Global Health, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
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Mukiga AK, Boadu ES, Edson T. Perceived Public Participation and Health Delivery in Local Government Districts in Uganda. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:820. [PMID: 39063398 PMCID: PMC11276518 DOI: 10.3390/ijerph21070820] [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: 04/14/2024] [Revised: 06/13/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024]
Abstract
Citizen participation is a crucial aspect of the national health system, empowering individuals to contribute to improving local health services through Health Committees (HCs). HCs promote the participation of citizens in the delivery of primary healthcare services. The study explores the perceptions of citizen participation in the context of the Ruhama County Ntungamo local government area, Uganda. This study aims to understand the impact of HCs on healthcare service delivery. Using a qualitative approach of inquiry grounded in thematic analysis and rooted in principal-agent theory in a single case study, this study examined citizens' participation in the delivery of a local healthcare service. The study is based on interviews with 66 participants comprising health workers, patients, residents, health administrators, local councillors, and HC members. The findings reveal a notable absence of a health committee in healthcare delivery in Ruhama County. The absence is attributed to a need for a formalised citizen participation structure in managing health facilities and service delivery. It raises concerns about the limited influence of citizens in shaping healthcare policies and decision-making processes. The study recommends the incorporation of health committees into the local health systems to enhance participation and grant communities greater influence over the management of health facilities and service delivery. Incorporating health committees into local health systems strengthens citizen participation and leads to more effective and sustainable healthcare services aligned with people's needs and preferences. Integrating health committees within Itojo Hospital and similar facilities can grant citizens a meaningful role in shaping the future of their healthcare.
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Affiliation(s)
- Alex Kihehere Mukiga
- Centre for Development Support, University of Free State, Bloemfontein 9300, South Africa
| | - Evans Sakyi Boadu
- School of Governance, University of the Witwatersrand, Johannesburg 2050, South Africa;
- School of Sustainable Development, University of Environment and Sustainable Development (UESD), Somanya 00233, Ghana
| | - Tayebwa Edson
- Department of Surgery, Mbarara University of Science and Technology, Mbarara 1410, Uganda
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Mash RJ, Von Pressentin K. Family practice research in the African region 2020-2022. Afr J Prim Health Care Fam Med 2024; 16:e1-e8. [PMID: 38426783 PMCID: PMC10913144 DOI: 10.4102/phcfm.v16i1.4329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The African region produces a small proportion of all health research, including primary health care research. The SCOPUS database only lists the African Journal of Primary Health Care Family Medicine (PHCFM) and the South African Family Practice Journal (SAFP) in the field of family practice. AIM To review the nature of all original research (2020-2022) published in PHCFM and SAFP. SETTING African region. METHOD All 327 articles were included. Data were extracted into REDCap, using a standardised tool and exported to the Statistical Package for Social Sciences. RESULTS The median number of authors was 3 (interquartile range [IQR]: 2-4) and institutions and disciplines 1 (IQR: 1-2). Most authors were from South Africa (79.8%) and family medicine (45.3%) or public health (34.2%). Research focused on integrated health services (76.1%) and was mostly clinical (66.1%) or service delivery (37.9%). Clinical research addressed infectious diseases (23.4%), non-communicable diseases (24.6%) and maternal and women's health (19.4%). Service delivery research addressed the core functions of primary care (35.8%), particularly person-centredness and comprehensiveness. Research targeted adults and older adults (77.0%) as well as health promotion or disease prevention (38.5%) and treatment (30.9%). Almost all research was descriptive (73.7%), mostly surveys. CONCLUSION Future research should include community empowerment and multisectoral action. Within integrated health services, some areas need more attention, for example, children, palliative and rehabilitative care, continuity and coordination. Capacity building and support should enable larger, less-descriptive and more collaborative interdisciplinary studies with authors outside of South Africa.Contribution: The results highlight the strengths and weaknesses of family practice research in Africa.
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Affiliation(s)
- Robert J Mash
- Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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Leyns CC, Stilma Memelink D, Bullinga L, De Maeseneer J, Willems S, Campman Melssen C. Integrated person- and people-centred primary care for diabetes in low- and middle-income countries: The nurses' perspective on patient needs. J Adv Nurs 2023; 79:4044-4057. [PMID: 37427833 DOI: 10.1111/jan.15760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 05/03/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023]
Abstract
AIMS The aim of this study was to identify what nurses working in primary care settings perceive as necessary to support the life needs of people with type 2 diabetes. Articulate these needs with the needs expressed by people with diabetes in a previous study. Finally, illustrate the potential of the used method. DESIGN A highly structured qualitative group method for brainstorming and idea sharing was used to generate a participant-owned concept map that can support and evaluate practice change. METHODS Data were collected between April and May 2022 in two public primary healthcare centres in Sacaba, Bolivia, with 33 professional nurses, technical nurses, nurse trainees and one physician. The concept mapping process by Trochim was used to generate, share and structure ideas, maximizing equality of input. RESULTS The nurses identified 73 unique needs that were structured in 11 conceptual clusters related to four different stakeholders or domains: organization of care and health policy, strengthening knowledge, skills and attitudes of healthcare providers, empower people living with diabetes and their family, and community-level health promotion and diabetes education. CONCLUSION The needs and domains identified by nurses and people with type 2 diabetes are very similar and inform a multisectoral and transdisciplinary action plan to jointly monitor and evaluate progress towards people-centred care for people with diabetes. IMPACT This study demonstrates nurses' important contribution to analysing and designing people-centred care in their community. They identify and act upon social determinants of health related to schools, safety and legislation. Besides global relevance, results inform the municipal health plan and an ongoing research project on cardiometabolic health. PATIENT OR PUBLIC CONTRIBUTION Data from prior patient consultations were included in the study design, and study results inform the municipal health plan.
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Affiliation(s)
- Christine Cecile Leyns
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Research Institute of Social Sciences, Universidad Mayor de San Simón, Cochabamba, Bolivia
| | | | | | - Jan De Maeseneer
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Moosa S. Exploring the Challenges for Universal Health Coverage: A Call to Africa by AfroPHC. Risk Manag Healthc Policy 2023; 16:1999-2017. [PMID: 37790983 PMCID: PMC10544043 DOI: 10.2147/rmhp.s392454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
The primary health care (PHC) system in Africa faces many challenges AND opportunities. To date, human resources for health in PHC are grossly insufficient in number, often inefficiently and inequitably distributed, lacking adequate training for delivering fully responsive and comprehensive frontline care and are treated inequitably within the health system. There has been a lack of solidarity among key role players in healthcare to create adequate PHC funding in Africa. Resources do not appropriately or adequately reach the frontline PHC service platform due to outdated service delivery and payment models. Patients experience PHC as numbers in a queue, with poor comprehensiveness, continuity, and coordination. Health workers are also treated like numbers in a bureaucracy that fragments and undermines training and service for integrated care around patient and population needs. However, opportunities abound with global PHC milestones, increasing political will for investment in PHC, and proven mechanisms for achieving a stronger workforce such as community health workers, clinical task-sharing, and the integration of family doctors into PHC. The African Forum for PHC (AfroPHC) has a vision for PHC and UHC that is team-based with skills mix appropriate to Africa, including family doctors, family nurse practitioners, clinical officers, community health workers and others that are empowered to take care of an empaneled population in high-quality people centred PHC. AfroPHC is making a call on stakeholders to develop and implement a regional forward-looking plan to 1) build robust PHC systems, 2) train, recruit and maintain a sufficient frontline PHC workforce, and 3) support PHC with appropriate financing. This can all come together easily in a nationally defined PHC contract using risk-adjusted blended capitation payment to decentralised PHC teams empanelled to enrolled populations, coordinated by district health services and easily administered at national or sub-national level for empowered public and private providers.
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Affiliation(s)
- Shabir Moosa
- African Forum for Primary Health Care, Johannesburg, South Africa
- Department of Family Medicine and Primary Care, University of Witwatersrand, Johannesburg, South Africa
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Khan IA, Karim HMR. Anesthesia Services in Low- and Middle-Income Countries: The Fragile Point for Safe Surgery and Patient Safety. Cureus 2023; 15:e43174. [PMID: 37692747 PMCID: PMC10484723 DOI: 10.7759/cureus.43174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
The Safe Surgery Saves Life campaign of the World Health Organization advocates patient safety best practices during surgical procedures. Anesthesia service is indivisible from the patient safety best practices. Although anesthesia services are safer than ever before, safe delivery of anesthesia service and patient safety depends significantly on the availability of qualified anesthesiologists, the knowledge and competency of anesthesiologists, the work environment, and the availability of essential equipment and monitoring facilities. Despite anesthesiologists being the midstream of perioperative care, their role and service are often underacknowledged, especially in low- and middle-income countries (LMICs). Anesthesia services in LMICs face myriad challenges such as a shortage of skilled personnel, inadequate resources, limited training opportunities, and minimal administrative say, which act as the fragile point in the chain of safe surgery delivery. Specific solutions should focus on strengthening the anesthesia workforce, providing fair remuneration and incentives, advocating for anesthesia autonomy, and facilitating access to educational resources. Nevertheless, managing these problems requires a collaborative effort involving governments, healthcare organizations, and international stakeholders to develop sustainable solutions and prioritize the well-being of both anesthesia providers and patients. This editorial focuses on it briefly, emphasizing the anesthesia of rural healthcare service and patient safety.
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Affiliation(s)
- Imran A Khan
- Community and Family Medicine, Baba Raghav Das Medical College, Gorakhpur, IND
| | - Habib Md R Karim
- Anesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
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Khatri RB, Hill PS, Wolka E, Nigatu F, Zewdie A, Assefa Y. Beyond Astana: Configuring the World Health Organization Collaborating Centres for primary health care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002204. [PMID: 37506057 PMCID: PMC10381056 DOI: 10.1371/journal.pgph.0002204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
The understanding of primary health care (PHC) has evolved significantly, evident in key World Health Organization (WHO) reports, promoting PHC as a means for health for all, identifying key health systems reforms and focusing on health care experience. This study explores the WHO's current framing of PHC, and its configuration of WHO Collaborating Centres (WHOCCs) on PHC using the data available on the WHOCCs Portal. We analysed the following variables: title, institutions, location, economy, date of mandate, objectives, subject, and activity. There were 13 WHOCCs on PHC, nine based in North America and Europe, and none in Africa. Only three were in Low- and Middle-Income Countries (LMICs). The WHOCCs on PHC focused on three broad subjects: five focused on human resources for health (HRH); four on health systems research (HSR) and development, with an emphasis on family medicine; four on PHC systems. Activities were related to training and education, provision of technical advice, and research. Support to WHO on implementation of PHC was an activity for two LMIC based WHOCCs. The current configuration of WHOCCs on PHC is consistent with the evolution of PHC and its intersection with Universal Health Coverage and the Sustainable Development Goals. The increasing attention to people-centred health systems aligns with WHO's commitment to PHC in all health systems, though this needs special interpretation for LMICs with their limited HRH. There has been a shift in subjects from HRH towards primary care and family medicine, and HSR highlighting primary care and PHC systems. The concern is an absence of WHOCCs in the Africa and Latin and South Americas, and under-representation in LMICs. Designating more institutions from the South with expertise in PHC is necessary to address the challenges post-Astana.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, the University of Queensland, Brisbane, Australia
- Health Social Science and Development Research Institute, Kathmandu, Nepal
| | - Peter S Hill
- School of Public Health, the University of Queensland, Brisbane, Australia
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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Byiringiro S, Ogungbe O, Commodore-Mensah Y, Adeleye K, Sarfo FS, Himmelfarb CR. Health systems interventions for hypertension management and associated outcomes in Sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001794. [PMID: 37289741 DOI: 10.1371/journal.pgph.0001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/21/2023] [Indexed: 06/10/2023]
Abstract
Hypertension is a significant global health problem, particularly in Sub-Saharan Africa (SSA). Despite the effectiveness of medications and lifestyle interventions in reducing blood pressure, shortfalls across health systems continue to impede progress in achieving optimal hypertension control rates. The current review explores the health system interventions on hypertension management and associated outcomes in SSA. The World Health Organization health systems framework guided the literature search and discussion of findings. We searched PubMed, CINAHL, and Embase databases for studies published between January 2010 and October 2022 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We assessed studies for the risk of bias using the tools from the Joanna Briggs Institute. Twelve studies clustered in 8 SSA countries met the inclusion criteria. Two thirds (8/12) of the included studies had low risk of bias. Most interventions focused on health workforce factors such as providers' knowledge and task shifting of hypertension care to unconventional health professionals (n = 10). Other health systems interventions addressed the supply and availability of medical products and technology (n = 5) and health information systems (n = 5); while fewer interventions sought to improve financing (n = 3), service delivery (n = 1), and leadership and governance (n = 1) aspects of the health systems. Health systems interventions showed varied effects on blood pressure outcomes but interventions targeting multiple aspects of health systems were likely associated with improved blood pressure outcomes. The general limitations of the overall body of literature was that studies were likely small, with short duration, and underpowered. In conclusion, the literature on health systems internventions addressing hypertension care are limited in quantity and quality. Future studies that are adequately powered should test the effect of multi-faceted health system interventions on hypertension outcomes with a special focus on financing, leadership and governance, and service delivery interventions since these aspects were least explored.
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Affiliation(s)
- Samuel Byiringiro
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - Yvonne Commodore-Mensah
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Khadijat Adeleye
- University of Massachusetts, Amherst, MA, United States of America
| | - Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ashanti Region, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ashanti Region, Ghana
| | - Cheryl R Himmelfarb
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Rodríguez DC, Balaji LN, Chamdimba E, Kafumba J, Koon AD, Mazalale J, Mkombe D, Munywoki J, Mwase-Vuma T, Namakula J, Nambiar B, Neel AH, Nsabagasani X, Paina L, Rogers B, Tsoka M, Waweru E, Munthali A, Ssengooba F, Tsofa B. Political economy analysis of subnational health management in Kenya, Malawi and Uganda. Health Policy Plan 2023; 38:631-647. [PMID: 37084282 DOI: 10.1093/heapol/czad021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 01/27/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023] Open
Abstract
The need to bolster primary health care (PHC) to achieve the Sustainable Development Goal (SDG) targets for health is well recognized. In Eastern and Southern Africa, where governments have progressively decentralized health decision-making, health management is critical to PHC performance. While investments in health management capacity are important, so is improving the environment in which managers operate. Governance arrangements, management systems and power dynamics of actors can have a significant influence on health managers' ability to improve PHC access and quality. We conducted a problem-driven political economy analysis (PEA) in Kenya, Malawi and Uganda to explore local decision-making environments and how they affect management and governance practices for health. This PEA used document review and key informant interviews (N = 112) with government actors, development partners and civil societies in three districts or counties in each country (N = 9). We found that while decentralization should improve PHC by supporting better decisions in line with local priorities from community input, it has been accompanied by thick bureaucracy, path-dependent and underfunded budgets that result in trade-offs and unfulfilled plans, management support systems that are less aligned to local priorities, weak accountability between local government and development partners, uneven community engagement and insufficient public administration capacity to negotiate these challenges. Emergent findings suggest that coronavirus disease 2019 (COVID-19) not only resulted in greater pressures on health teams and budgets but also improved relations with central government related to better communication and flexible funding, offering some lessons. Without addressing the disconnection between the vision for decentralization and the reality of health managers mired in unhelpful processes and politics, delivering on PHC and universal health coverage goals and the SDG agenda will remain out of reach.
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Affiliation(s)
- Daniela C Rodríguez
- International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | | | - Elita Chamdimba
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Juba Kafumba
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Adam D Koon
- International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Jacob Mazalale
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Dadirai Mkombe
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Joshua Munywoki
- KEMRI-Wellcome Trust Research Programme, Hospital Road, P.O. Box 230, Kilifi, Kenya
| | - Tawonga Mwase-Vuma
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Justine Namakula
- School of Public Health, Makerere University, New Mulago Hill Road, Mulago, Kampala, Uganda
| | - Bejoy Nambiar
- UNICEF Malawi, PO Box 30375, Airtel Complex Area 40/31, Lilongwe, Malawi
| | - Abigail H Neel
- International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Xavier Nsabagasani
- School of Public Health, Makerere University, New Mulago Hill Road, Mulago, Kampala, Uganda
| | - Ligia Paina
- International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Braeden Rogers
- Health Section, UNICEF Eastern and Southern Africa Regional Office, United Nations Complex, Gigiri, P.O. Box 44145-00100, Nairobi, Kenya
| | - Maxton Tsoka
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Evelyn Waweru
- KEMRI-Wellcome Trust Research Programme, Hospital Road, P.O. Box 230, Kilifi, Kenya
| | - Alister Munthali
- Centre for Social Research, University of Malawi, P.O. Box 280, Zomba, Malawi
| | - Freddie Ssengooba
- School of Public Health, Makerere University, New Mulago Hill Road, Mulago, Kampala, Uganda
| | - Benjamin Tsofa
- KEMRI-Wellcome Trust Research Programme, Hospital Road, P.O. Box 230, Kilifi, Kenya
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Haregu TN, Alemayehu YK, Alemu YA, Medhin G, Woldegiorgis MA, Fentaye FW, Gerbaba MJ, Teklu AM. Disparities in the implementation of the Health Extension Program in Ethiopia: Doing more and better towards universal health coverage. DIALOGUES IN HEALTH 2022; 1:100047. [PMID: 38515918 PMCID: PMC10953949 DOI: 10.1016/j.dialog.2022.100047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 03/23/2024]
Abstract
Introduction Large-scale implementation of the Health Extension Program (HEP) has enabled Ethiopia to make significant progress in health services coverage and health outcomes. However, evidence on equity and disparities in the implementation of the HEP is limited. The aim of this study was to examine disparities in the implementation of the HEP in Ethiopia. Methods We used data from the 2019 National HEP assessment which was conducted between Oct 2018 and Sept 2019 in nine regions in the country. Data were collected from 62 districts, 343 Health posts, 179 Health centres, 584 Health Extension Workers (HEWs), and 7043 women from 7122 Households. This study focused on selected input, service delivery, and coverage indicators. We used rate differences, rate ratios and index of disparity to assess disparities in HEP implementation across regions. Results We found wide inter-regional disparities in HEP implementation. Developing regional states (DRS) had significantly lower availability of qualified HEWs (Rate Ratio (RR) = 0.54), proportion of households visited by Health Extension workers (RR = 0.40), and proportion of mothers who received education on child nutrition (RR = 0.45) as compared national average. There were also significant disparities in HEP implementation among DRS in the proportion of households visited by HEWs in the past 12 months (Index of disparity = 1.58) and proportion of adolescents who interacted with HEWs (Index of disparity = 1.43). Despite low overall coverage of health services in DRS, the contribution of the HEP for maternal health services was relatively high. Conclusion There were significant inter-regional disparities in the implementation HEP in Ethiopia. The level of disparity among DRS was also remarkable. To achieve Universal Health Coverage, it is important that these disparities are addressed systematically and strategically. We recommend a tailored approach in HEP implementation in DRS.
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Affiliation(s)
- Tilahun Nigatu Haregu
- The MERQ Institute, Addis Ababa, Ethiopia
- Nossal Institute for Global Health, University of Melbourne, Australia
| | | | | | - Girmay Medhin
- The MERQ Institute, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
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Mohamoud G, Mash R. The quality of primary care performance in private sector facilities in Nairobi, Kenya: a cross-sectional descriptive survey. BMC PRIMARY CARE 2022; 23:120. [PMID: 35585488 PMCID: PMC9114290 DOI: 10.1186/s12875-022-01700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 04/06/2022] [Indexed: 12/03/2022]
Abstract
Background Integrated health services with an emphasis on primary care are needed for effective primary health care and achievement of universal health coverage. The key elements of high quality primary care are first-contact access, continuity, comprehensiveness, coordination, and person-centredness. In Kenya, there is paucity of information on the performance of these key elements and such information is needed to improve service delivery. Therefore, the study aimed to evaluate the quality of primary care performance in private sector facilities in Nairobi, Kenya. Methods A cross-sectional descriptive study using an adapted Primary Care Assessment Tool for the Kenyan context and surveyed 412 systematically sampled primary care users, from 13 PC clinics. Data were analysed to measure 11 domains of primary care performance and two aggregated primary care scores using the Statistical Package for Social Sciences. Results Mean primary care score was 2.64 (SD=0.23) and the mean expanded primary care score was 2.68 (SD=0.19), implying an overall low performance. The domains of first contact-utilisation, coordination (information system), family-centredness and cultural competence had mean scores of >3.0 (acceptable to good performance). The domains of first contact-access, coordination, comprehensiveness (provided and available), ongoing care and community-orientation had mean scores of < 3.0 (poor performance). Older respondents (p=0.05) and those with higher affiliation to the clinics (p=0.01) were more likely to rate primary care as acceptable to good. Conclusion These primary care clinics in Nairobi showed gaps in performance. Performance was rated as acceptable-to-good for first-contact utilisation, the information systems, family-centredness and cultural competence. However, patients rated low performance related to first-contact access, ongoing care, coordination of care, comprehensiveness of services, community orientation and availability of a complete primary health care team. Performance could be improved by deploying family physicians, increasing the scope of practice to become more comprehensive, incentivising use of these PC clinics rather than the tertiary hospital, improving access after-hours and marketing the use of the clinics to the practice population.
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Martens M, Danhieux K, Van Belle S, Wouters E, Van Damme W, Remmen R, Anthierens S, Van Olmen J. Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study. Int J Health Policy Manag 2022; 11:1668-1681. [PMID: 34273935 PMCID: PMC9808233 DOI: 10.34172/ijhpm.2021.58] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 05/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Globally, health systems have been struggling to cope with the increasing burden of chronic diseases and respond to associated patient needs. Integrated care (IC) for chronic diseases offers solutions, but implementing these new models requires multi-stakeholder action and integrated policies to address social, organisational, and financial barriers. Policy implementation for IC has been little studied, especially through a political lens. This paper examines how IC policies in Belgium were developed over the last decade and how stakeholders have played a role in these policies. METHODS We used a case study design. After an exploratory document review, we selected three IC policies. We then interviewed 25 key stakeholders in the field of IC. The stakeholder analysis entailed a detailed mapping of the stakeholders' power, position, and interest related to the three selected policies. Interview participants included policy-makers, civil servants (from ministry of health and health insurance), representatives of health professionals' associations, academics, and patient organisations. Additionally, a processual analysis of IC policy processes (2007-2020) through literature review was used to frame the interviews by means of a chronic care policy timeline. RESULTS In Belgium, a variety of policy initiatives have been developed in recent years both at central and decentralised levels. The power analysis and policy position maps exposed tensions between federal and federated governments in terms of overlapping competence, as well as the implications of the power shift from federal to federated levels as a consequence of the 2014 state reform. CONCLUSION The 2014 partial decentralisation of healthcare has created fragmentation of decisive power which undermines efforts towards IC. This political trend towards fragmentation is at odds with the need for IC. Further research is needed on how public health policy competences and reform durability of IC policies will evolve.
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Affiliation(s)
- Monika Martens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Katrien Danhieux
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sara Van Belle
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Edwin Wouters
- Centre for Population, Family & Health, Department of Social Sciences, University of Antwerp, Antwerp, Belgium
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Roy Remmen
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Josefien Van Olmen
- Department of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Organization of primary care. Prim Health Care Res Dev 2022; 23:e49. [PMID: 36047002 PMCID: PMC9472237 DOI: 10.1017/s1463423622000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.
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Preparedness to self-employed careers: Development, validity, and reliability of an inventory for nursing students. Nurse Educ Pract 2022; 62:103383. [PMID: 35749961 DOI: 10.1016/j.nepr.2022.103383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/06/2022] [Accepted: 06/13/2022] [Indexed: 11/24/2022]
Abstract
AIMS To develop and psychometrically validate an inventory based on two scales: awareness regarding factors for determining the prices of freelance activities and knowledge regarding freelance-related norms among nursing undergraduate students in Italy. BACKGROUND Although self-employed nursing careers are strategic to enhance employability, no valid scales for assessing nursing students' preparedness to undertake self-employed careers are available. DESIGN A multi-method and multi-phase design were employed. Phase one encompassed developmental tasks for generating items and phase two included a cross-sectional data collection for determining the psychometric proprieties of the developed scales and their reliability. RESULTS The final inventory encompassed two scales showing adequate validity and reliability after testing it on 882 Italian undergraduate nursing students. The first scale, factors for determining the prices of activities, is based on care complexity and logistic characteristic (two-factor structure). The second scale, knowledge regarding freelance-related characteristics, encompassed two domains: knowledge regarding administrative rules and pensions and retirement issues. CONCLUSIONS The developed inventory showed adequate evidence of initial validity and reliability, useful for filling the gap given by the unavailability of valid assessments for educators who pursue measuring the nursing students' preparedness to undertake self-employed careers.
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Astier-Peña MP, Martínez-Bianchi V, Torijano-Casalengua ML, Ares-Blanco S, Bueno-Ortiz JM, Férnandez-García M. [The Global Patient Safety Action Plan 2021-2030: Identifying actions for safer primary health care]. Aten Primaria 2021; 53 Suppl 1:102224. [PMID: 34961576 PMCID: PMC8721340 DOI: 10.1016/j.aprim.2021.102224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/01/2022] Open
Abstract
The 74th World Health Assembly adopted in May 2021 the "Global Patient Safety Action Plan: 2021-2030" to enhance patient safety as an essential component in the design, procedures and performance evaluation of health systems worldwide. It is a strategic plan that guides country governments, health sector entities, health organisations and the World Health Organisation secretariat on how to implement the assembly's patient safety resolution. Deployment of the plan will strengthen the quality and safety of health systems worldwide by spanning the entire continuum of people's health care from diagnosis to treatment and care, reducing the likelihood of harm in the course of care. The Declaration on Primary Health Care during the Global Conference on Primary Health Care in Astana, 2018, urged countries to strengthen their primary health care systems as an essential step towards achieving universal health coverage and providing access to safe, quality care without financial loss. The deployment of the Global Patient Safety Action Plan in primary care is therefore a high-priority health policy action. The Action Plan is structured into 6 strategic objectives with 35 strategic actions. We present an analysis of the strategic actions regarding healthcare organizations and the challenges ahead for their particular deployment in primary health care settings.
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Affiliation(s)
- María Pilar Astier-Peña
- Medicina Familiar y Comunitaria. Centro de Salud Universitas, Servicio Aragonés de Salud, Aragon, España; Universidad de Zaragoza. GIBA-IIS Aragón, Aragón, España; Grupo de Seguridad del Paciente de Semfyc (Sociedad Española de Medicina Familiar y Comunitaria) y de Calidad y Seguridad de Wonca World (Global Family Doctors).
| | - Viviana Martínez-Bianchi
- Equidad en la Unidad Docente de Medicina Familiar y Comunitaria, Universidad de Duke, Duke, EE. UU.; WONCA-World Health Organization Liason. WONCA (World Organization of Family Doctors), Bruselas, Bélgica
| | - María Luisa Torijano-Casalengua
- Medicina Familiar y Comunitaria y Medicina Preventiva y Salud Pública, Servicio de Salud de Castilla-La Mancha (SESCAM), Castilla-La Mancha, España
| | - Sara Ares-Blanco
- Centro de Salud Federica Montseny, Servicio Madrileño de Salud (SERMAS), Madrid, España; Representante de semFYC (Sociedad Española de Medicina Familiar y Comunitaria) en EGPRN (European General Practitioner Research Network), Maastricht, Netherlands
| | - José-Miguel Bueno-Ortiz
- WONCA-World Health Organization Liason. WONCA (World Organization of Family Doctors), Bruselas, Bélgica; Centro de Salud Fuente Álamo, Servicio Murciano de Salud (SMS), Murcia, España; Representante de la Sección Internacional de semFYC (Sociedad Española de Medicina Familiar y Comunitaria), Barcelona, España
| | - María Férnandez-García
- Representante de semFYC (Sociedad Española de Medicina Familiar y Comunitaria) en EGPRN (European General Practitioner Research Network), Maastricht, Netherlands; C.S. Las Cortes, Servicio Madrileño de Salud (SERMAS), Madrid, España
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De Maeseneer J. COVID-19: using the crisis as an opportunity to strengthen Primary Health Care. Prim Health Care Res Dev 2021; 22:e73. [PMID: 34802483 PMCID: PMC8628580 DOI: 10.1017/s1463423621000748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jan De Maeseneer
- Family Physician. Head WHO Collaborating Centre on Family Medicine and PHC - Ghent University. E-mail:
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Masis L, Gichaga A, Zerayacob T, Lu C, Perry HB. Community health workers at the dawn of a new era: 4. Programme financing. Health Res Policy Syst 2021; 19:107. [PMID: 34641893 PMCID: PMC8506106 DOI: 10.1186/s12961-021-00751-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the fourth of our 11-paper supplement on "Community Health Workers at the Dawn of New Era". Here, we first make the case for investing in health programmes, second for investing in human resources for health, third for investing in primary healthcare (PHC) workers, and finally for investing in community health workers (CHWs). METHODS Searches of peer-reviewed journals and the grey literature were conducted with a focus on community health programme financing. The literature search was supplemented with a search of the grey literature for information about national health sector plans, community health strategies/policies, and costing information from databases of various countries' ministries of health, and finally a request for information from in-country partners. RESULTS The global shortage of human resources for health is projected to rise to 18 million health workers by 2030, with more acute shortages in Africa and South Asia. CHWs have an important role to play in mitigating this shortage because of their effectiveness (when properly trained and supported) and the feasibility of their deployment. Data are limited on the costs of current CHW programmes and how they compare to government and donor expenditures for PHC and for health services more broadly. However, available data from 10 countries in Africa indicate that the median per capita cost of CHW programmes is US$ 4.77 per year and US$ 2574 per CHW, and the median monthly salary of CHWs in these same countries is US$ 35 per month. For a subset of these countries for which spending for PHC is available, governments and donors spend 7.7 times more on PHC than on CHW programming, and 15.4 times more on all health expenditures. Even though donor funding for CHW programmes is a tiny portion of health-related donor support, most countries rely on donor support for financing their CHW programmes. CONCLUSION The financing of national CHW programmes has been a critical element that has not received sufficient emphasis in the academic literature on CHW programmes. Increasing domestic government funding for CHW programmes is a priority. In order to ensure growth in funding for CHW programmes, it will be important to measure CHW programme expenditures and their relationship to expenditures for PHC and for all health-related expenditures.
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Affiliation(s)
- Lizah Masis
- Financing Alliance for Health, Nairobi, Kenya
| | | | | | - Chunling Lu
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Henry B Perry
- Department of International Health, Health Systems Program, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
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Barkley S, Marten R, Reynolds T, Kelley E, Dalil S, Swaminathan S, Ghaffar A. Primary health care: realizing the vision. Bull World Health Organ 2020; 98:727-727A. [PMID: 33177765 PMCID: PMC7607456 DOI: 10.2471/blt.20.279943] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Shannon Barkley
- Integrated Health Services, Universal Health Coverage and Life Course, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Robert Marten
- Alliance for Health Policy and Systems Research, Science Division, World Health Organization, Geneva, Switzerland
| | - Teri Reynolds
- Integrated Health Services, Universal Health Coverage and Life Course, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Edward Kelley
- Integrated Health Services, Universal Health Coverage and Life Course, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Suraya Dalil
- Primary Health Care Programme, World Health Organization, Geneva, Switzerland
| | | | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, Science Division, World Health Organization, Geneva, Switzerland
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