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Mosadeghrad AM, Afshari M, Isfahani P, Ezzati F, Abbasi M, Farahani SA, Zahmatkesh M, Eslambolchi L. Strategies to strengthen the resilience of primary health care in the COVID-19 pandemic: a scoping review. BMC Health Serv Res 2024; 24:841. [PMID: 39054502 PMCID: PMC11270795 DOI: 10.1186/s12913-024-11278-4] [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: 01/14/2024] [Accepted: 07/03/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Primary Health Care (PHC) systems are pivotal in delivering essential health services during crises, as demonstrated during the COVID-19 pandemic. With varied global strategies to reinforce PHC systems, this scoping review consolidates these efforts, identifying and categorizing key resilience-building strategies. METHODS Adopting Arksey and O'Malley's scoping review framework, this study synthesized literature across five databases and Google Scholar, encompassing studies up to December 31st, 2022. We focused on English and Persian studies that addressed interventions to strengthen PHC amidst COVID-19. Data were analyzed through thematic framework analysis employing MAXQDA 10 software. RESULTS Our review encapsulated 167 studies from 48 countries, revealing 194 interventions to strengthen PHC resilience, categorized into governance and leadership, financing, workforce, infrastructures, information systems, and service delivery. Notable strategies included telemedicine, workforce training, psychological support, and enhanced health information systems. The diversity of the interventions reflects a robust global response, emphasizing the adaptability of strategies across different health systems. CONCLUSIONS The study underscored the need for well-resourced, managed, and adaptable PHC systems, capable of maintaining continuity in health services during emergencies. The identified interventions suggested a roadmap for integrating resilience into PHC, essential for global health security. This collective knowledge offered a strategic framework to enhance PHC systems' readiness for future health challenges, contributing to the overall sustainability and effectiveness of global health systems.
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Affiliation(s)
- Ali Mohammad Mosadeghrad
- Health policy and management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Afshari
- Health policy, School of Nursing and Midwifery, Saveh University of Medical Sciences, Saveh, Iran
| | - Parvaneh Isfahani
- Health management, School of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Farahnaz Ezzati
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Abbasi
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Akhavan Farahani
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Zahmatkesh
- Health Management, School of Business and Management, Royal Holloway University of London, London, UK
| | - Leila Eslambolchi
- Health services management, Health Economics and Management Department, Tehran University of Medical Sciences, Tehran, Iran.
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Rajabi-Arani Z, Asadi-Piri Z, Zamani-Alavijeh F, Mirhosseini F, Bigdeli S, Dandekar SP, Bastami F. Examining the educational experiences of Behvarzes from the insufficient participation of some people in preventive measures against the COVID-19 pandemic: a lesson for the future. BMC MEDICAL EDUCATION 2024; 24:785. [PMID: 39039468 PMCID: PMC11265148 DOI: 10.1186/s12909-024-05752-0] [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: 01/05/2024] [Accepted: 07/08/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND This study aims to explore the experiences of Behvarzes regarding the reasons behind the insufficient participation of some individuals with the preventive protocols established during the COVID-19 pandemic. METHODS A qualitative study was conducted from July 2021 to December 2022 using the conventional content analysis method. Purposive sampling was employed to select 14 Behvarzes working in villages covered by Kashan University of Medical Sciences. Data were collected through semi-structured in-depth individual interviews and analyzed using conventional content analysis. RESULTS The study identified seven subcategories which were grouped into two main categories of reasons for inadequate compliance with health protocols by some individuals. These include: (1) Intentional non-compliance with preventive protocols, with the following subcategories: perceived obligation and adherence to social customs, denial of risk, belief in external health locus of control, and fear and distrust of prevention and treatment methods. (2) Unintentional non-compliance with preventive protocols, with the following subcategories: insufficient or contradictory information, negligence, and inevitability. CONCLUSION The findings suggest that ensuring compliance with health guidelines is not a one-size-fits-all approach. providing empowerment and obstacle removal solutions to those forced to violate preventive protocols for various reasons are all critical components of successful interventions. Also, cultural familiarity can aid in the design of appropriate interventions to address these challenges.
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Affiliation(s)
- Zohreh Rajabi-Arani
- School of Behvarz Training Center, Kashan University of Medical sciences, Kashan, Iran
| | - Zahra Asadi-Piri
- Department of Health Management Policy and Economic, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Fereshteh Zamani-Alavijeh
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fakhrosadat Mirhosseini
- Head of Anesthesia Department, Trauma Research Center & School of Allied Medical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Shoaleh Bigdeli
- Department of Medical Education, School of Medicine, Center for Educational Research in Medical Sciences (CERMS), Iran University of Medical Sciences (IUMS), Tehran, Iran
| | | | - Fatemeh Bastami
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
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Tsampouri E, Kapetaniou K, Missiou A, Bakola M, Willems S, Van Poel E, Tatsioni A. Measures during the COVID-19 pandemic in public primary health care in Greece: is there still a missing link to universal health coverage? BMC PRIMARY CARE 2024; 24:287. [PMID: 38760684 PMCID: PMC11100090 DOI: 10.1186/s12875-024-02392-7] [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: 10/14/2022] [Accepted: 04/12/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The PRICOV-19 study aimed to assess the organization of primary health care (PHC) during the COVID-19 pandemic in 37 European countries and Israel; and its impact on different dimensions of quality of care. In this paper, we described measures taken by public PHC centers in Greece. Additionally, we explored potential differences between rural and non-rural settings. METHODS The study population consisted of the 287 public PHC centers in Greece. A random sample of 100 PHC centers stratified by Health Region was created. The online questionnaire consisted of 53 items, covering six sections: general information on the PHC center, patient flow, infection prevention, information processing, communication to patients, collaboration, and collegiality. RESULTS Seventy-eight PHC centers (78%) - 50 rural and 28 non-rural - responded to the survey. Certain measures were reported by few PHC centers. Specifically, the use of online messages about complaints that can be solved without a visit to the PHC center (21% rural; and 31% non-rural PHC centers), the use of video consultations with patients (12% rural; and 7% non-rural PHC centers), and the use of electronic medical records (EMRs) to systematically identify the list of patients with chronic conditions (5% rural; and 10% non-rural PHC centers) were scarcely reported. Very few PHC centers reported measures to support identifying and reaching out to vulnerable population, including patients that may have experienced domestic violence (8% rural; and 7% non-rural PHC centers), or financial problems (26% rural; and 7% non-rural PHC centers). Providing administrative documents to patients through postal mail (12% rural; and 21% non-rural PHC centers), or regular e-mail (11% rural; and 36% non-rural PHC centers), or through a secured server (8% rural; and 18% non-rural PHC centers) was rarely reported. Finally, providing information in multiple languages through a PHC website (12% rural PHC centers only), or an answering machine (6% rural PHC centers only), or leaflets (3% rural PHC centers only; and for leaflets specifically on COVID-19: 6% rural; and 8% non-rural PHC centers) were lacking in most PHC centers. CONCLUSION Our study captured measures implemented by few PHC centers suggesting potential priority areas of future improvement.
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Affiliation(s)
- Efthalia Tsampouri
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantina Kapetaniou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Aristea Missiou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Sara Willems
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Esther Van Poel
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
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Yücel U, Erkal Aksoy Y, Yaşar Yetişmiş H, Gök Ç. Psychological effects of the COVID-19 pandemic on primary healthcare professionals in Turkey: One year into the pandemic. J Clin Nurs 2024. [PMID: 38258514 DOI: 10.1111/jocn.17013] [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: 08/25/2021] [Revised: 12/20/2022] [Accepted: 01/07/2024] [Indexed: 01/24/2024]
Abstract
AIM AND OBJECTIVES This study aimed to determine the psychological effects of the COVID-19 pandemic on healthcare professionals working in primary care settings in the first year of the pandemic. BACKGROUND The healthcare industry has faced an unprecedented burden in the COVID-19 pandemic. Primary care professionals experienced the high level of psychological problems. DESIGN AND METHODS A total of 793 healthcare professionals from different regions of Turkey participated in this cross-sectional study. The STROBE (Strengthening the reporting of observational studies in epidemiology) checklist was used in the study. Data were collected online. RESULTS It has been found that more than half of healthcare professionals experienced severe depression, three-quarters experienced anxiety, and almost half experienced stress. It was also found that about half of the participants experienced a high degree of acute and chronic fatigue, and one-fifth experienced low inter-shift recovery. CONCLUSION The effects of the COVID-19 pandemic on the mental health of primary care professionals, especially nurses and midwives, are alarming. The problems that arise from the flawed healthcare delivery models and gender inequality, which worsen the usual psychological effects of the pandemic on primary care professionals, should be addressed urgently. RELEVANCE TO CLINICAL PRACTICE Psychological support and rehabilitative services should be expanded to eliminate the short- and long-term psychological effects of the pandemic on healthcare professionals.
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Affiliation(s)
- Ummahan Yücel
- Department of Midwifery, Faculty of Health Sciences, Ege University, İzmir, Turkey
| | - Yasemin Erkal Aksoy
- Department of Midwifery, Faculty of Health Sciences, Selcuk University, Konya, Turkey
| | - Habibe Yaşar Yetişmiş
- Department of Midwifery, Faculty of Health Sciences, Munzur University, Tunceli, Turkey
| | - Çiğdem Gök
- Republic of Turkey Ministry of Health Uşak Dikilitaş Family Health Center, Uşak, Turkey
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Khatri RB, Endalamaw A, Erku D, Wolka E, Nigatu F, Zewdie A, Assefa Y. Preparedness, impacts, and responses of public health emergencies towards health security: qualitative synthesis of evidence. Arch Public Health 2023; 81:208. [PMID: 38037151 PMCID: PMC10687930 DOI: 10.1186/s13690-023-01223-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Natural and human-made public health emergencies (PHEs), such as armed conflicts, floods, and disease outbreaks, influence health systems including interruption of delivery and utilization of health services, and increased health service needs. However, the intensity and types of impacts of these PHEs vary across countries due to several associated factors. This scoping review aimed to synthesise available evidence on PHEs, their preparedness, impacts, and responses. METHODS We conducted a scoping review of published evidence. Studies were identified using search terms related to two concepts: health security and primary health care. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines to select studies. We adapted the review framework of Arksey and O'Malley. Data were analyzed using a thematic analysis approach and explained under three stages of PHEs: preparedness, impacts, and responses. RESULTS A total of 64 studies were included in this review. Health systems of many low- and middle-income countries had inadequate preparedness to absorb the shocks of PHEs, limited surveillance, and monitoring of risks. Health systems have been overburdened with interrupted health services, increased need for health services, poor health resilience, and health inequities. Strategies of response to the impact of PHEs included integrated services such as public health and primary care, communication and partnership across sectors, use of digital tools, multisectoral coordination and actions, system approach to responses, multidisciplinary providers, and planning for resilient health systems. CONCLUSIONS Public health emergencies have high impacts in countries with weak health systems, inadequate preparedness, and inadequate surveillance mechanisms. Better health system preparedness is required to absorb the impact, respond to the consequences, and adapt for future PHEs. Some potential response strategies could be ensuring need-based health services, monitoring and surveillance of post-emergency outbreaks, and multisectoral actions to engage sectors to address the collateral impacts of PHEs. Mitigation strategies for future PHEs could include risk assessment, disaster preparedness, and setting digital alarm systems for monitoring and surveillance.
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Affiliation(s)
- Resham B Khatri
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
- School of Public Health, University of Queensland, Brisbane, Australia.
| | - Aklilu Endalamaw
- School of Public Health, University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, 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, University of Queensland, Brisbane, Australia
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Heunis C, Chikobvu P, Muteba M, Kigozi-Male G, Engelbrecht M, Mushori P. Impact of COVID-19 on selected essential public health services - lessons learned from a retrospective record review in the Free State, South Africa. BMC Health Serv Res 2023; 23:1244. [PMID: 37951875 PMCID: PMC10640739 DOI: 10.1186/s12913-023-10166-7] [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: 04/03/2023] [Accepted: 10/17/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND In an attempt to discern lessons to improve future pandemic responses, this study measured the effects of the COVID-19 pandemic on essential public health services (EPHSs) related to primary health care (PHC) and outpatient department (OPD) utilisation, antiretroviral treatment (ART) commencement, drug-susceptible tuberculosis (DS-TB) confirmation and treatment commencement, and Bacillus Calmette-Guérin (BCG) coverage, in the Free State province of South Africa during January 2019 to March 2021. METHODS A pre-post study design comparing EPHS performance between 2019 and 2020/21 was employed. Routinely collected data were analysed. An interrupted time series analysis was used to measure changes in service use and outcomes from January 2019 to March 2021. Median changes were compared using Wilcoxon rank-sum tests. A 5% statistical significance level was considered. RESULTS Over the study period, the median values for the annual number of PHC visits was 1.80, 55.30% for non-referred OPD visits, 69.40% for ART commencement, 95.10% and 18.70% for DS-TB confirmation and treatment commencement respectively, and 93.70% for BCG coverage. While BCG coverage increased by 5.85% (p = 0.010), significant declines were observed in PHC utilisation (10.53%; p = 0.001), non-referred OPD visits (12.05%; p < 0.001), and ART commencement (9.53%; p = 0.017) rates. Given the importance of PHC in addressing a new pandemic, along with the existing HIV and TB epidemics - as well as the entire quadruple burden of disease - in South Africa, the finding that the PHC utilisation rate statistically significantly decreased in the Free State post-COVID-19 commencement is particularly concerning. CONCLUSIONS The lessons learned from this retrospective review attest to a measure of resilience in EPHS delivery in the Free State in as far as a significant hike in BCG vaccination over the study period, 2019-2020/21 was observed. As evidenced by a decline in PHC service utilisation and the decreased numbers of new patients commencing ART, we also learned that EPHS delivery in the province was fragile.
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Affiliation(s)
- Christo Heunis
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa.
| | - Perpetual Chikobvu
- Free State Department of Health, Bloemfontein, South Africa
- Department of Community Health, University of the Free State, Bloemfontein, South Africa
| | - Michel Muteba
- World Health Organization, Bloemfontein, South Africa
| | - Gladys Kigozi-Male
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
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Jonsson F, Blåhed H, Hurtig AK. More than meets the eye: a critical discourse analysis of a Swedish health system reform. BMC Health Serv Res 2023; 23:1226. [PMID: 37946232 PMCID: PMC10634034 DOI: 10.1186/s12913-023-10212-4] [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: 01/12/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND In line with international trends acknowledging the importance of Primary Health Care (PHC) for improving population health and reducing health inequalities, the Swedish health system is undergoing a restructuring towards the coordinated development of a modern, equitable, accessible, and effective system, with PHC principles and functions at its core. Since discursive analyses of documents underpinning PHC reforms are scarce in Sweden and beyond, the aim of this study was to explore how the reorientation towards good quality and local health care has been represented in official government reports. METHODS Based on a policy-as-discourse analysis, four Swedish Government Official Reports underpinning the good quality and local health care reform were interrogated following four questions of Bacchi's "What's the Problem Represented to be?" (WPR) approach. By applying the first WPR question, concrete proposals guiding the reorientation were identified, analyzed and thematized into candidate problem representations. These problem representations were then analyzed in relation to previous empirical and conceptual research considering WPR questions two and three, which resulted in the development of three problem representations. Potential silences that the problem representations might produce were then identified by applying WPR question four. RESULTS The three problem representations connected the Swedish health system "problem" to a narrow mission, a siloed structure, and a front-line service disconnected, especially from the needs and preferences of individual patients. By representing the problem along these lines, the analysis also illustrated how the policy reorientation towards good quality and local health care risk silencing important PHC aspects such as health promotion, equitable access, and human resources. CONCLUSION The results from this study indicate that as discursively framed within concrete proposals, government official reports in Sweden represent the health system problem in particular ways and with these problem representations overlooking several aspects that are central to a health system characterized by PHC principles and functions. In the continued reorientation towards good quality and local health care, these silences might need to be acknowledged.
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Affiliation(s)
- Frida Jonsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
- Arctic Research Center (Arcum) at Umeå University, Umeå, Sweden.
| | - Hanna Blåhed
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Arctic Research Center (Arcum) at Umeå University, Umeå, Sweden
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Kleber Cabral Silva H, Silva Cardoso C, Di Lorenzo Oliveira C, Carrilho Menezes A, Avelar Maia Seixas AF, Machado Rocha G. Validation of a Satisfaction Scale with a Telemedicine COVID-19 Service: Satis-COVID. Telemed J E Health 2023; 29:1514-1522. [PMID: 37022788 DOI: 10.1089/tmj.2022.0473] [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: 04/07/2023] Open
Abstract
Objectives: Despite being a widespread tool, telehealth was significantly incorporated during the COVID-19 pandemic period, but it still lacks analysis methodologies, greater digital security, and satisfaction assessment instruments that are still little explored and validated. The objective is to assess user satisfaction through the validation of a satisfaction scale with a telemedicine COVID-19 service (TeleCOVID). Methods: Cross-sectional study of a cohort of confirmed COVID-19 cases evaluated and monitored by the TeleCOVID team. To study the scale's measurement qualities, a factorial analysis was performed to test the validity of the construct. Correlation between items and the global scale was assessed using Spearman's correlation coefficient, and the instrument's internal consistency was assessed using Cronbach's alpha coefficient. Results: There were 1,181 respondents evaluating the care received from the TeleCOVID project. A total of 61.6% were female, and 62.4% aged between 30 and 59 years. The correlation coefficients indicated a good correlation between the items present in the instrument. The internal consistency of the global scale was high (Cronbach's alpha = 0.903) and the item-total correlations for the scale ranged from 0.563 to 0.820. The average overall user satisfaction was 4.58, based upon a 5-point Likert scale where 5 is the highest level of satisfaction. Conclusions: The results presented here show how much telehealth can contribute to improving access, resolutibility, and quality of care to the population in general in Public Health Care. In view of the results found, it can be said that the TeleCOVID team offered excellent care and fulfilled its proposed objectives. The scale fulfills its objective of evaluating the quality of teleservice, bringing good results in terms of validity and reliability, in addition to showing high levels of user satisfaction.
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Sreekumar S, Ravindran TKS. A critique of the policy discourse on primary health care under the Aardram mission of Kerala. Health Policy Plan 2023; 38:949-959. [PMID: 37354455 DOI: 10.1093/heapol/czad041] [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: 06/12/2022] [Revised: 06/13/2023] [Accepted: 06/22/2023] [Indexed: 06/26/2023] Open
Abstract
In 2017, the State of Kerala in India, launched the 'Aardram' mission for health. One of the aims of the mission was to enhance the primary health care (PHC) provisioning in the state through the family health centre (FHC) initiative. This was envisaged through a comprehensive PHC approach that prioritized preventive, promotive, curative, rehabilitative and palliative services, and social determinants of health. Given this backdrop, the study aimed to examine the renewed policy commitment towards comprehensive PHC and the extent to which it remains true to the globally accepted ideals of PHC. This was undertaken using a critical discourse analysis (CDA) of the policy discourse on PHC. This included examining the policy documents related to FHC and Aardram as well as the narratives of policy-level actors on PHC and innovations for them. Through CDA we examined the discursive representation of PHC and innovations for improving it at the level of local governments in the state. Though the mission envisaged a shift from the influence of market-driven ideas of health, analysis of the current policy discourse on PHC suggested otherwise. The discourse continues to carry a curative care bias within its ideas of PHC. The disproportionate emphasis on strategies for early detection, treatment and infrastructural improvements meant limited space for preventive, protective and promotive dimensions, thus digressing from the gatekeeping role of PHC. The reduced emphasis on preventive and promotive dimensions and depoliticization of social determinants of health within the PHC discourse indicates that, in the long run, the mission puts at risk its stated goals of social justice and health equity envisioned in the FHC initiative.
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Affiliation(s)
- Sreenidhi Sreekumar
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - T K Sundari Ravindran
- International Institute for Global Health, United Nations University, Kuala Lampur 56000, Malaysia
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Xu X, Huang X. Risk Characteristics of Catastrophic Health Expenditure in Multidimensional Borderline Poor Households in China. Healthc Policy 2023; 16:15-29. [PMID: 36636036 PMCID: PMC9830416 DOI: 10.2147/rmhp.s382812] [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] [Received: 07/18/2022] [Accepted: 11/16/2022] [Indexed: 01/07/2023] Open
Abstract
Background Ending poverty and realizing common prosperity are the essential requirements for the localization of Marxism in China. The ongoing COVID-19 pandemic in the post-poverty era further aggravates the risk of catastrophic health expenditure for borderline poor households and increases the uncertainty of returning to poverty due to illness, potentially undermining decades of hard-won efforts to eradicate poverty in China. Methods Based on the latest data released by China Health and Retirement Longitudinal Survey (CHARLS) database, this paper uses the Logit model to empirically explore the risk characteristics of catastrophic health expenditure of multidimensional borderline poor households based on identifying multidimensional borderline poor households. Results The results show that factors such as family income level, child support, and medical insurance have different impacts on catastrophic health expenditure, and the risk of catastrophic health expenditure of multidimensional borderline poor households is much higher than that of non- multidimensional borderline poor households, and there is a certain difference between urban and rural areas. Discussion The government should strengthen and improve the social security system and health service system, such as medical insurance, and more resources should be allocated to multidimensional borderline poor households, especially in rural areas.
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Affiliation(s)
- Xiaocang Xu
- School of Economics and Management, Huzhou University, Huzhou, 313000, People’s Republic of China
| | - Xiuquan Huang
- Faculty of Humanities and Social Sciences, Macao Polytechnic University, Macao, 999078, People’s Republic of China,Correspondence: Xiuquan Huang, Email
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Taylor MK, Kinder K, George J, Bazemore A, Mannie C, Phillips R, Strydom S, Goodyear-Smith F. Multinational primary health care experiences from the initial wave of the COVID-19 pandemic: A qualitative analysis. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100041. [PMID: 35043104 PMCID: PMC8755427 DOI: 10.1016/j.ssmqr.2022.100041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 12/29/2021] [Accepted: 01/08/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To learn from primary health care experts' experiences from the COVID-19 pandemic across countries. METHODS We applied qualitative thematic analysis to open-text responses from a multinational rapid response survey of primary health care experts assessing response to the initial wave of the COVID-19 pandemic. RESULTS Respondents' comments focused on three main areas of primary health care response directly influenced by the pandemic: 1) impact on the primary care workforce, including task-shifting responsibilities outside clinician specialty and changes in scope of work, financial strains on practices, and the daily uncertainties and stress of a constantly evolving situation; 2) impact on patient care delivery, both essential care for COVID-19 cases and the non-essential care that was neglected or postponed; 3) and the shift to using new technologies. CONCLUSIONS Primary health care experiences with the COVID-19 pandemic across the globe were similar in their levels of workforce stress, rapid technologic adaptation, and need to pivot delivery strategies, often at the expense of routine care.
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Affiliation(s)
- Melina K. Taylor
- American Board of Family Medicine, 1648 McGrathiana Parkway Suite 550, Lexington, KY, 40511, USA,Corresponding author. American Board of Family Medicine, Lexington, KY, USA
| | - Karen Kinder
- Technische Universität Berlin, Fachgebiet Management im Gesundheitswesen, Straße des 17, Juni 135, H80, 10623, Berlin, Germany
| | - Joe George
- Center for Professionalism & Value in Health Care, 1016 16th St NW, Suite 700, Washington DC, 20036, USA
| | - Andrew Bazemore
- American Board of Family Medicine, 1648 McGrathiana Parkway Suite 550, Lexington, KY, 40511, USA,Center for Professionalism & Value in Health Care, 1016 16th St NW, Suite 700, Washington DC, 20036, USA
| | - Cristina Mannie
- Mast Analytics, 4th Floor, Sunclare Building, 21 Dreyer Street, Claremont, 7708, South Africa,Department of General Practice & Primary Health Care, University of Auckland, Room 3018, Building B507 Grafton Campus, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand
| | - Robert Phillips
- Center for Professionalism & Value in Health Care, 1016 16th St NW, Suite 700, Washington DC, 20036, USA
| | - Stefan Strydom
- Mast Analytics, 4th Floor, Sunclare Building, 21 Dreyer Street, Claremont, 7708, South Africa,Department of General Practice & Primary Health Care, University of Auckland, Room 3018, Building B507 Grafton Campus, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Room 3018, Building B507 Grafton Campus, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand
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12
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Lee ST, Yang EB. Factors affecting social accountability of medical schools in the Korean context: exploratory factor and multiple regression analyses. MEDICAL EDUCATION ONLINE 2022; 27:2054049. [PMID: 35313788 PMCID: PMC8942500 DOI: 10.1080/10872981.2022.2054049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/13/2022] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
The concept of social accountability of medical schools is becoming increasingly important worldwide, and numerous frameworks and evaluation tools have been developed. This study examined how global concepts work in a specific context by identifying the factors affecting medical schools' social accountability performance in the Korean context. A survey was conducted with 40 current deans of medical schools and 15 medical education experts in Korea to assess their opinions on the implementation of social accountability of medical schools. A questionnaire survey comprising five key factors, including 39 items, was developed based on a literature review. Exploratory factors were analyzed to derive factors affecting social accountability Multiple regression analysis was conducted to determine the importance of each factor in the implementation of social accountability of medical schools. The exploratory factor analysis revealed that eight factors in three areas influenced the implementation of social accountability by medical schools. The hardware (H) area included the declaration of social accountability and physicians, organizations and systems for implementing social accountability, and physical environment and finance. The software (S) area included curriculum design-related social accountability and monitoring and evaluation system. The partner (P) area included the proximity between partners, building partnerships among stakeholders, and interactions between partners. Multiple regression analysis revealed that 'interactions between partners' had the greatest impact on the implementation of social accountability of medical schools. It is a social accountability implementation model that reflects global principles within the Korean context. The HSP model is significant in that individual medical schools can be used in establishing mandated mechanisms for accreditation. Future studies could adapt this model to study standards and indicators in other contexts.
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Affiliation(s)
- Sangmi T. Lee
- Department of Medical Education, Yonsei University Wonju College of Medicine, Gangwon-do, South Korea
| | - Eunbae B. Yang
- Department of Medical Education, Yonsei University College of Medicine, Seoul, South Korea
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13
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Wang Q, Liu X, Wang T, Zhu Z, Yang L, Guo S, Li H, Sun Q. Primary care provider's job satisfaction and organizational commitment after COVID-19 restrictions ended: A mixed-method study using a mediation model. Front Psychol 2022; 13:873770. [PMID: 36312180 PMCID: PMC9606785 DOI: 10.3389/fpsyg.2022.873770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/16/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives More and more countries have decided to cancel most or even all COVD-19 restrictions. However, it is unclear how ending of restrictions will affect primary care providers' job satisfaction and organizational commitment. Our objectives are to explore the current status and possible change in primary care providers' job satisfaction and organizational commitment after massive restriction policies ended in China. Methods This was a mixed-method study that utilized structured questionnaires and semi-structured qualitative individual interviews. The 20-item Minnesota Satisfaction Questionnaire (MSQ) and 25-item organizational commitment survey were adopted to assess job satisfaction and organization commitment. Descriptive statistics and mediation models, as well as inductive thematic analysis, were used to analyze quantitative and qualitative data. Results A total of 18 interviews and 435 valid survey responses were included in our analysis. The average scores for job satisfaction and organizational commitment were 80.6 and 90.8. The thematic analysis revealed one major theme: ethical and moral responsibility to provide care as primary care providers, on which we established a mediation model. The mediation analysis revealed that normative commitment could positively affect the other four dimensions of organizational commitment and job satisfaction. The direct effect of affective commitment on job satisfaction was significant (LLCI = 0.11, ULCI = 0.31), and the mediators were identified to have a partial mediating effect instead of a total mediating effect. Conclusion After COVID-19 restrictions end, the job satisfaction and organizational commitment of primary care providers will return to levels before the pandemic and during this estimated process, a brief rise in resignation is predictable. The normative commitment positively affects the other four dimensions of organizational commitment and job satisfaction for primary care providers, which suggests a possible way to motivate primary care providers when restrictions end.
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Affiliation(s)
- Quan Wang
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Xinyu Liu
- Jinan Municipal Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Ting Wang
- School of Public Health, Peking University, Beijing, China
| | - Zemeng Zhu
- School of Basic Medicine Science, Shandong University, Jinan, China
- School of Integrated Traditional Chinese and Western Medicine, Binzhou Medical University, Yantai, China
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Shasha Guo
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Hui Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Qiang Sun
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission (NHC) Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- *Correspondence: Qiang Sun
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14
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Gasparyan AY, Kumar AB, Yessirkepov M, Zimba O, Nurmashev B, Kitas GD. Global Health Strategies in the Face of the COVID-19 Pandemic and Other Unprecedented Threats. J Korean Med Sci 2022; 37:e174. [PMID: 35668684 PMCID: PMC9171346 DOI: 10.3346/jkms.2022.37.e174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/05/2022] [Indexed: 11/20/2022] Open
Abstract
Global health is evolving as a discipline aiming at exploring needs and offering equitable health services for all people. Over the past four decades, several global initiatives have been introduced to improve the accessibility of primary health care (PHC) and solve most health issues at this level. Historically, the 1978 Alma-Ata and 2018 Astana Declarations were perhaps the most important documents for a comprehensive approach to PHC services across the world. With the introduction of the United Nations Sustainable Development Goals in 2015, developments in all spheres of human life and multi-sectoral cooperation became the essential action targets that could contribute to improved health, well-being, and safety of all people. Other global initiatives such as the Riyadh Declaration on Digital Health and São Paulo Declaration on Planetary Health called to urgent action to employ advanced digital technologies, improve health data processing, and invest more in research management. All these initiatives are put to the test in the face of the coronavirus disease 2019 (COVID-19) pandemic and other unprecedented threats to humanity.
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Affiliation(s)
- Armen Yuri Gasparyan
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK.
| | - Ainur B Kumar
- Department of Health Policy and Management, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Olena Zimba
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | | | - George D Kitas
- Departments of Rheumatology and Research and Development, Dudley Group NHS Foundation Trust (Teaching Trust of the University of Birmingham, UK), Russells Hall Hospital, Dudley, UK
- Centre for Epidemiology versus Arthritis, University of Manchester, Manchester, UK
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15
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Deml MJ, Jungo KT, Maessen M, Martani A, Ulyte A. Megatrends in Healthcare: Review for the Swiss National Science Foundation’s National Research Programme 74 (NRP74) “Smarter Health Care”. Public Health Rev 2022; 43:1604434. [PMID: 35528712 PMCID: PMC9069234 DOI: 10.3389/phrs.2022.1604434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/10/2022] [Indexed: 01/26/2023] Open
Abstract
Objectives: In this paper, we present a review of some relevant megatrends in healthcare conducted as part of the Swiss National Science Foundation’s National Research Programme 74 (NRP74) “Smarter Health Care.” Our aim is to stimulate discussions about long-term tendencies underlying the current and future development of the healthcare system. Methods: Our team—a multidisciplinary panel of researchers involved in the NRP74—went through an iterative process of internal consultations followed by a rapid literature review with the goal of reaching group consensus concerning the most relevant megatrends in healthcare. Results: Five megatrends were identified, namely: 1) Socio-demographic shifts. 2) Broadening meaning of “health.” 3) Empowered patients and service users. 4) Digitalization in healthcare. 5) Emergence of new models of care. The main features of each megatrend are presented, drawing often on the situation in Switzerland as a paradigmatic example and adding reflections on the potential influence of the COVID-19 pandemic on them. Conclusion: Considering the long-term megatrends affecting the evolution of healthcare is important—amongst other things–to understand and contextualise the relevance and implications of innovative health services research results.
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Affiliation(s)
- Michael J. Deml
- Department of Sociology, Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - Katharina Tabea Jungo
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- *Correspondence: Katharina Tabea Jungo,
| | - Maud Maessen
- University Centre for Palliative Care, Inselspital University Hospital Bern, Bern, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Andrea Martani
- Institute for Biomedical Ethics (IBMB), University of Basel, Basel, Switzerland
| | - Agne Ulyte
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Population Heath Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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16
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The Application of Hospital Safety Index for Analyzing Primary Healthcare Center (PHC) Disaster and Emergency Preparedness. SUSTAINABILITY 2022. [DOI: 10.3390/su14031488] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The World Health Organization (WHO) defines the primary healthcare center (PHC) as a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation, and palliative care, and as close as feasibly possible to people’s everyday environment. PHCs are expected to remain operational when disasters occur. This study aimed to assess the PHC disaster preparedness level in Indonesia using The Hospital Safety Index (HSI) from WHO/PAHO. Eleven PHCs located in four provinces in Indonesia, i.e., Jakarta, Yogyakarta, North Sumatera, and West Java, were selected. Data were collected through interviews, focus-group discussions (FGDs), observations, and document reviews. The parameters assessed were all types of hazards, structural or construction safety, nonstructural safety, and functional attributes. The results show that the overall score of HSI for PHCs in Jakarta (0.674) and North Sumatera (0.752) fell into the “A” category, meaning that these PHCs would likely remain operational in the case of disasters. Meanwhile, the overall HSI scores for PHCs in West Java (0.601) and Yogyakarta (0.602) were between 0.36 and 0.65, or in “B” category, meaning that these PHCs would be able to recover during disasters but several services would be exposed to danger. The results suggested that there are several gaps that need urgent interventions to be applied for the structural safety of buildings, water supply systems, fuel storage, disaster committee organization, furniture and fittings, offices and storage equipment, as well as increasing the capacity of workers through a structured and systematic training framework for disaster readiness. The results from this study can be used for prioritizing budgets and resource allocation, cost planning, providing specific solutions for local and national government, and efforts to achieve disaster risk reduction.
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17
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Rifkin SB, Fort M, Patcharanarumol W, Tangcharoensathien V. Primary healthcare in the time of COVID-19: breaking the silos of healthcare provision. BMJ Glob Health 2021; 6:e007721. [PMID: 34732515 PMCID: PMC8572355 DOI: 10.1136/bmjgh-2021-007721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Susan B Rifkin
- Distance Learning, London School of Hygiene and Tropical Medicine, London, UK
| | - Meredith Fort
- Colorado School of Public Health, Aurora, Colorado, USA
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18
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Sarabia-Cobo CM, Delgado Uria A, García Lecue M, Izaguirre Palazuelos E, Martínez Ruiz C, Fernández-Rodríguez Á. Predictive Model of Preventive Behaviors against COVID-19 in the Older Adult: The PREASOC-COVID-19 Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111067. [PMID: 34769587 PMCID: PMC8583025 DOI: 10.3390/ijerph182111067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022]
Abstract
Background: The purpose of this study was to analyze the relationship between COVID-19 preventive behaviors, as the dependent variable, with risk perception, coping style and sense of coherence, as independent variables, in older people living in the community. Methods: An observational design for predictive model development. This study was reported following the STROBE statement. The subjects were people over 65 years of age living in the community. Data collection included sociodemographic variables related to COVID-19, risk perception and types, coping styles in the face of contagion, sense of coherence, and preventive behaviors in the face of COVID-19. The data collection period was from November 2020 to January 2021. Results: A total of 305 people participated in this study (71.5% women, mean age 71.34 years; 6.9% suffered from COVID-19 and 44.3% knew someone close to them who suffered from the virus). The coping style variables problem-focused, emotion-focused, and sense of coherence subscales Significance and manageability explained 17% of the variable preventive behaviors against COVID-19. There were statistically significant differences by gender in all subscales, with women scoring higher in all of them; Conclusions: Men with low risk perception, extrinsic risk perception, and low sense of coherence presented worse COVID-19 preventive behaviors. It would be interesting to develop specific prevention and health education campaigns for this population.
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Affiliation(s)
- Carmen María Sarabia-Cobo
- Nursing Research Group IDIVAL, Geriatric Nursing Research Group, Faculty of Nursing, Universidad de Cantabria, 39011 Santander, Spain
- Correspondence:
| | - Aroa Delgado Uria
- Gerencia de Atención Primaria, Servicio Cántabro de Salud, Cantabria, IDIVAL, Universidad de Cantabria, 39011 Santander, Spain; (A.D.U.); (M.G.L.); (E.I.P.); (C.M.R.)
| | - Marta García Lecue
- Gerencia de Atención Primaria, Servicio Cántabro de Salud, Cantabria, IDIVAL, Universidad de Cantabria, 39011 Santander, Spain; (A.D.U.); (M.G.L.); (E.I.P.); (C.M.R.)
| | - Eva Izaguirre Palazuelos
- Gerencia de Atención Primaria, Servicio Cántabro de Salud, Cantabria, IDIVAL, Universidad de Cantabria, 39011 Santander, Spain; (A.D.U.); (M.G.L.); (E.I.P.); (C.M.R.)
| | - César Martínez Ruiz
- Gerencia de Atención Primaria, Servicio Cántabro de Salud, Cantabria, IDIVAL, Universidad de Cantabria, 39011 Santander, Spain; (A.D.U.); (M.G.L.); (E.I.P.); (C.M.R.)
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19
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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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20
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Abstract
Background: In May 2020, the African Journal of Primary Health Care and Family Medicine invited submissions on lessons learnt from responses to the COVID-19 pandemic from primary care providers in Africa. This included descriptions of innovations and good practices, the management of COVID-19 in district health services and responses of communities to the outbreak. Aim: To synthesise the lessons learnt from the COVID-19 pandemic in the Africa region. Methods: A thematic document analysis was conducted on twenty-seven short report publications from Botswana, Ghana, Nigeria, South Africa, Uganda and Zimbabwe. Findings: Eight major themes were derived from the data: community-based activities; screening and testing; reorganisation of health services; emergency care for COVID-19; maintenance of essential non-COVID-19 health services; caring for the vulnerable; use of information technology; and reframing training opportunities. Community health workers were a vital community resource, delivering medications and other supplies to homes, as well as following up on patients with chronic conditions. More investment in community partnerships and social mobilisation was proposed. Difficulties with procurement of test kits and turn-around times were constraints for most countries. Authors described how services were reorganised for focused COVID-19 activities, sometimes to the detriment of essential services and training of junior doctors. Innovations in use of internet technology for communication and remote consultations were explored. The contribution of family medicine principles in upholding the humanity of patients and their families, clear leadership and planning, multidisciplinary teamwork and continuity of care was emphasised even in the context of providing critical care. Conclusions: The community-orientated primary care approach was emphasised as well as long-term benefits of technological innovations. The pandemic exposed the need to deliver on governmental commitments to strengthening primary health care and universal health coverage.
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21
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Edelman A, Marten R, Montenegro H, Sheikh K, Barkley S, Ghaffar A, Dalil S, Topp SM. Modified scoping review of the enablers and barriers to implementing primary health care in the COVID-19 context. Health Policy Plan 2021; 36:1163-1186. [PMID: 34185844 PMCID: PMC8344743 DOI: 10.1093/heapol/czab075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/13/2021] [Accepted: 06/10/2021] [Indexed: 11/25/2022] Open
Abstract
Since the Alma Ata Declaration of 1978, countries have varied in their progress towards establishing and sustaining comprehensive primary health care (PHC) and realizing its associated vision of 'Health for All'. International health emergencies such as the coronavirus-19 (COVID-19) pandemic underscore the importance of PHC in underpinning health equity, including via access to routine essential services and emergency responsiveness. This review synthesizes the current state of knowledge about PHC impacts, implementation enablers and barriers, and knowledge gaps across the three main PHC components as conceptualized in the 2018 Astana Framework. A scoping review design was adopted to summarize evidence from a diverse body of literature with a modification to accommodate four discrete phases of searching, screening and eligibility assessment: a database search in PubMed for PHC-related literature reviews and multi-country analyses (Phase 1); a website search for key global PHC synthesis reports (Phase 2); targeted searches for peer-reviewed literature relating to specific components of PHC (Phase 3) and searches for emerging insights relating to PHC in the COVID-19 context (Phase 4). Evidence from 96 included papers were analysed across deductive themes corresponding to the three main components of PHC. Findings affirm that investments in PHC improve equity and access, healthcare performance, accountability of health systems and health outcomes. Key enablers of PHC implementation include equity-informed financing models, health system and governance frameworks that differentiate multi-sectoral PHC from more discrete service-focussed primary care, and governance mechanisms that strengthen linkages between policymakers, civil society, non-governmental organizations, community-based organizations and private sector entities. Although knowledge about, and experience in, PHC implementation continues to grow, critical knowledge gaps are evident, particularly relating to country-level, context-specific governance, financing, workforce, accountability and service coordination mechanisms. An agenda to guide future country-specific PHC research is outlined.
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Affiliation(s)
- Alexandra Edelman
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Switzerland
| | - Hernán Montenegro
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
| | - Kabir Sheikh
- Alliance for Health Policy and Systems Research, World Health Organization, Switzerland
| | - Shannon Barkley
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Switzerland
| | - Suraya Dalil
- Special Programme on Primary Health Care, World Health Organization, Geneva, Switzerland
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
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22
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Ezeonwu M. The Role of African Nurse Diaspora in Addressing Public Health Priorities in Africa. Glob Qual Nurs Res 2021; 8:23333936211031501. [PMID: 34291124 PMCID: PMC8278446 DOI: 10.1177/23333936211031501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 01/31/2023] Open
Abstract
African countries experience many complex public health challenges that, to tackle, require coordinated, multi-stakeholder, collaborative partnerships at local and global levels. The African nurse diaspora is a strategic stakeholder, contributor, and liaison to public health interventions, given their roots in the continent, their professional connections in the west, and their ability to build an extensive network of global partners. Using a descriptive qualitative approach that amplifies the voices of the Africa nurse diaspora, this study provides an insider view of the continent’s public health priorities and what roles the diaspora can play to improve health and population outcomes. Findings show that Africa’s high disease burden is generally preventable but compounded by enduring socioeconomic challenges. Against this situation, African-born nurses in the diaspora are uniquely positioned to mobilize both local and global stakeholders in coordinated global health policy interventions and actively engage communities in preventive care while earning their trust.
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Family Physician Perceptions of Climate Change, Migration, Health, and Healthcare in Sub-Saharan Africa: An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126323. [PMID: 34207979 PMCID: PMC8296126 DOI: 10.3390/ijerph18126323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/30/2022]
Abstract
Although family physicians (FPs) are community-oriented primary care generalists and should be the entry point for the population’s interaction with the health system, they are underrepresented in research on the climate change, migration, and health(care) nexus (hereafter referred to as the nexus). Similarly, FPs can provide valuable insights into building capacity through integrating health-determining sectors for climate-resilient and migration-inclusive health systems, especially in Sub-Saharan Africa (SSA). Here, we explore FPs’ perceptions on the nexus in SSA and on intersectoral capacity building. Three focus groups conducted during the 2019 WONCA-Africa conference in Uganda were transcribed verbatim and analyzed using an inductive thematic approach. Participants’ perceived interactions related to (1) migration and climate change, (2) migration for better health and healthcare, (3) health impacts of climate change and the role of healthcare, and (4) health impacts of migration and the role of healthcare were studied. We coined these complex and reinforcing interactions as continuous feedback loops intertwined with socio-economic, institutional, and demographic context. Participants identified five intersectoral capacity-building opportunities on micro, meso, macro, and supra (international) levels: multi-dimensional and multi-layered governance structures; improving FP training and primary healthcare working conditions; health advocacy in primary healthcare; collaboration between the health sector and civil society; and more responsibilities for high-income countries. This exploratory study presents a unique and novel perspective on the nexus in SSA which contributes to interdisciplinary research agendas and FP policy responses on national, regional, and global levels.
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Arvidsson E, Švab I, Klemenc-Ketiš Z. Core Values of Family Medicine in Europe: Current State and Challenges. Front Med (Lausanne) 2021; 8:646353. [PMID: 33708785 PMCID: PMC7940667 DOI: 10.3389/fmed.2021.646353] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/01/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Values are deeply held views that act as guiding beliefs for individuals and organizations. They state what is important in a profession. The aims of this study were to determine whether European countries have already developed (or are developing) documents on core values in family medicine; to gather the lists of core values already developed in countries; and to gather the opinions of participants on what the core family values in their countries are. Methods: This was a qualitative study. The questionnaire was distributed as an e-survey via email to present and former members of the European Society for Quality and Safety in Family Practice (EQuiP), and other family medicine experts in Europe. The questionnaire included six items concerning core values in family medicine in the respondent's country: the process of defining core values, present core values, the respondents' suggestions for core values, and current challenges of core values. Results: Core values in family medicine were defined or in a process of being defined in several European countries. The most common core values already defined were the doctor-patient relationship, continuity, comprehensiveness and holistic care, community orientation, and professionalism. Some countries expressed the need for an update of the current core values' list. Most respondents felt the core values of their discipline were challenged in today's world. The main values challenged were continuity, patient-centered care/the doctor-patient relationship and comprehensive and holistic care, but also prioritization, equity, and community orientation and cooperation. These were challenged by digital health, workload/lack of family physicians, fragmentation of care, interdisciplinary care, and societal trends and commercial interests. Conclusion: We managed to identify suggestions for core values of family medicine at the European level. There is a clear need to adopt a definition of a value and tailor the discussion and actions on the family medicine core values accordingly. There is also a need to identify the core values of family medicine in European countries. This could strengthen the profession, promote its development and research, improve education, and help European countries to advocate for the profession.
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Affiliation(s)
- Eva Arvidsson
- Futurum, Jönköping, Sweden.,School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Igor Švab
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Ljubljana Community Health Centre, Ljubljana, Slovenia
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25
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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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