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Lava JB, Claro VD, Quiñon MS, Labis R, Marcelo W, Lucero MA, Mendoza O, Stan L. Integrating COVID-19 Vaccination in Primary Care Service Delivery: Insights From Implementation Research in the Philippines. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300202. [PMID: 38378272 PMCID: PMC10948126 DOI: 10.9745/ghsp-d-23-00202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/19/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND In 2019, the Philippines enacted a universal health coverage law that aimed to establish an integrated health system centered around robust primary care as a core strategy of its health system reform agenda. Although the COVID-19 pandemic disrupted initial progress in the reform process, it also presented an opportunity to pilot interventions to demonstrate integration in various ways. METHODS We conducted a participatory implementation research study to integrate selected public health interventions into the implementation of the primary care benefit package funded by public health insurance. The study was conducted from October 2022 to April 2023 in the Province of Iloilo, Philippines. Entry points within the primary care service delivery process were identified, and interventions related to COVID-19 vaccination and family planning were implemented and monitored. We used the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to organize the results and present the analysis. RESULTS The intervention showed substantial improvement across the 5 dimensions of the RE-AIM framework, including enhanced access to health care services, as indicated by improvements in primary care patient registration, family planning services, and COVID-19 vaccination processes, as well as an increase in registrations and first patient encounters. These improvements corresponded to sustained primary care facility participation throughout the study period. Additionally, emergent factors that either impeded or facilitated the integration process were identified, providing insights for effectively integrating COVID-19 vaccination within the primary care health system. CONCLUSION Our study provides evidence of the feasibility of integrating public health interventions into primary care settings. It highlights the potential of using existing primary care service delivery and financing mechanisms as entry points for integration. However, further iteration of the model is required to identify specific conditions for success that can be applied in other contexts and settings.
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Affiliation(s)
| | | | | | - Rodney Labis
- Provincial Health Office, Province of Iloilo, Iloilo City, Philippines
| | - Wendel Marcelo
- Provincial Health Office, Province of Iloilo, Iloilo City, Philippines
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Marzouk M, Lam ST, Durrance-Bagale A, Nagashima-Hayashi M, Neo P, Ung M, Zaseela A, Aribou ZM, Agarwal S, Howard N. Effects of COVID-19 on sexual and reproductive health services access in the Asia-Pacific region: a qualitative study of expert and policymaker perspectives. Sex Reprod Health Matters 2023; 31:2247237. [PMID: 37682084 PMCID: PMC10494729 DOI: 10.1080/26410397.2023.2247237] [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: 09/09/2023] Open
Abstract
The COVID-19 pandemic has strained health systems globally, with governments imposing strict distancing and movement restrictions. Little is known about the effects of the COVID-19 pandemic on sexual and reproductive health (SRH). This study examined perceived effects of COVID-19 on SRH service provision and use in the Asia-Pacific region. We conducted a qualitative study using semi-structured interviews with 28 purposively sampled SRH experts in 12 Asia-Pacific countries (e.g. United Nations, international and national non-governmental organisations, ministries of health, academia) between November 2020 and January 2021. We analysed data using the six-stage thematic analysis approach proposed by Braun and Clarke (2019). Interviewees reported that COVID-19 mitigation measures, such as transport restrictions and those that decreased the availability of personal protective equipment (PPE), reduced SRH service provision and use in most countries. SRH needs related to service barriers and gender-based violence increased. Systemic challenges included fragmented COVID-19 response plans and insufficient communication and collaboration, particularly between public and private sectors. SRH service-delivery challenges included COVID-19 response prioritisation, e.g. SRH staff task-shifting to COVID-19 screening and contact tracing, and lack of necessary supplies and equipment. Innovative SRH delivery responses included door-to-door antenatal care and family planning provision in the Philippines, online platforms for SRH education and outreach in Viet Nam, and increasing SRH service engagement through social media in Myanmar and Indonesia. To ensure continuation of SRH services during health emergencies, governments should earmark human and financial resources and prioritise frontline health-worker safety; work with communities and the private sector; and develop effective risk communications.
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Affiliation(s)
- Manar Marzouk
- Research Fellow, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK; Overseas Research Associate], Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sze Tung Lam
- Visiting Scholar Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Alumnus, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK
| | - Anna Durrance-Bagale
- Research Fellow, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK
| | - Michiko Nagashima-Hayashi
- Research Associate, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Pearlyn Neo
- Research Associate, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Mengieng Ung
- Research Fellow, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Ayshath Zaseela
- Intern, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Zeenathnisa Mougammadou Aribou
- Senior Resident, Preventive Medicine, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Sunanda Agarwal
- Partner, Stanford University, Stanford Distinguished Careers Institute, Stanford, USA
| | - Natasha Howard
- Associate Professor, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Associate Professor, London School of Hygiene & Tropical Medicine, Department of Global Health & Development, London, UK
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Saif-Ur-Rahman KM, Islam MS, Alaboson J, Ola O, Hasan I, Islam N, Mainali S, Martina T, Silenga E, Muyangana M, Joarder T. Artificial intelligence and digital health in improving primary health care service delivery in LMICs: A systematic review. J Evid Based Med 2023; 16:303-320. [PMID: 37691394 DOI: 10.1111/jebm.12547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
AIM Technology including artificial intelligence (AI) may play a key role to strengthen primary health care services in resource-poor settings. This systematic review aims to explore the evidence on the use of AI and digital health in improving primary health care service delivery. METHODS Three electronic databases were searched using a comprehensive search strategy without providing any restriction in June 2023. Retrieved articles were screened independently using the "Rayyan" software. Data extraction and quality assessment were conducted independently by two review authors. A narrative synthesis of the included interventions was conducted. RESULTS A total of 4596 articles were screened, and finally, 48 articles were included from 21 different countries published between 2013 and 2021. The main focus of the included studies was noncommunicable diseases (n = 15), maternal and child health care (n = 11), primary care (n = 8), infectious diseases including tuberculosis, leprosy, and HIV (n = 7), and mental health (n = 6). Included studies considered interventions using AI, and digital health of which mobile-phone-based interventions were prominent. m-health interventions were well adopted and easy to use and improved the record-keeping, service deliver, and patient satisfaction. CONCLUSION AI and the application of digital technologies improve primary health care service delivery in resource-poor settings in various ways. However, in most of the cases, the application of AI and digital health is implemented through m-health. There is a great scope to conduct further research exploring the interventions on a large scale.
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Affiliation(s)
- K M Saif-Ur-Rahman
- College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Shariful Islam
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Joan Alaboson
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Oluwadara Ola
- Sacred Heart Hospital, Abeokuta, Ogun State, Nigeria
| | - Imran Hasan
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Nazmul Islam
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shristi Mainali
- Department of Operations, Marie Stopes International, Kathmandu, Nepal
| | - Tina Martina
- General Hospital of Haji Padjonga, South Sulawesi, Indonesia
| | - Eva Silenga
- Department of Mother and Child Health, Ministry of Health, Lusaka, Zambia
| | - Mubita Muyangana
- Lewanika School of Nursing and Midwifery, Ministry of Health, Mongu, Zambia
| | - Taufique Joarder
- SingHealth Duke-NUS Global Health Institute, National University of Singapore, Singapore
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Prinja S, Singh MP, Bahuguna P. India's publicly financed insurance scheme: scope for revision - authors' reply. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 14:100236. [PMID: 37492422 PMCID: PMC10363489 DOI: 10.1016/j.lansea.2023.100236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 07/27/2023]
Affiliation(s)
- Shankar Prinja
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
- National Health Authority, Government of India, New Delhi, India
| | - Maninder Pal Singh
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Pankaj Bahuguna
- Department of Community Medicine & School of Public Health, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Kasaye H, Sheehy A, Scarf V, Baird K. The roles of multi-component interventions in reducing mistreatment of women and enhancing respectful maternity care: a systematic review. BMC Pregnancy Childbirth 2023; 23:305. [PMID: 37127582 PMCID: PMC10150509 DOI: 10.1186/s12884-023-05640-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/24/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Despite recognition of the adverse impacts of the mistreatment of women during pregnancy, labour and birth, there remains limited evidence on interventions that could reduce mistreatment and build a culture of respectful maternity care (RMC) in health facilities. The sustainability of effective individual interventions and their adaptability to various global contexts remain uncertain. In this systematic review, we aimed to synthesise the best available evidence that has been shown to be effective in reducing the mistreatment of women and/or enhancing RMC during women's maternity care in health facilities. METHODS We searched the online databases PubMed, CINAHL, EBSCO Nursing/Academic Edition, Embase, African Journals Online (AJOL), Scopus, Web of Science, and grey literature using predetermined search strategies. We included cluster randomized controlled trials (RCTs) and pre-and-post observational studies and appraised them using JBI critical appraisal checklists. The findings were synthesised narratively without conducting a meta-analysis. The certainty of evidence was assessed using GRADE criteria. RESULTS From the 1493 identified records, 11 studies from six sub-Sahara African countries and one study from India were included: three cluster RCTs and nine pre- and post-studies. We identified diverse interventions implemented via various approaches including individual health care providers, health systems, and policy amendments. Moderate certainty evidence from two cluster RCTs and four pre- and post-studies suggests that multi-component interventions can reduce the odds of mistreatment that women may experience in health facilities, with odds of reduction ranging from 18 per cent to 66 per cent. Similarly, women's perceptions of maternity care as respectful increased in moderate certainty evidence from two cluster RCTs and five pre- and post-studies with reported increases ranging from 5 per cent to 50 per cent. CONCLUSIONS Multi-component interventions that address attitudes and behaviors of health care providers, motivate staff, engage the local community, and alleviate health facility and system constraints have been found to effectively reduce mistreatment of women and/or increase respectful maternity care. Such interventions which go beyond a single focus like staff training appear to be more likely to bring about change. Therefore, future interventions should consider diverse approaches that incorporate these components to improve maternal care.
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Affiliation(s)
- Habtamu Kasaye
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
- Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Annabel Sheehy
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Vanessa Scarf
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Kathleen Baird
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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The role of hospitals in strengthening primary health care in the Western Pacific. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 33:100698. [PMID: 36880058 PMCID: PMC9984548 DOI: 10.1016/j.lanwpc.2023.100698] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
Despite the imperative to strengthen primary health care (PHC) to respond to demographic and epistemological transitions, and meet commitments to achieve universal health coverage, health systems remain hospital-centric with health resources largely concentrated in urban centres. This paper examines islands of innovation that demonstrate the role hospitals can play in influencing the provision of PHC. Drawing on the literature and country case studies from the Western Pacific region, we illustrate mechanisms used to unlock hospital resources to improve PHC, with the transition towards "systems-focused hospitals". This paper identifies four "ideal types" of roles hospitals perform to strengthen PHC in different contexts. This provides a framework to inform health systems policy by examining existing and potential roles of hospitals to support the provision of frontline services and reorient health systems towards PHC.
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Of primary health care reforms and pandemic responses: understanding perspectives of health system actors in Kerala before and during COVID-19. BMC PRIMARY CARE 2023; 24:59. [PMID: 36859179 PMCID: PMC9975828 DOI: 10.1186/s12875-023-02000-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/02/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND In 2016, the Government of the southern Indian state of Kerala launched the Aardram mission, a set of reforms in the state's health sector with the support of Local Self Governments (LSG). Primary Health Centres (PHCs) were slated for transformation into Family Health Centres (FHCs), with extended hours of operation as well as improved quality and range of services. With the COVID-19 pandemic emerging soon after their introduction, we studied the outcomes of the transformation from PHC to FHC and how they related to primary healthcare service delivery during COVID-19. METHODS A qualitative study was conducted using In-depth interviews with 80 health system actors (male n = 32, female n = 48) aged between 30-63 years in eight primary care facilities of four districts in Kerala from July to October 2021. Participants included LSG members, medical and public health staff, as well as community leaders. Questions about the need for primary healthcare reforms, their implementation, challenges, achievements, and the impact of COVID-19 on service delivery were asked. Written informed consent was obtained and interview transcripts - transliterated into English-were thematically analysed by a team of four researchers using ATLAS.ti 9 software. RESULTS LSG members and health staff felt that the PHC was an institution that guarantees preventive, promotive, and curative care to the poorest section of society and can help in reducing the high cost of care. Post-transformation to FHCs, improved timings, additional human resources, new services, fully functioning laboratories, and well stocked pharmacies were observed and linked to improved service utilization and reduced cost of care. Challenges of geographical access remained, along with concerns about the lack of attention to public health functions, and sustainability in low-revenue LSGs. COVID-19 pandemic restrictions disrupted promotive services, awareness sessions and outreach activities; newly introduced services were stopped, and outpatient numbers were reduced drastically. Essential health delivery and COVID-19 management increased the workload of health workers and LSG members, as the emphasis was placed on managing the COVID-19 pandemic and delivering essential health services. CONCLUSION Most of the health system actors expressed their belief in and commitment to primary health care reforms and noted positive impacts on the clinical side with remaining challenges of access, outreach, and sustainability. COVID-19 reduced service coverage and utilisation, but motivated greater efforts on the part of both health workers and community representatives. Primary health care is a shared priority now, with a need for greater focus on systems strengthening, collaboration, and primary prevention.
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Akinwumi AI, OlaOlorun AD, Adesina SA, Durodola AO, Amole IO, Singer SR, Levine H. Strong primary care services, an important feature of primary health care: What can Nigeria learn from Israel? Front Public Health 2022; 10:1006095. [PMID: 36589941 PMCID: PMC9801635 DOI: 10.3389/fpubh.2022.1006095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- Akinsola Idowu Akinwumi
- Department of Family Medicine, Afe Babalola University, Ado Ekiti, Nigeria,Department of Family Medicine, ABUAD Multi-System Hospital, Ado Ekiti, Ekiti, Nigeria,*Correspondence: Akinsola Idowu Akinwumi ; ;
| | - Akintayo David OlaOlorun
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Stephen Adesope Adesina
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Adewumi Ojeniyi Durodola
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Isaac Olusayo Amole
- Department of Family Medicine, Bowen University, Iwo, Osun, Nigeria,Department of Family Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo, Nigeria
| | - Shepherd Roee Singer
- Hadassah Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel,Division of Epidemiology, Ministry of Health, Jerusalem, Israel
| | - Hagai Levine
- Hadassah Braun School of Public Health, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Kabir A, Karim N, Billah B. Preference and willingness to receive non-communicable disease services from primary healthcare facilities in Bangladesh: A qualitative study. BMC Health Serv Res 2022; 22:1473. [PMID: 36463166 PMCID: PMC9719224 DOI: 10.1186/s12913-022-08886-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In Bangladesh, non-communicable diseases (NCDs) are increasing rapidly and account for approximately 68% of mortality and 64% of disease burden. NCD services have been significantly mobilized to primary healthcare (PHC) facilities to better manage the rising burden of NCDs. However, little is known about community members' preference and willingness to receive NCD services from PHC facilities; therefore, this particular subject is the focus of this study. METHODS A qualitative study was conducted from May 2021 to October 2021. Data were collected via 16 focus group discussions involving community members and 14 key informant interviews with healthcare professionals, facility managers, and public health practitioners. Based on a social-ecological model (SEM), data were analyzed thematically. The triangulation of methods and participants was conducted to validate the information provided. RESULTS Preference and willingness to receive NCD services from PHC facilities were influenced by a range of individual, interpersonal, societal, and organizational factors that were interconnected and influenced each other. Knowledge and the perceived need for NCD care, misperception, self-management, interpersonal, and family-level factors played important roles in using PHC facilities. Community and societal factors (i.e., the availability of alternative and complementary services, traditional practices, social norms) and organizational and health system factors (i.e., a shortage of medicines, diagnostic capacity, untrained human resources, and poor quality of care) also emerged as key aspects that influenced preference and willingness to receive NCD services from PHC facilities. CONCLUSION Despite their substantial potential, PHC facilities may not take full advantage of managing NCDs. All four factors need to be considered when developing NCD service interventions in the primary healthcare system to better address the rising burden of NCDs.
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Affiliation(s)
- Ashraful Kabir
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nazmul Karim
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Baki Billah
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Kabir A, Karim MN, Billah B. Health system challenges and opportunities in organizing non-communicable diseases services delivery at primary healthcare level in Bangladesh: A qualitative study. Front Public Health 2022; 10:1015245. [PMID: 36438215 PMCID: PMC9682236 DOI: 10.3389/fpubh.2022.1015245] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction The weak health system is viewed as a major systematic obstacle to address the rising burden of non-communicable diseases (NCDs) in resource-poor settings. There is little information about the health system challenges and opportunities in organizing NCD services. This study examined the health system challenges and opportunities in organizing NCD services for four major NCDs (cervical cancer, diabetes mellitus, cardiovascular diseases, and chronic respiratory illnesses) at the primary healthcare (PHC) level in Bangladesh. Methods Using a qualitative method, data were collected from May to October 2021 by conducting 15 in-depth interviews with local healthcare providers, 14 key informant interviews with facility-based providers and managers, and 16 focus group discussions with community members. Based on a health system dynamics framework, data were analyzed thematically. Information gathered through the methods and sources was triangulated to validate the data. Results Organization of NCD services at the PHC level was influenced by a wide range of health system factors, including the lack of using standard treatment guidelines and protocols, under-regulated informal and profit-based private healthcare sectors, poor health information system and record-keeping, and poor coordination across healthcare providers and platforms. Furthermore, the lack of functional referral services; inadequate medicine, diagnostic facilities, and logistics supply; and a large number of untrained human resources emerged as key weaknesses that affected the organization of NCD services. The availability of NCD-related policy documents, the vast network of healthcare infrastructure and frontline staff, and increased demand for NCD services were identified as the major opportunities. Conclusion Despite the substantial potential, the health system challenge impeded the organization of NCD services delivery at the PHC level. This weakness needs be to addressed to organize quality NCD services to better respond to the rising burden of NCDs at the PHC level.
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Saif-Ur-Rahman K, Sultana S, Afrin S, Islam K. Participatory approaches in primary health care related implementation research in low-and middle-income countries: A narrative review. PUBLIC HEALTH IN PRACTICE 2022; 4:100344. [DOI: 10.1016/j.puhip.2022.100344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/13/2022] [Accepted: 11/17/2022] [Indexed: 11/24/2022] Open
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Fazal F, Saleem T, Ur Rehman ME, Haider T, Khalid AR, Tanveer U, Mustafa H, Tanveer J, Noor A. The rising cost of healthcare and its contribution to the worsening disease burden in developing countries. Ann Med Surg (Lond) 2022; 82:104683. [PMID: 36148082 PMCID: PMC9486377 DOI: 10.1016/j.amsu.2022.104683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/10/2022] [Indexed: 11/25/2022] Open
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Kabir A, Karim MN, Islam RM, Romero L, Billah B. Health system readiness for non-communicable diseases at the primary care level: a systematic review. BMJ Open 2022; 12:e060387. [PMID: 35140165 PMCID: PMC8830230 DOI: 10.1136/bmjopen-2021-060387] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To synthesise evidence on the primary healthcare system's readiness for preventing and managing non-communicable diseases (NCDs). DESIGN Systematic review. DATA SOURCES Ovid MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus were searched from 1 January 1984 to 30 July 2021, with hand-searching references and expert advice. ELIGIBILITY CRITERIA Any English-language health research with evidence of readiness/preparedness of the health system at the primary healthcare level in the context of four major NCDs: diabetes mellitus, cancer, chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs). DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data and assessed the bias. The full-text selected articles were then assessed using the Mixed Methods Appraisal Tool. Health system readiness was descriptively and thematically synthesised in line with the health system dynamics framework. RESULTS Out of 7843 records, 23 papers were included in this review (15 quantitative, 3 qualitative and 5 mixed-method studies). The findings showed that existing literature predominantly examined health system readiness from the supply-side perspective as embedded in the WHO's health system framework. However, at the primary healthcare level, these components are insufficiently prepared for NCDs. Among NCDs, higher levels of readiness were reported for diabetes mellitus and hypertension in comparison to CRDs (asthma, chronic obstructive pulmonary disease), CVDs and cancer. There has been a dearth of research on the demand-side perspective, which is an essential component of a health system and must be addressed in the future research. CONCLUSION The supply-side components at the primary healthcare level are inadequately ready to address the growing NCD burden. Improving supply-side factors, with a particular focus on CRDs, CVDs and cancer, and improving understanding of the demand-side components of the health system's readiness, may help to prevent and manage NCDs at the primary healthcare level.
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Affiliation(s)
- Ashraful Kabir
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Md Nazmul Karim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rakibul M Islam
- Women's Health Research Program, Monash University, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Ian Potter Library, Ground Floor, AMREP Building, The Alfred, Melbourne, Victoria, Australia
| | - Baki Billah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Goberdhan S, Gobin R, Perreira O, Sharma M, Ramdeen M, Harding S. Formative Exploration of the Feasibility of Embedding Community Assets Into Primary Health Care: Barbershop and Place of Worship Readiness in Guyana. J Prim Care Community Health 2022; 13:21501319221135949. [PMID: 36373680 PMCID: PMC9666845 DOI: 10.1177/21501319221135949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Community engagement is key to improving the quality of primary health care
(PHC), with asset-based interventions shown to have a positive impact on
equity and health outcomes. However, there tends to be a disconnect between
community-based interventions and PHC, with a lack of evidence on how to
develop sustainable community—primary care partnerships. This paper reports
on the formative phases of 2 studies exploring the feasibility of embedding
community assets, namely places of worship and barbershops, into the PHC
pathway for the prevention and control of NCDs in deprived settings. It
describes the participatory approach used to map and gather contextual
readiness information, including the enablers and constrainers for
collaborative partnerships with PHC. Methods: Grounded in community-based participatory research, we used elements of
ground-truthing and participatory mapping to locate and gather contextual
information on places of worship and barbershops in urban and rural
communities. Local knowledge, gathered from community dialogs, led to the
creation of sampling frames of these community assets. Selected places of
worship were administered a 66-item readiness questionnaire, which included
domains on governance and financing, congregation profile, and existing
health programs and collaborations. Participating barbershops were
administered a 40-item readiness questionnaire, which covered barbers’
demographic information, previous training in health promotion, and barbers’
willingness to deliver health promotion activities. Results: Fourteen barbershops were identified, of which 10 participated in the
readiness survey, while 240 places of worship were identified, of which 14
were selected and assessed for readiness. Contextual differences were found
within and between these assets regarding governance, accessibility, and
reach. Key enablers for both include training in health promotion, an
overwhelming enthusiasm for participation and recognition of the potential
benefits of a community—primary care partnership. Lack of previous
collaborations with the formal health system was common to both. Conclusion: The participatory approach extended reach within underserved communities,
while the readiness data informed intervention design and identified
opportunities for partnership development. Contextual differences between
community assets require comprehensive readiness investigations to develop
suitably tailored interventions that promote reach, acceptance, and
sustainability.
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Murphy SD, Moosa S. The views of public service managers on the implementation of National Health Insurance in primary care: a case of Johannesburg Health District, Gauteng Province, Republic of South Africa. BMC Health Serv Res 2021; 21:969. [PMID: 34521399 PMCID: PMC8439954 DOI: 10.1186/s12913-021-06990-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background The South African government is implementing National Health Insurance (NHI) as a monopsony health care financing mechanism to drive the country towards Universal Health Coverage (UHC). Strategic purchasing, with separation of funder, purchaser and provider, underpins this initiative. The NHI plans Contracting Units for Primary healthcare (PHC) Services (CUPS) to function as either independent sub-district purchasers or public providers and District Health Management Offices (DHMOs) to support and monitor these CUPS. This decentralised operational unit of PHC, the heartbeat of NHI, is critical to the success of NHI. The views of district-level managers, who are responsible for these units, are fundamental to this NHI implementation. This qualitative study aimed to explore district and sub-district managerial views on NHI and their role in its implementation. Methods Purposive sampling was used to identify key respondents from a major urban district in Gauteng, South Africa, for participation in in-depth interviews. This study used framework analysis methodology within MaxQDA software. Results Three main themes were identified: managerial engagement in NHI policy development (with two sub-themes), managerial views on NHI (with three sub-themes) and perceptions of current NHI implementation (with six sub-themes). The managers viewed NHI as a social and moral imperative but lacked clarity and insight into the NHI Bill as well as the associated implementation strategies. The majority of respondents had not had the opportunity to engage in NHI policy formulation. Managers cited several pitfalls in current organisational operations. The respondents felt that national and provincial governments continue to function in a detached and rigid top-down hierarchy. Managers highlighted the need for their inclusion in NHI policy formulation and training and development for them to oversee the implementation strategies. Conclusions It appears that strategic purchasing is not being operationalised in PHC. NHI policy implementation appears to function in a rigid top-down hierarchy that excludes key stakeholders in the NHI implementation strategy. The findings of this study suggest an inadequate decentralisation of healthcare governance within the public sector necessary to attain UHC. District managers need to be engaged and capacitated to operationalise the planned decentralised purchasing-provision function of the DHS within the NHI Bill.
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Affiliation(s)
- S D Murphy
- Department of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - S Moosa
- Department of Family Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Calderon Gomez C, Betancurth Loaiza DP. Atención Primaria de Salud: una mirada global para orientarnos en lo local. Rev Salud Publica (Bogota) 2021. [DOI: 10.15446/rsap.v23n5.85333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
La atención sanitaria en general y la atención primaria de salud en particular necesi- tan ser pensadas y desarrolladas atendiendo a las cambiantes realidades sanitarias y sociales. Dichas realidades, complejas y diversas en función de las particularidades de cada país y la evolución de sus servicios de salud, presentan a su vez determinados retos comunes a los que también deberíamos responder de manera compartida.
El presente trabajo es una reflexión abierta acerca de las características básicas de la atención primaria desde una perspectiva internacional, elaborada y compartida en el contexto del II Simposio de Atención Primaria Social, organizado por la Universidad de Caldas en noviembre de 2019.
Utilizando la metáfora de la travesía por mar, se resitúan los principales atributos y condicionantes de la atención primaria a modo de carta de navegación y se sugieren los referentes de una posible brújula que puedan servirnos para sortear amenazas y avanzar conjuntamente hacia una atención primaria pública de calidad y al servicio de la salud de nuestras poblaciones.
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Koly KN, Baskin C, Lata I, Rao M, Rasheed S, Law G, Gnani S. Educational and training interventions aimed at healthcare workers in the detection and management of people with mental health conditions in South and Southeast Asia: systematic review protocol. BMJ Open 2021; 11:e045615. [PMID: 34215602 PMCID: PMC8256758 DOI: 10.1136/bmjopen-2020-045615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The mental health burden and treatment gap in South and Southeast Asia is high and significant. Capacity building of healthcare workers is essential to support programmes related to the detection and management of patients with mental health conditions. We aim to conduct a systematic review to summarise the research on educational, training and capacity-building interventions aimed at the healthcare workforce in detection and management of mental health conditions in South and Southeast Asia. OBJECTIVE To synthesise evidence on (1) the types of educational and training interventions that have been used to improve the knowledge, skills and attitudes of healthcare workers in South and Southeast Asian countries in the detection and management of mental health conditions; (2) the effectiveness, including cost-effectiveness of the interventions; and (3) the enabling factors and barriers that influence the effectiveness of these interventions. METHODS AND ANALYSIS This review will be conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. We will search six electronic databases: MEDLINE, EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Global Health for empirical studies published from 1 January 2000 to 31 August 2020. Search results from each database will be combined and uploaded in Covidence library. Title, abstract and full-text screening, and data extraction of each included study will be performed by two independent reviewers. Disagreements between reviewers will be resolved by a third reviewer and study team. Quality of included studies will be assessed by the modified Cochrane Collaboration tool and ROBINS-I tool. Data will be synthesised and if a meta-analysis is not appropriate, a stepwise thematic analysis will be performed. ETHICS AND DISSEMINATION Ethics approval is not required for this study. Findings will be disseminated through peer-reviewed publications, fact sheets, multimedia press briefings, conferences, seminars and symposia. PROSPERO REGISTRATION NUMBER CRD42020203955.
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Affiliation(s)
- Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Cleo Baskin
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Ivy Lata
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Mala Rao
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sabrina Rasheed
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Graham Law
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, Imperial College London, London, UK
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18
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Scott J, Johnson R, Ibemere S. Addressing health inequities re-illuminated by the COVID-19 pandemic: How can nursing respond? Nurs Forum 2021; 56:217-221. [PMID: 32959411 PMCID: PMC7537307 DOI: 10.1111/nuf.12509] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/11/2020] [Accepted: 09/07/2020] [Indexed: 04/21/2023]
Abstract
The coronavirus disease 2019 mortality rate among Black adults in the U.S. is double that of other racial and ethnic groups. The current pandemic is re-illuminating health inequities that are pervasive in our society and reflected in our health system. This creative controversy describes critical conversations needed within nursing to acknowledge the contribution of structural racism to health equity. We recommend implementing structural competency into nursing education and prioritizing nursing research and policies focused on health equity and community-based interventions.
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Affiliation(s)
- Jewel Scott
- Cardiovascular Behavioral Medicine ResearchUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Ragan Johnson
- Healthcare in Adult PopulationsDuke University School of NursingDurhamNorth CarolinaUSA
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Koly KN, Baskin C, Khanam I, Rao M, Rasheed S, Law GR, Sarker F, Gnani S. Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review. Front Psychiatry 2021; 12:741328. [PMID: 34707524 PMCID: PMC8542900 DOI: 10.3389/fpsyt.2021.741328] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/07/2021] [Indexed: 01/18/2023] Open
Abstract
Background: To bridge significant mental health treatment gaps, it is essential that the healthcare workforce is able to detect and manage mental health conditions. We aim to synthesise evidence of effective educational and training interventions aimed at healthcare workers to increase their ability to detect and manage mental health conditions in South and South-East Asia. Methods: Systematic review of six electronic academic databases from January 2000 to August 2020 was performed. All primary research studies were eligible if conducted among healthcare workers in South and South-East Asia and reported education and training interventions to improve detection and management of mental health conditions. Quality of studies were assessed using Modified Cochrane Collaboration, ROBINS-I, and Mixed Methods Appraisal Tools and data synthesised by narrative synthesis. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A review protocol was registered with the PROSPERO database (CRD42020203955). Findings: We included 48 of 3,654 screened articles. Thirty-six reported improvements in knowledge and skills in the detection and management of mental health conditions. Training was predominantly delivered to community and primary care health workers to identify and manage common mental health disorders. Commonly used training included the World Health Organization's mhGAP guidelines (n = 9) and Cognitive Behavioural Therapy (n = 8) and were successfully tailored and delivered to healthcare workers. Digitally delivered training was found to be acceptable and effective. Only one study analysed cost effectiveness. Few targeted severe mental illnesses and upskilling mental health specialists or offered long-term follow-up or supervision. We found 21 studies were appraised as low/moderate and 19 as high/critical risk of bias. Interpretation: In low resource country settings, upskilling and capacity building of primary care and community healthcare workers can lead to better detection and management of people with mental health disorders and help reduce the treatment gap. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42020203955.
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Affiliation(s)
- Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Cleo Baskin
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Ivylata Khanam
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Mala Rao
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
| | - Sabrina Rasheed
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Graham R Law
- School of Health and Social Care, University of Lincoln, Lincoln, United Kingdom
| | - Farhana Sarker
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Shamini Gnani
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Haque M, Islam T, Rahman NAA, McKimm J, Abdullah A, Dhingra S. Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries. Risk Manag Healthc Policy 2020; 13:409-426. [PMID: 32547272 PMCID: PMC7244358 DOI: 10.2147/rmhp.s239074] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/24/2020] [Indexed: 12/31/2022] Open
Abstract
The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85–90% of premature deaths among 30–69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/33l6gK1RNFo
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Tariqul Islam
- UChicago Research Bangladesh, Dhaka 1230, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, 25200, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Adnan Abdullah
- Unit of Occupational Medicine, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Mount Hope, Trinidad & Tobago
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Faujdar DS, Sahay S, Singh T, Jindal H, Kumar R. Public health information systems for primary health care in India: A situational analysis study. J Family Med Prim Care 2019; 8:3640-3646. [PMID: 31803666 PMCID: PMC6881929 DOI: 10.4103/jfmpc.jfmpc_808_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 09/21/2019] [Accepted: 10/01/2019] [Indexed: 12/03/2022] Open
Abstract
Introduction: Information communication technology (ICT) based health information systems (HISs) are expected to transform health system functionality. The present study was aimed to evaluate HISs in India with a focus on primary health care (PHC). Methodology: The study used a qualitative method to evaluate and understand various ICT-based HIS implemented at the state/union territory (UT) level in India. After initial scoping research on HIS through literature search and observation, in-depth interviews of key informants at various levels (programme managers, analysts, co-ordinators, data entry operator and health care providers) was carried out to have an insight on the user experience of these systems. An inductive applied thematic coding of qualitative data was done for analysing the data. Results: Multiple applications have been developed under national health programmes to meet the health information needs, but at present, there is a limited role of these HISs in enhancing the effectiveness of comprehensive PHC. Many of these systems are proprietary-based, and the long-term sustainability and integration of these systems remain a challenge. Conclusion: A change is required in the approach to design a HIS that will cater to the needs of PHC. Moreover, HIS should be people-centred rather than technology-centric with focus on integration and sustainability.
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Affiliation(s)
- Dharamjeet Singh Faujdar
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Norway
| | - Tarundeep Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harashish Jindal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Kumar
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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Angell B, Dodd R, Palagyi A, Gadsden T, Abimbola S, Prinja S, Jan S, Peiris D. Primary health care financing interventions: a systematic review and stakeholder-driven research agenda for the Asia-Pacific region. BMJ Glob Health 2019; 4:e001481. [PMID: 31478024 PMCID: PMC6703289 DOI: 10.1136/bmjgh-2019-001481] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/27/2019] [Accepted: 07/15/2019] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Interventions targeting the financing of primary health care (PHC) systems could accelerate progress towards universal health coverage; however, there is limited evidence to guide best-practice implementation of these interventions. This study aimed to generate a stakeholder-led research agenda in the area of PHC financing interventions in the Asia-Pacific region. METHODS We adopted a two-stage process: (1) a systematic review of financing interventions targeting PHC service delivery in the Asia-Pacific region was conducted to develop an evidence gap map and (2) an electronic-Delphi (e-Delphi) exercise with key national PHC stakeholders was undertaken to prioritise these evidence needs. RESULTS Thirty-one peer-reviewed articles (including 10 systematic reviews) and 10 grey literature reports were included in the review. There was limited consistency in results across studies but there was evidence that some interventions (removal of user fees, ownership models of providers and contracting arrangements) could impact PHC service access, efficiency and out-of-pocket cost outcomes. The e-Delphi exercise highlighted the importance of contextual factors and prioritised research in the areas of: (1) interventions to limit out-of-pocket costs; (2) financing models to enhance health system performance and maintain PHC budgets; (3) the design of incentives to promote optimal care without unintended consequences and (4) the comparative effectiveness of different PHC service delivery strategies using local data. CONCLUSION The research questions which were deemed most important by stakeholders are not addressed in the literature. There is a need for more research on how financing interventions can be implemented at scale across health systems. Such research needs to be pragmatic and balance academic rigour with practical considerations.
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Affiliation(s)
- Blake Angell
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Dodd
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
| | - Thomas Gadsden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Seye Abimbola
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Faculty of Medicine and Health, Sydney University, Sydney, New South Wales, Australia
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Palagyi A, Dodd R, Jan S, Nambiar D, Joshi R, Tian M, Abimbola S, Peiris D. Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda. BMJ Glob Health 2019; 4:e001467. [PMID: 31478022 PMCID: PMC6703300 DOI: 10.1136/bmjgh-2019-001467] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/22/2022] Open
Abstract
Health system planners in low- and middle-income countries (LMIC) of the Asia-Pacific region seeking to reorient primary health care (PHC) systems to achieve universal health coverage may be hindered by lack of knowledge of what works in their setting. With limited resources for research available, it is important to identify evidence-based strategies for reorganising PHC delivery, determine where relevant evidence gaps exist and prioritise these for future study. This paper describes an approach for doing this using the best available evidence combined with consultation to establish evidence priorities. We first reviewed PHC organisational interventions in Asia-Pacific LMICs and ascertained evidence gaps. The largest gaps related to interventions to promote access to essential medicines, patient management tools, effective health promotion strategies and service planning and accountability. Evidence from Pacific Island countries was particularly scant. We then engaged an expert panel of 22 PHC stakeholders from seven Asia-Pacific LMICs in a Delphi exercise to identify priority questions for future research. Research priorities were: (1) identifying effective PHC service delivery models for chronic diseases; (2) devising sustainable models of disease integration; (3) optimising task shifting; (4) understanding barriers to care continuity; (5) projecting future PHC needs; and (6) designing appropriate PHC service packages. Notably, stakeholder-determined priorities reflected large, context-dependent system issues, while evidence gaps centred on discrete interventions. Future research on the organisation of PHC services in Asia-Pacific LMICs should incorporate codesign principles to engage researchers and national PHC system stakeholders, and innovative methods that build on existing evidence and account for system complexity.
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Affiliation(s)
- Anna Palagyi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Dodd
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
- The George Institute for Global Health, New Delhi, India
| | - Maoyi Tian
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Beijing, China
| | - Seye Abimbola
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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