Integration of General Practitioners with Hospitals and Community Health Services: A Qualitative Examination

1998 ◽  
Vol 4 (4) ◽  
pp. 68
Author(s):  
Yelena Fridgant ◽  
Gawaine P. Powell Davies ◽  
Brian I. O'Toole ◽  
Luc Betbeder-Matibet ◽  
Mark F. Harris
Keyword(s):  
General Practice ◽  
Health System ◽  
Community Health ◽  
General Practitioners ◽  
Service Providers ◽  
Health Workers ◽  
Hospital Staff ◽  
Community Health Services ◽  
Health Staff ◽  
Barriers To Integration

A series of focus groups was conducted with general practitioners (GPs), community health workers, hospital staff and consumers to examine the issue of integration of general practice within the wider Australian health system. Groups were held in various urban and rural locations to provide coverage of urban and rural conditions. The groups had representation from managerial as well as service provider staff and included GPs, hospital discharge planners, and emergency department staff, and from community health staff, nurses, physiotherapists, mental health workers, occupational therapists, and educators. Agreement was widespread that enhanced integration would confer benefits to patients, GPs, other health professionals, and to the health system generally. However, the health system was seen to be limited in its ability to integrate services. General practice, as small business working within the public health system, had different procedures and methods of remuneration than other health system components. Barriers to integration included structural, procedural and organisational factors, and included communication difficulties, variability in the roles and expectations of various service providers, and resource allocation and methods of funding. It is necessary to examine the barriers to integration more closely within the context of each type of service, to investigate effective ways of overcoming these barriers, and to describe and quantify the benefits that might arise from increased integration.

Primary care networks: an opportunity to improve community wound care

2020 ◽  
Vol 25 (3) ◽  
pp. S20-S25
Author(s):  
Liam Benison
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Health Services ◽  
Health System ◽  
Community Health ◽  
Patient Outcomes ◽  
Wound Care ◽  
Community Health Services ◽  
Predominant Role ◽  
Poor Outcomes

Primary care networks (PCNs) were introduced in England in 2019 to bring about closer collaboration between general practice and community health services. The ambition is that greater collaboration between services will achieve better patient outcomes and reduce costs through more effective sharing of staff and resources. Wound care might be considered an ideal focus for PCNs, since general practice and community health services not only have a predominant role in the management of wounds, but variable and suboptimal practice continues and poor outcomes persist. This article investigates some ways in which PCNs might enable health-system changes that could improve the provision of wound care.

Research culture and capacity in community health services: results of a structured survey of staff

2017 ◽  
Vol 23 (2) ◽  
pp. 123 ◽  
Author(s):  
Emma L. Friesen ◽  
Elizabeth J. Comino
Keyword(s):  
Community Health ◽  
Research Capacity ◽  
Community Health Services ◽  
External Support ◽  
Health Staff ◽  
Recent Experience ◽  
Research Experience ◽  
Research Culture ◽  
Vocational Qualifications ◽  
Paper Format

Developing research capacity is recognised as an important endeavour. However, little is known about the current research culture, capacity and supports for staff working in community-based health settings. A structured survey of Division of Community Health staff was conducted using the research capacity tool. The survey was disseminated by email and in paper format. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed thematically. In total, 109 usable responses were received, giving a response rate of 26%. Respondents were predominately nurses (n=71, 65.7%), with ~50% reporting post-graduate vocational qualifications. The highest levels of skills or organisational success were in using evidence to plan, promote and guide clinical practice. Most participants were unsure of organisational and team level skills and success at generating research. Few reported recent experience in research-generating activities. Barriers to undertaking research included lack of skills, time and access to external support and funding. Lack of skills and success in accessing external funding and resources to protect research time or to ‘buy-in’ technical expertise appeared to exacerbate these barriers. Community health staff have limited capacity to generate research with current levels of skill, funding and time. Strategies to increase research capacity should be informed by knowledge of clinicians’ research experience and interests, and target development of skills to generate research. Resources and funding are needed at the organisational and team levels to overcome the significant barriers to research generation reported.

scholarly journals Capacitação de agentes comunitários de saúde: integração entre universidade e atenção básica

2020 ◽  
Vol 11 (3) ◽  
pp. 349-359
Author(s):  
Amanda Brait Zerbeto ◽  
Leonardo De Carvalho ◽  
Thaís Amanda Rossa ◽  
Daniel De Paula
Keyword(s):  
Health System ◽  
Continuing Education ◽  
Community Health ◽  
Engineering Students ◽  
Health Workers ◽  
Unified Health System ◽  
Local Problems ◽  
Health Concept ◽  
Institutional Relations ◽  
Training Community

O Projeto Rondon tem criado oportunidades, especialmente na saúde, para que universitários interajam com comunidades vulneráveis, socializando saberes e discutindo soluções coletivamente. O Agente Comunitário de Saúde (ACS) é um personagem fundamental na implementação do Sistema Único de Saúde (SUS), fortalecendo a integração entre os serviços de saúde e a comunidade. Mesmo com muitos avanços, a formação dos ACS permanece um desafio. Este estudo relata a experiência de um projeto de extensão na elaboração, desenvolvimento e realização de uma capacitação para ACS no município de Lindoeste, Paraná. As oficinas foram elaboradas multidisciplinarmente por acadêmicos de enfermagem, nutrição, psicologia e engenharia ambiental. Adotou-se o conceito ampliado de saúde, abordando conceitos do SUS, promoção e prevenção, educação ambiental, nutrição, humanização, além de demandas locais. A utilização de metodologias ativas e de temas relacionados à comunidade permitiram a troca de saberes, criando um espaço em que todos puderam expor suas opiniões e assim buscar soluções para os problemas locais. O desconhecimento dos ACS sobre os conceitos do SUS foi um desafio para o aprofundamento da discussão, moldando o debate muitas vezes num modelo pedagógico clássico. Um ponto positivo foi a integração e colaboração entre os ACS a partir do entendimento dos impactos que o processo de trabalho pode trazer ao município. A partir da capacitação dos ACS, ficou evidente a importância de os projetos de extensão estarem em consonância com as necessidades do território que, no presente trabalho, revelou a necessidade de elaboração e realização da educação continuada dos ACS. Palavras-chave: Sistema Único de Saúde; Atenção Primária à Saúde; Educação Continuada; Relações Comunidade-Instituição Training community health workers: integration between university and primary healthcare   Abstract: The Rondon Project has provided opportunities, especially in the health area, for university students to interact with vulnerable communities, share knowledge, and discuss solutions collectively. The Community Health Worker (CHW) plays a key role in implementing the Brazilian Unified Health System (Sistema Único de Saúde - SUS), strengthening the integration between health services and the community. Even with many advances, the education of CHWs remains a challenge. This study reports an extension project's experience in elaborating, developing, and accomplishing training for CHW in Lindoeste, Paraná state, Brazil. The workshops were developed in a multidisciplinary manner by nursing, nutrition, psychology, and environmental engineering students. The expanded health concept was adopted, addressing SUS concepts, health promotion, prevention, environmental education, nutrition, humanization, and local demands. The use of active learning methods and community-related themes allowed for knowledge sharing, creating an environment where everyone could express their opinions and seek solutions to local problems. CHW's lack of knowledge about SUS concepts was a challenge to deepen the discussion, often shaping the debate in a traditional way. A positive point was the integration and collaboration among CHW, which were carried out in understanding the value of the collaborative workflow for their community. This experience highlighted the importance of the extension project being in tune with the demand of the territory, which in the present work revealed the need to elaborate and carry out continuing education of the CHW. Keywords: : Unified Health System; Primary Health Care; Continuing Education; Community Institutional Relations

scholarly journals Integrating a nationally scaled workforce of community health workers in primary care: a modelling study

2018 ◽  
Vol 111 (12) ◽  
pp. 453-461 ◽  
Author(s):  
Benedict Hayhoe ◽  
Thomas E Cowling ◽  
Virimchi Pillutla ◽  
Priya Garg ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Community Health ◽  
Health Worker ◽  
Community Health Workers ◽  
Community Health Worker ◽  
Health Workers ◽  
Pilot Studies ◽  
Cancer Screenings ◽  
Home Based

Objective To model cost and benefit of a national community health worker workforce. Design Modelling exercise based on all general practices in England. Setting United Kingdom National Health Service Primary Care. Participants Not applicable. Data sources Publicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake. Main outcome measures We estimated numbers of community health workers needed, anticipated workload and likely benefits to patients. Results Conservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease. Conclusion A scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.

What are the roles of community health workers? Looking back at the philosophies of primary health care

2019 ◽  
Vol 27 (2) ◽  
pp. 117-120
Author(s):  
Marietou Niang
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Development ◽  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Health Workers ◽  
Primary Health ◽  
Looking Back

This commentary discusses the different roles of community health workers (CHWs), their challenges and limitations in a historical perspective of primary health care (PHC). We first try to show that the comprehensive philosophy of PHC promulgated in Alma-Ata proposed the role of CHWs as actors who work in community development. On the other hand, in the 1980s, with the emergence of the selective philosophy of PHC, CHWs’ role was more affiliated with the health system. We conclude our pitch about the balance that can exist between these different roles by suggesting that CHWs can work in continuity with the health system, but they should not be considered as affordable labor. Also, they must be supported in their activities to develop their communities, allowing them to participate effectively in programs and policies that concern them and their community.

scholarly journals Health system readiness for innovation scale-up: the experience of community-based distribution of injectable contraceptives in Nigeria

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Oluwaseun Akinyemi ◽  
Bronwyn Harris ◽  
Mary Kawonga
Keyword(s):  
Health System ◽  
Community Health ◽  
Health Workers ◽  
Scale Up ◽  
Task Shifting ◽  
Policy Framework ◽  
Framework Analysis ◽  
Community Based ◽  
System Readiness ◽  
Injectable Contraceptives

Abstract Background Following the successful pilot of the community-based distribution of injectable contraceptives (CBDIC) by community health extension workers (CHEWs) in Gombe, northern Nigeria in 2010, there was a policy decision to scale-up the innovation to other parts of the country. However, there is limited understanding of health system factors that may facilitate or impede the successful scale-up of this innovation beyond the pilot site. Thus, this study assessed the health system readiness to deliver CBDIC in Nigeria and how this may influence the scale-up process. Methods This study was conducted in two Local Government Areas in Gombe State in September 2016. Seven key informant interviews were held with purposively sampled senior officials of the ministries of health at the federal and state levels as well as NGO program managers. Also, 10 in-depth interviews were carried out with health workers. All transcripts were analyzed using the thematic framework analysis approach. Result The availability of a policy framework that supports task-shifting and task-sharing, as well as application of evidence from the pilot programme and capacity building programmes for health workers provided a favourable environment for scale-up. Health system challenges for the scale-up process included insufficient community health workers, resistance to the task-shifting policy from professional health groups (who should support the CHEWs), limited funding and poor logistics management which affected commodity distribution and availability. However, there were also a number of health worker innovations which kept the scale-up going. Health workers sometimes used personal resources to make up for logistics failures and poor funding. They often modify the process in order to adapt to the realities on the ground. Conclusion This study shows health system weaknesses that may undermine scale-up of CBDIC. The study also highlights what happens when scale-up is narrowly focused on the intervention without considering system context, capacity and readiness. However, agency and discretionary decision-making among frontline health workers facilitated the process of scaling up, although the sustainability of this is questionable. Benefits observed during the pilot may not be realised on a larger scale if health system challenges are not addressed.

scholarly journals Community Empowerment in Health: An Exploratory Study in Rural Community of a District of West Bengal

2020 ◽  
pp. 11-19
Author(s):  
Dipta Kanti Mukhopadhyay ◽  
Sujishnu Mukhopadhyay ◽  
Nivedita Das ◽  
Tarun Kumar Sarkar ◽  
Fasihul Akbar ◽  
...  
Keyword(s):  
Health Services ◽  
Health System ◽  
National Health ◽  
Rural Areas ◽  
West Bengal ◽  
Health Workers ◽  
Community Empowerment ◽  
Current Status ◽  
Health Staff ◽  
Key Informants

Background: Community empowerment is the process and outcome where community itself is able to identify, prioritize health problems and address them. It has been considered as the key strategy for scalability and sustainability of health services. Objectives: To explore the status of community empowerment in health in rural areas in West Bengal, India and the interplay of different stakeholders. Methods: A cross-sectional, qualitative study was conducted in 2017 – 2018 among the people residing in rural areas of Birbhum district in West Bengal, India who utilized the public health system (lay informants), formal and informal leaders of the community, community level health workers and peripheral health staff (key informants). Three community blocks, two sub-centers from each block and one village from each sub-center were selected randomly. In-depth interviews were conducted among 36 lay and 36 key informants using Laverack’s nine dimension model of community empowerment. Framework analysis was done to summarize data. Results: Participation of people was restricted to awareness and utilization of existing health services. Unmet aspiration for greater participation was noted among a small section of the community. They were mostly fitted to the role of beneficiaries. Functioning of village level organization to promote communitization as envisaged in national health programmes was largely deficient. The community health workers acted as the most peripheral appendages of formal health system rather than the health activists to empower community regarding community’s health. Conclusion: Although, every national health programme advocated community empowerment, the current status and the process of empowerment in health is in nascent stage.

scholarly journals Counseling at all contacts for postpartum contraceptive use: can paper-based tools help community health workers improve continuity of care? A qualitative study from Ethiopia

2019 ◽  
Vol 3 ◽  
pp. 1652 ◽  
Author(s):  
Muluneh Yigzaw Mossie ◽  
Anne Pfitzer ◽  
Yousra Yusuf ◽  
China Wondimu ◽  
Eva Bazant ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Community Health ◽  
Low Income ◽  
Health Workers ◽  
Continuum Of Care ◽  
Low Income Countries ◽  
Health Extension Workers ◽  
Pregnancy Risk ◽  
The Continuum

Background: Globally, there has been a resurgence of interest in postpartum family planning (PPFP) to advance reproductive health outcomes. Few programs have systematically utilized all contacts a woman and her baby have with the health system, from pregnancy through the first year postpartum, to promote PPFP. Nested into a larger study covering two districts, this study assessed the use, acceptability, and feasibility of tools for tracking women’s decision-making and use of PPFP in the community health system in Oromia region, Ethiopia. Community-level tracking tools included a modified Integrated Maternal and Child Health (IMCH) card with new PPFP content, and a newly developed tool for pregnant and postpartum women for use by Women Development Armies (WDAs). Proper completion of the tools was monitored during supervision visits. Methods: In-depth interviews and focus group discussions were conducted with health officials, health extension workers, and volunteers. A total of 34 audio-files were transcribed and translated into English, double-coded using MAXQDA, and analyzed using a thematic approach. Results: The results describe how HEWs used the modified IMCH card to track women’s decision making through the continuum of care, to assess pregnancy risk and to strengthen client-provider interaction. Supervision data demonstrated how well HEWs completed the modified IMCH card. The WDA tool was intended to promote PPFP and encourage multiple contacts with facilities from pregnancy to extended postpartum period. HEWs have reservations about the engagement of WDAs and their use of the WDA tool. Conclusions: To conclude, the IMCH card improves counseling practices through the continuum of care and is acceptable and feasible to apply. Some elements have been incorporated into a revised national tool and can serve as example for other low-income countries with similar community health systems. Further study is warranted to determine how to engage WDAs in promoting PPFP.

scholarly journals Assessing community health governance for evidence-informed decision-making: a cross-sectional study across nine districts of India

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Shantanu Sharma ◽  
Sucheta Rawat ◽  
Faiyaz Akhtar ◽  
Rajesh Kumar Singh ◽  
Sunil Mehra
Keyword(s):  
Community Health ◽  
Service Providers ◽  
Health Workers ◽  
Uttar Pradesh ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Health Governance ◽  
Cross Sectional ◽  
Content Type ◽  
Community Monitoring

PurposeThe authors intend to assess the village health sanitation and nutrition committees (VHSNC) on six parameters, including their formation, composition, meeting frequencies, activities, supervisory mechanisms and funds receipt and expenditures across nine districts of the three states of India.Design/methodology/approachThe cross-sectional study, conducted in the states of Uttar Pradesh (five districts), Odisha (two districts) and Rajasthan (two districts), used a quantitative research design. The community health workers of 140 VHSNCs were interviewed using a semi-structured questionnaire. The details about the funds' receipt and expenditures were verified from the VHSNC records (cashbook). Additionally, the authors asked about the role of health workers in the VHSNC meetings, and the issues and challenges faced.FindingsThe average number of members in VHSNCs varied from 10 in Odisha to 15 in Rajasthan. Activities were regularly organized in Rajasthan and Odisha (one per month) compared to Uttar Pradesh (one every alternate month). Most commonly, health promotion activities, cleanliness drives, community monitoring and facilitation of service providers were done by VHSNCs. Funds were received regularly in Odisha compared to Rajasthan and Uttar Pradesh. Funds were received late and less compared to the demands or needs of VHSNCs.Research limitations/implications This comprehensive analysis of VHSNCs' functioning in the selected study areas sheds light on the gaps in many components, including the untimely and inadequate receipt of funds, poor documentation of expenditures and involvement of VHSNC heads and inadequate supportive supervision.Originality/value VHSNCs assessment has been done for improving community health governance.

scholarly journals Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

2021 ◽  
Vol 19 (S3) ◽  
Author(s):  
Karen LeBan ◽  
Maryse Kok ◽  
Henry B. Perry
Keyword(s):  
Health System ◽  
Community Health ◽  
Community Health Workers ◽  
Large Scale ◽  
Health Workers ◽  
Local Level ◽  
Grey Literature ◽  
Community Context ◽  
New Era

Abstract Background This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities. Methods The authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes. Results The space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders. Conclusion To be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.

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