scholarly journals Primary Heealth Care Development: Where is Nepal after 30 years of Alma Ata Declaration??

2010 ◽  
Vol 49 (178) ◽  
Author(s):  
R Karkee ◽  
N Jha
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Workers ◽  
Care Delivery ◽  
Policy Formulation ◽  
Community Empowerment ◽  
Oral Rehydration ◽  
Primary Health ◽  
Comprehensive Primary Health Care ◽  
Care Development

The year 2008 has witnessed the global conversation to return to tenets of Alma-Ata and to review its 30 years of journey. We reviewed Nepal's journey on Primary Health Care development: policy formulation, structure development, progress and constraints. Though Nepal has institutionalised the PHC approach in health policy, strategy and health care delivery system, this has not been effectively translated into actions, and the results are mixed. Nepal has gained impressive achievements in selective primary health care markers: 45.43% maternal mortality and 62.34% child mortality reduction during 1990-2005. But gain in comprehensive health care markers is not impressive: 18.7% Skilled Birth Attendant (4% in poorest quintile and 45% in richest quintile), 39% having access to improved sanitation and 55.7% of females are literate as compared to males. Socio-political environment until recently was not favourable for comprehensive primary health care, allowing limited health sector decentralisation and community empowerment. Health activities were focussed more on selective health care strategy in the form of disease control, immunisation, vitamin A supplementation, oral rehydration solution use and contraceptive use. Nepal's rural hilly geography posed great challenge on logistic supply, communication and retention of health workers rendering public health centres of low quality with negative perceptions of consumers. Nepal is on the pathway to build equitable comprehensive primary health care.

Primary health care reform, dilemmatic space and risk of burnout among health workers

2017 ◽  
Vol 22 (3) ◽  
pp. 277-297 ◽  
Author(s):  
Toby Freeman ◽  
Fran Baum ◽  
Ronald Labonté ◽  
Sara Javanparast ◽  
Angela Lawless
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
State Government ◽  
Health Care Services ◽  
Health Workers ◽  
South Australia ◽  
Aboriginal Health ◽  
Future Health ◽  
Primary Health ◽  
Comprehensive Primary Health Care

Health system changes may increase primary health care workers’ dilemmatic space, created when reforms contravene professional values. Dilemmatic space may be a risk factor for burnout. This study partnered with six Australian primary health care services (in South Australia: four state government–managed services including one Aboriginal health team and one non-government organisation and in Northern Territory: one Aboriginal community–controlled service) during a period of change and examined workers’ dilemmatic space and incidence of burnout. Dilemmatic space and burnout were assessed in a survey of 130 staff across the six services (58% response rate). Additionally, 63 interviews were conducted with practitioners, managers, regional executives and health department staff. Dilemmatic space occurred across all services and was associated with higher rates of self-reported burnout. Three conditions associated with dilemmatic space were (1) conditions inherent in comprehensive primary health care, (2) stemming from service provision for Aboriginal and Torres Strait Islander peoples and (3) changes wrought by reorientation to selective primary health care in South Australia. Responses to dilemmatic space included ignoring directives or doing work ‘under the radar’, undertaking alternative work congruent with primary health care values outside of hours, or leaving the organisation. The findings show that comprehensive primary health care was contested and political. Future health reform processes would benefit from considering alignment of changes with staff values to reduce negative effects of the reform and safeguard worker wellbeing.

scholarly journals Delivering primary health care as envisioned

2018 ◽  
Vol 26 (3) ◽  
pp. 231-241 ◽  
Author(s):  
Jennifer Rayner ◽  
Laura Muldoon ◽  
Imaan Bayoumi ◽  
Dale McMurchy ◽  
Kate Mulligan ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Equity ◽  
Care Delivery ◽  
Well Being ◽  
Evidence Base ◽  
Content Type ◽  
Primary Health ◽  
Comprehensive Primary Health Care ◽  
Health And Well Being

PurposeFor over 40 years, Canadian and international bodies have endorsed comprehensive primary health care (PHC), yet very little work has been done to describe how services and programs are delivered within these organizations. Because health equity is now of greater interest to policy makers and the public, it is important to describe an evidence-informed framework for the delivery of integrated and equitable PHC. The purpose of this paper is to describe the development of a “Model of Health and Well-being” (MHWB) that provides a roadmap to the delivery of PHC in a successful network of community-governed PHC organizations in Ontario, Canada.Design/methodology/approachThe MHWB was developed through an iterative process that involved members of community-governed PHC organizations in Ontario and key stakeholders. This included literature review and consultation to ensure that the model was evidence informed and reflected actual practice.FindingsThe MHWB has three guiding principles: highest quality health and well-being for people and communities; health equity and social justice; and community vitality and belonging. In addition, there are eight attributes that describe how services are provided. There is a reasonable evidence base underpinning the all principles and attributes.Originality/valueAs comprehensive, equitable PHC organizations become increasingly recognized as critical parts of the health care system, it is important to have a means to describe their approach to care and the values that drive their care. The MHWB provides a blueprint for comprehensive PHC as delivered by over 100 Community Governed Primary Health Care (CGPHC) organizations in Ontario. All CGPHC organizations have endorsed, adopted and operationalized this model as a guide for optimum care delivery.

A comprehensive primary health care delivery model

1994 ◽  
Vol 10 (4) ◽  
pp. 201-208 ◽  
Author(s):  
Carol Pullen ◽  
Joellen B. Edwards ◽  
Cynthia L. Lenz ◽  
Nancy Alley
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Delivery Model ◽  
Primary Health ◽  
Comprehensive Primary Health Care ◽  
Care Delivery Model

scholarly journals Perspectives of health workers regarding primary health care delivery to the rural population in the Bothaville district*

Curationis ◽  
1999 ◽  
Vol 22 (4) ◽  
Author(s):  
E Janse van Rensburg
Keyword(s):  
Public Health ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Delivery ◽  
Rural Areas ◽  
Information Dissemination ◽  
Health Workers ◽  
Care Delivery ◽  
Public Health Services ◽  
Primary Health

This article reports on the views of public health workers regarding recent changes in the delivery of primary health care to people living and working in the Bothaville rural area. These changes in mobile health care form part of the Initiative for Sub-District Support’s programme to provide sustained, concerted support to sub-districts to bring about improvements in health care management and health care delivery. Main shortcomings of the recent changes were identified as inadequate transportation facilities in rural areas, insufficient information dissemination to rural dwellers and lack of farmers’ participation in rural health matters. Furthermore, poor communication and co-operation between different public health services prevailed and the need for an integration of these services was emphasised.

scholarly journals Erectile Dysfunction in Brazilian Primary Health Care: Dealing with Medicalization

2017 ◽  
Vol 12 (2) ◽  
pp. 431-440 ◽  
Author(s):  
Antônio Augusto Dall’Agnol Modesto ◽  
Marcia Thereza Couto
Keyword(s):  
Health Care ◽  
Erectile Dysfunction ◽  
Primary Health Care ◽  
Adult Male ◽  
Sexual Problem ◽  
Primary Health ◽  
Medical Associations ◽  
Comprehensive Primary Health Care ◽  
Hidden Agenda ◽  
Semistructured Interviews

Erectile dysfunction (ED) is a common sexual problem and has been attracting growing interest from the field of medicine. The pharmaceutical industry works together with medical associations to popularize the theme, emphasizing individual enhancement and medication, besides reinforcing an idea of a male sexuality defined by the ability to have an erection and penetrate. Patients worried about erection problems search for general practitioners (GPs), frequently without a clear complaint, and a comprehensive primary health care (PHC) must be capable of dealing with these issues considering medicalization and disease mongering. This article discusses how PHC physicians take (and might take) care of men with erection problems, and how users perceive it and search for help in two cities in the State of São Paulo, Brazil. The qualitative research, performed in five PHC services, included semistructured interviews with 16 GPs and 15 adult male users. The adult male users were invited by their doctors during consultations where questions about prostate, ED, or other sexual problems arose. Interviews were transcribed and submitted for content analysis. In addition, the five participating services were observed with help of a specific script. Results indicate that ED is frequently a hidden agenda and that doctors have trouble approaching the problem, usually focusing on the biological aspects. Based on empirical data and literature, this work indicates some measures to qualify the care of men with ED in PHC which includes contemplating users’ questions, respecting their autonomy, avoiding an antidrug stance, and considering drug and nondrug approaches as a continuum of resources.

Childhood Mental Disorders in Primary Health Care: Results of Observations in Four Developing Countries

PEDIATRICS ◽  
1981 ◽  
Vol 68 (5) ◽  
pp. 677-683
Author(s):  
R. Giel ◽  
M. V. de Arango ◽  
C. E. Climent ◽  
T. W. Harding ◽  
H. H. A. Ibrahim ◽  
...  
Keyword(s):  
Health Care ◽  
Developing Countries ◽  
Primary Health Care ◽  
Mental Disorders ◽  
Health Workers ◽  
Health Care Facilities ◽  
Primary Health ◽  
Care Facilities ◽  
Research Procedure ◽  
Primary Health Care Facilities

To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Colombia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to that encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The results have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.

Community midwifery: a primary health care approach to care during pregnancy for Aboriginal and Torres Strait Islander women

2021 ◽  
Vol 27 (1) ◽  
pp. 57
Author(s):  
Ailsa Munns
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Torres Strait Islander ◽  
Service Providers ◽  
Early Years ◽  
Health Staff ◽  
Liaison Officer ◽  
Primary Health ◽  
Comprehensive Primary Health Care ◽  
Torres Strait

Comprehensive primary health care is integral to meaningful client-centred care, with nurses and midwives central to partnership approaches with individuals, families and communities. A primary health model of antenatal care is needed for Aboriginal and Torres Strait Islander women in rural and remote areas, where complex social determinants of health impact on pregnancy outcomes, early years and lifelong health. Staff experiences from a community midwifery-led antenatal program in a remote Western Australian setting were explored, with the aim of investigating program impacts from health service providers’ perspectives. Interviews with 19 providers, including community midwives, child health nurses, program managers, a liaison officer, doctors and community agency staff, examined elements comprising a culturally safe community antenatal program for Aboriginal and Torres Strait Islander women, exploring program benefits and challenges. Thematic analysis derived five themes: Organisational and Accessibility Factors; Culturally Appropriate Support; Staff Availability and Competencies; Collaboration; and Sustainability. The ability of program staff to work in culturally safe partnerships with clients in collaboration with community agencies was essential to building meaningful and sustainable antenatal strategies. Midwifery primary health care competencies were viewed as a strong enabling factor, with potential to reduce health disparities in accordance with Australian Government and research recommendations.

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