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Measures to strengthen primary health-care systems in low- and middle-income countries
Etienne V Langlois, Andrew Mc Kenzie, Helen Schneider & Jeffrey W Mecaskey
World Health Organization
(2020)
C_WHO
Primary health care offers a cost–effective route to achieving universal health coverage (UHC). However, primary health-care syst
...
ems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primary health-care systems in 20 low- and middle-income countries using a semi-grounded approach. Options for strengthening primary health-care systems were identified by thematic content analysis. We found that: (i)despite the growing burden of noncommunicable disease, many low- and middle-income countries lacked funds for preventive services; (ii)community health workers were often under-resourced, poorly supported and lacked training; (iii)out-of-pocket expenditure exceeded 40% of total health expenditure in half the countries studied, which affected equity; and (iv)health insurance schemes were hampered by the fragmentation of public and private systems, underfunding, corruption and poor engagement of informal workers. In 14 countries, the private sector was largely unregulated. Moreover, community engagement in primary health care was weak in countries where services were largely privatized. In some countries, decentralization led to the fragmentation of primary health care. Performance improved when financial incentives were linked to regulation and quality improvement, and community involvement was strong. Policy-making should be supported by adequate resources for primary health-care implementation and government spending on primary health care should be increased by at least 1% of gross domestic product. Devising equity-enhancing financing schemes and improving the accountability of primary health-care management is also needed. Support from primary health-care systems is critical for progress towards UHC in the decade to 2030.
more
Primary health care is about caring for people, rather than simply treating specific diseases or conditions. Good primary health care is made up of three parts: empowered people and communities who
...
can take care of and advocate for their health; ensuring multisectoral policy and action to systematically address social, economic, environmental and commercial determinants of health; and primary care and essential public health functions as the core of integrated health services. Primary health care can meet the majority of a person’s health needs throughout their life. With a strong foundation of primary health care, together we can achieve #HealthForAll
more
Primary care represents the first level of personal health care services in the community, which ensures accessible, continual,
whole-person care for health needs throughout an individual’s lifes
...
pan. Primary care professionals work with patients and
their families to address their immediate and long-term health needs and not just for a set of specific diseases with an
approach that addresses the broader determinants of health and the interrelated aspects that influence people’s physical,
mental, and social well-being.
Nurses have a key role to play in primary care in expanding, connecting and coordinating care. Through their training and
work, they are well placed and have been shown to provide safe and effective care in disease prevention, diagnosis,
treatment, management and rehabilitation. The purpose of this document is to provide guidance and inspiration for
policymakers, instructors, managers and clinicians
more
Primary health care, as outlined in the 1978 Declaration of Alma-Ata and again 40 years later in the 2018 WHO/UNICEF document A vision for primary health care in the 21st century: towards universal
...
health coverage and the Sustainable Development Goals, is a whole-of-government and whole-of-society approach to health that combines the following three components: multisectoral policy and action; empowered people and communities; and primary care and essential public health functions as the core of integrated health services.(1) Primary health care-oriented health systems are health systems organized and operated so as to make the right to the highest attainable level of health the main goal, while maximizing equity and solidarity. They are composed of a core set of structural and functional elements that support achieving universal coverage and access to services that are acceptable to the population and that are equity enhancing. The term “primary care” refers to a key process in the health system that supports first-contact, accessible, continued, comprehensive and coordinated patient-focused care.
more
Policy makers and public health professionals may be forced to weigh and prioritize potentially competing ethical values in the face of severe time and resource constraints. This video from the World Healt
...
h Organisation explains that ethical concerns associated with the planning, preparedness and response to disease outbreaks are important to consider, ensuring that response efforts are not hindered in the event of a pandemic.
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This report makes the case for a major new initiative—to rapidly recruit, train and deploy 2 million community health workers in Africa. Drawing on a vast body of evidence and substantial regional experience, the report shows how community
...
health workers save lives and improve quality of life and how investments in community health workers effectively harness the demographic dividend, reduce gender inequality and accelerate economic growth and development. Indeed, the benefits of community health workers stretch from one end of the Agenda for Sustainable Development to the other.
more
As the global community aims to fulfill its commitments to the UN Sustainable Development Goals, and the achievement of universal health coverage, dozens of countries have committed to the expansion of community
...
health workers (CHWs) as the front line of their healthcare systems [1, 2]. Robust research demonstrates CHWs improve access to care, reduce maternal, newborn, and child mortality, improve clinical outcomes for chronic diseases, and prevent disease outbreaks [3].
To support the operationalization of quality CHW program design and implementation, USAID, UNICEF, the Community Health Impact Coalition, and Initiatives Inc. have updated and adapted the Community Health Worker Assessment and Improvement Matrix (CHW AIM) Program Functionality Matrix [12]. This tool can be used to identify design and implementation gaps in both small- and national-scale CHW programs, and close gaps in policy and practice.
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The Community Health Community of Practice (CH CoP) builds on the Institutionalisation Community Health Conference co-hosted by USAID and UNICEF in Johannesburg in March 2017. Conceived as an ‘ope
...
n space’ in terms of both contribution and access to knowledge, it aims at gathering practitioners, policy makers, researchers, program implementers and other experts actively involved in the technical or policy development of community health programs in low- and middle-income countries. It offers a network to share your country experience with other countries facing similar challenges; access to global knowledge on community health and its institutionalisation; opportunities for learning, exchanging and debating; constant information on new theoretical, operational or empirical developments in this domain of knowledge. The CoP is facilitated by an international team based in Africa, Asia and Europe. The CH CoP is supported by UNICEF in collaboration with USAID.
accessed 23.07.2021
Collectivity Platform has more group networks to join. The Platform is also available in French.
more
CHWs are trained public health workers who serve as a bridge between communities, health care systems, and state health departments.
Resources on
...
this page include:
Online courses, lessons learned, and best practices to help state health departments train and further build capacity for CHWs in their communities.
Training and education materials for CHWs to use within their communities.
accessed 23.07.2021
more
The CHW Toolkit assists the assessment, improvement, and planning of CHW programs by deepening understanding of the elements of successful programs and the use of best practices as an evidence-based approach to improvement. The toolkit is framed around ten key themes that describe the definition, en
...
try level, age, gender, recruitment, training, scope of work, supervision, career progression, entry level and remuneration of CHWs.
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Community-based interventions are vital for facilitating poststroke recovery, increasing community participation, and raising awareness about stroke survivors. To optimize recovery and community reintegration, there is a need to understand research findings on community-based interventions that focu
...
s on stroke survivors and their caregivers. Although nurses and community health workers (CHWs) are commonly involved in community-based interventions, less is known about their roles relative to other poststroke rehabilitation professionals (physical therapists, occupational therapists, and speech-language pathologists). Thus, the purpose of this review is to explore research focused on improving community-based stroke recovery for adult stroke survivors, caregivers, or both when delivered by nurses or CHWs.
more
Community health workers (CHWs) play a significant role in Primary health Care due to their proximity to households, communities and the health car
...
e system. Many studies focus on CHWs and the work they do. However, few have examined their experiences and identity and how that might influence how they view and perform their roles. The objectives of the study were to: Describe the role of CHWs in community-based health care in Northern Cape, Identify the perceived barriers and enablers to CHWs role performance, Explore CHWs views regarding the support from the communities and the formal healthcare system in Northern Cape. An exploratory qualitative design using focus groups was adopted. Forty-six (46) CHWs were purposively selected using the critical case sampling approach. Data were collected through three focus group interviews in three regions. Analysis followed the Graneheim & Lundman thematic analysis. Three themes emerged from data: perceived contribution to Primary Health Care, recognition of CHWs role, measures to improve working conditions. Findings showed that CHWs were engaged in various health and social care roles, they believed that they made a significant contribution to PHC, and that the health system persistently relied on their services. The enabler for finding meaning in their work was the positive community response and the good relations they had with the team leaders. The major barrier was the structure of the CHWs programme and the perceived lack of support by the government. The complex issues CHWs address in the community call for a review of their roles and workload as well as the support they receive from the formal healthcare system.
more
Implementation of the CHWs guidelines using Amref Health Africa lessons learnt
focuses on providing CHWs with predictable financial and non financial incentives,
frequent support supervision, continuous training and embedding them in
...
health
systems with clear roles.
Empowering CHWs represents a cost effective approach with a critical change to-
wards achieving universal health coverage.
more
The object of this bill is to provide for a legal framework to promote the existence of Community Health Workers (CHWs) and to provide for clarity in the role and responsibilities assigned to CHWs in the H
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ealth sector and to promote and strengthen service delivery at the Community level. The law will regulate training, certification and registration and set minimum qualifications and standards and working conditions for the CHWs.
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Frontline health workers (FHWs) provide services directly to communities where they are most needed, especially in remote and rural areas. Many are community health workers and midwives, though they
...
can also include local emergency responders/paramedics, pharmacists, nurses, and doctors who serve in community clinics.
The growing burden of non-communicable diseases (NCDs) on low- and middle-income countries threatens many health systems that are already weakened. In many countries, health systems—and health workers—are not prepared to address the complex nature of NCDs. Health systems are often fragmented, and designed to respond to single episodes of care or long-term prevention and control of infectious diseases.1 Many countries also continue to face shortages and distribution challenges of trained and supported health workers. As most NCDs are multifactorial in origin and are detected later in their evolution, health systems face significant challenges to provide early detection as well as affordable, effective, and timely treatment, particularly in underserved communities.
more
This National Health Policy has 5 objectives, namely
i. To strengthen the healthcare delivery system to be resilient
ii. To encourage the adoption of healthy lifestyles
iii. To improve the physical environment
iv. To improve the socio-economic s
...
tatus of the population
v. To ensure sustainable financing for health
These objectives shall collectively ensure that there will be improved alignment, complementarity and synergies within and across all public sector ministries as well as with other stakeholders, towards achieving the national health goal.
The policy shall therefore ensure that MDAs and other identifiable organizations work within the principles of the Health-in-All Policy and the One-Health Policy frameworks (WHO), to achieve the desired healthy life status of people living in Ghana.
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Community health workers (CHWs) play a vital role in health service delivery, especially in countries with less resilient health systems. During an
...
y outbreak CHWs are relied on to help control the spread. However, they are often the last in line to receive necessary health products and protective equipment, which affects their ability to safely serve their communities.
more
The Global Health Network enables easier, faster, and better research in the world’s most challenging settings.
Capacity Development and Process Improvement:
Regional and online training, resources and professional development to build skills
...
and careers that deliver evidence to change practice.
Knowledge Sharing Hubs:
Transferring knowledge and exchanging methods, processes and research findings between diseases, regions and organisations.
accessed 30.07.2021
more
Community health nurses have the potential to make significant contributions to meet the health care needs of various population groups in a variety of community settings. In order to assess the ext
...
ent to which CHNs are achieving this potential, WHO conducted a study between 2010 and 2014 that examined the status of community health nursing in 22 countries, 13 of which were experiencing a critical shortage of health care workers. The study revealed that the countries surveyed had the basic and operational framework for optimizing CHN in their health systems as evidenced by the availability of PHC structures to guide interventions. However, challenges were identified related to the education, practice and management of CHNs in these countries. The major challenges identified were: Limited availability of career opportunities; poor worker retention; low recognition for CHNs; inadequate and unsupportive working conditions and environments; absence of educational standards; varying educational entry-level requirements for CHN programmes; and a lack of consensus on the scope of practice for CHNs.
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