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Publication Years
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Toolboxes
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The manual has been designed in a comprehensive manner, the aim being to provide a holistic approach to the short-term development of human resources, with a focus on primary care physicians. This i
...
s a reference manual meant for primary care physicians who will provide care to older people in primary health care facilities. The information on old age care is meant to be incorporated into the everyday clinical practice of primary care physicians. This manual will help to enhance the knowledge and skills of physicians. It is expected that the use of the manual will improve the approach to issues of old age and promote holistic care of older people, which will ultimately improve their quality of life.
more
For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complica
...
ted by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work. At the core of this intervention, called Practical Approach to Care Kit (PACK), is a clinical decision support tool, the PACK guide. This paper describes the development of the guide over an 18-year period and explains the design features that have addressed what the patient, the clinician and the health system need from clinical guidance, and have made it, in the words of a South African primary care nurse, ‘A tool for every day for every patient’. It describes the lessons learnt during the development process that the KTU now applies to further development, maintenance and in-country localisation of the guide: develop clinical decision support in context first, involve local stakeholders in all stages, leverage others’ evidence databases to remain up to date and ensure content development, updating and localisation articulate with implementation.
more
As the world population is growing and health care resources are in high demand the pressure on medical services is becoming higher. Developing countries are already at a crisis point in health care
...
provision, and time demands a new approach in structuring medical resources. Primary care is the vital pillar for fundamental health care at community level and has been deemed as a cost-effective modality. In the West the primary care physician manages chronic medical conditions in communities and therefore reduces unnecessary hospital admissions. In the West, the primary care system is extremely well organised. Low-income countries must improve teaching, training and funding in primary care. In this article the urgent need for primary care is discussed in developing countries, and ways to minimise costs and improve clinical outcomes at community level.
more
The Lancet Global Health January 24, 2022
In 2018 the Astana Declaration reaffirmed a global commitment to PHC as a cornerstone of sustainable health systems for accelerated progress on universal health coverage (UHC) (1). The vision for PHC in the 21st century is for a wholeof-government and whole-of-society approach to health that combine
...
s: 1) multisectoral policy and action; 2) empowered people and communities; and 3) primary care and essential public health functions as the core of integrated health service. Signatories, including Nigeria, were urged to implement the vision and commitments of the Declaration according to their national contexts. This case study examines Nigeria’s response to COVID-19 from a PHC perspective between March 2020 and mid-2021.
more
It focuses on nine major priority areas, namely: Leadership and Governance for Health; Health Service Delivery; Human Resources for Health; Health Financing; Health Information Systems; Health Technologies; Community Ownership and Participation; Partnerships for Health Development; and Researc
...
h for Health.
more
Coronavirus (COVID-19): Primary health care workers and masks
Practical Approach to Care Kit (PACK); University of Cape Town; Knowledge Translation Unit (University of Cape Tow Lung Institute)
Practical Approach to Care Kit (PACK); University of Cape Town; Knowledge Translation Unit (University of Cape Tow Lung Institute)
(2020)
C2
Updated 20 March 2020
USAID funded/ Primary Health Care Project in Iraq (PHCPI) in cooperation with Iraqi Ministry of Health (MOH) aims to promote Primary Health
...
Care (PHC) services provided by Primary Health Care Clinics (PHCCs) in Iraq in order to achieve the development goal in enhancing the PHC provision system through achieving the following results: First: Enhancing management and operations systems, which support clinical care. Second: Improving the quality of the delivered PHC according to quality standards. Third: Enhancing and expanding local community participation and partnership in PHC. Maintaining the medical & service devices in the hospitals and health clinics besides making them function according to the adapted standard specifications, lead to providing most efficient medical services for people and accomplish the purposes for which they were invented. Maintenance and repair of facilities and infrastructure, and keeping them safe and clean are also of the important approaches for the results referred to in (first) and (second) above. This can be achieved through enhancing and developing facilities, and medical & service devices management. This guideline seeks to develop work mechanism for engineers, technicians and the PHCCs’ facilities and medical & service equipment maintenance workers; clarify the concept of maintenance, its importance and classifications in health area, its planning and implementation, the tasks and duties of other directorates and departments of the Ministry in relation to all kinds of maintenance. Add to that preparing documents and forms, which are used in documenting and monitoring the steps required to be accomplished in the maintenance of PHCCs’ facilities and medical & service equipment, for the equipment to perform the best possible services for people and get their satisfaction.
more
The region of Latin America and the Caribbean (LAC) has high levels of income inequality and urbanization. This leaves a large percentage of the population exposed and vulnerable to infectious disease outbreaks (1). The COVID-19 outbreak occurred suddenly, within a complex economic, social and polit
...
ical context and at a time of low economic growth and high levels of informal labour. Structural challenges of poverty, deep inequality across different dimensions, and weak health and social protection systems exacerbated the region’s vulnerability to the pandemic
more
The overall aim of the study was to understand the acceptability and usefulness of PHC clinical placements for nursing and midwifery students.
Policy and systems. Global Mental Health(2017),4, e7, page 1 of 6. doi:10.1017/gmh.2017.3
The recently published World Health Organization (WHO) Strengthening infection prevention and control in primary care document collates existing standards, measurement and implementation approaches,
...
and resources for infection prevention and control (IPC) in primary care. During its development, it became apparent that a number of already existing tools and resources have the potential to support facility-level implementation of IPC in primary care.
This toolkit brings together in one place a number of these tools and resources from WHO and other organizations, with a focus on those most relevant to primary care. These tools and resources have been compiled to support facility-level implementation in line with the recommended WHO IPC Hub and Task Force multimodal approach.
more
Patient safety standards are critical for the establishment and assessment of patient safety programmes within hospitals. This third edition of the Patient safety assessment manual provides an updated set of standards and assessment criteria that reflect current best practice and WHO guidance. The m
...
anual will support the implementation of patient safety assessments and improvement programmes within hospitals as part of the Patient Safety Friendly Hospital Framework to ensure that patient safety is prioritized and facilities and staff implement best practices. The manual is a key tool for use by professional associations regulatory accrediting or oversight bodies and ministries of health to improve patient safety.
more
The primary goal of the guideline is to improve the quality of care and the outcome in people with type 2 diabetes in low-resource settings. It recommends a set of basic interventions to integrate m
...
anagement of diabetes into primary health care. It will serve as basis for development of simple algorithms for use by health care staff in primary care in low-resource settings, to reduce the risk of acute and chronic complications of diabetes. The guideline was developed by a group of external and WHO experts, following the WHO process of guideline development. GRADE methodology was used to assess the quality of evidence and decide the strength of the recommendations.
more
Sunsari Technical College Journal Oktober 2012
Historical analysis of the Ebola virus: prospective implications for primary care nursing today
Amundsen, Susan
(2014)
Clincial Excellence for Nursing Care, Vol. 2 (1998) no.6 pp.-343-351. Open Access with the permission of the publisher and the author.
Ebola continues to attract worldwide attention as a highly lethal virus of unknown origin that leaves victims ble
...
eding to death and has no known vaccine or cure. The purpose of this historical research was to review and analyze the primary and secondary sources available on Ebola for use by primary care nurses in the event of future outbreaks.
You could send comments to the author: susanamundsen@comcast.net
more
The manual contains basic principles of prescribing followed by chapters on medicines used in psychotic disorders; depressive disorders; bipolar disorders; generalised anxiety and sleep disorders; obsessive-compulsive disorders and panic attacks; and alcohol and opioid dependence
Updates for the integrated management of childhood illness (IMCI) - Guideline.
As part of its response to the global epidemic of obesity, WHO has issued guidelines to support primary healthcare workers identify and manage children who are overweigh
...
t or obese. Specifically, all infants and children aged less than 5 years presenting to primary health-care facilities should have both weight and height measured in order to determine their weight-for-height and their nutritional status according to WHO child growth standards. Comparing a child's weight with norms for its length/height is an effective way to assess for both wasting and overweight
more
WHO alcohol brief intervention training manual for primary care
World Health Organization (Europe)
(2017)
C_WHO
Alcohol contributes significantly to the disease and mortality burden in the WHO European Region, and primary health care systems play an important role in reducing the impact of harmful alcohol use
...
. Screening and brief interventions (SBIs) for alcohol are an evidence-informed approach to addressing the needs of the many patients presenting in primary care who may benefit from reducing their alcohol consumption. This manual provides information to plan training and support for primary care practitioners to confidently deliver SBI for alcohol problems to their patients. The manual outlines the background and evidence base for SBI, and gives practical advice on establishing an implementation programme as well as detailed educational materials to develop the knowledge and skills of participants in organized training sessions.
more
Position Statement
Diabetes Care2018;42(Suppl. 1):S1–S194.
Updated 19 March 2020
Infection prevention and control (IPC) practices are of critical importance in protecting the function of healthcare services at all levels and mitigating the impact on vulnerable populations. Although the management of possible COVID-19 cases is usually guided by national policies for specific heal
...
thcare facilities, community transmission is currently widespread in most EU/EEA countries and the UK, therefore primary healthcare providers in the community such as GPs, dentists and pharmacists are at risk of being exposed to COVID-19.
more
This is an abridged version of the 2019 Standards containing the evidence-based recommendations most pertinent to primary care. The tables and figures have been renum-bered
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from the original document to match this version. The complete 2019 Standards of Care document, including all supporting references, is available at professional.diabetes.org/standards.
This is an abridged version of the American Diabetes Association’s Standards of Medical Care in Diabetes—2019. Diabetes Care2018;42(Suppl. 1):S1–S194. The complete 2019 Standards supplement, including all supporting references, is available at professional.diabetes.org/standards.
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BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3026 (Published 11 August 2020)
The BMJ "practice pointer" inlcudes a one-page visual summary of assessment and initial management of patients with persistant symptoms following acute SARS-CoV-2 infection
This document aims to support those working in primary care to strengthen IPC, informed by existing WHO IPC guidance and implementation resources. Many of the existing WHO IPC guidance and implement
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ation resources initially developed for acute health care facilities have a potential utility for IPC in primary care. However, navigating these resources to locate relevant content for IPC in primary care can be challenging as some documents can span over 100 pages. This document extracts relevant content, bringing together existing WHO IPC standards, indicators and implementation approaches that are focused on, or directly relevant to IPC in primary care. It should also be used to identify resources suitable for use in primary care that can be embedded within relevant IPC or other health programmes.
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What are the FP and CAC competencies?
Through the clear articulation of the family planning and comprehensive abortion care (FP and CAC) competencies for the primary health
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care workforce, the aim is to advance improvements in FP and CAC service delivery by aligning health worker education approaches with population health needs and health system demands.
This document, which describes these competencies in detail, is intended to:
be a foundational tool to be adopted and adapted by educators and regulators for FP and CAC providers (students) with a pre-service training pathway of at least 12 months;
describe competencies that are relevant to current and future health practice;
enable widespread use of the competencies not only for curriculum development for pre-service education, but also for in-service education, regulation, qualifications, quality assurance, personal development, performance evaluation, recruitment, management and career progression;
focus on the core functions of FP and CAC providers within broader efforts towards achieving universal health coverage
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This document, Programme and curriculum development guide, presents a systematic approach to developing programmes and curricula for implementation of the family planning (FP) and comprehensive abortion care (CAC) competencies,and the theory behind
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the approach. Specifically, the aim is for effective implementation of these competencies in the context of pre-service education and training, post-graduate studies and continuing professional development (CPD). This guide is designed for programme and curriculum developers who are preparing or revising formal education and training programmes and curricula for the FP and CAC workforce.
This guide proposes a new FP and CAC Educational Design Model for programme and curriculum development. This model can support competency-based education (CBE) for current and future FP and CAC services, with a pre-service training pathway of at least 12 months, and can also support in-service training. CBE provides the most effective means to orient educational programmes and curricula towards effective health services that meet population health needs, and this Educational Design Model provides a guide for linking the competencies required to provide a range of health services
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This document provides an overview of strategic purchasing of nutrition services within primary health care. It introduces key terms and payment methods for countries to use in preparing to transfor
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m their health financial systems to scale up nutrition services. It does so by introducing nutritional perspectives to strategic health purchasing core areas: What to buy, From whom to buy and How to buy.
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The OpenWHO course titled "Interventions for Noncommunicable Diseases in Primary Health Care" provides guidance on screening, detection, diagnosis, and management of major noncommunicable diseases (
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NCDs) such as cardiovascular diseases, type 2 diabetes, chronic respiratory diseases (asthma and chronic obstructive pulmonary disease), and early cancer detection within primary health care settings. It emphasizes delivering high-impact essential NCD interventions through a primary healthcare approach to enhance early detection and timely treatment. This course is part of the SEARO NCD PEN-HEARTS series, which includes four courses aimed at enabling learners to plan and deliver NCD services effectively.
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An integrated approach is particularly important for low-resource settings for efficient use of limited resources. The course contents will include risk factors, clinical course, guidance and protocols for diagnosis, management and referral as needed for NCDs in PHC. SEARO NCD PEN-HEARTS is a series
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of four courses with the other three courses focusing on Hearts of NCD: an integrated approach to management of NCDs in PHC, diabetic foot care and palliative care that will enable the learner to plan and deliver NCD services.
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Cancer, diabetes, heart disease and stroke, chronic respiratory disease
The "WHO Package of Essential Noncommunicable (PEN) Disease Interventions for Primary Health Care" provides a set of cost-effective, evidence-based interventions to address noncommunicable diseases
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(NCDs) such as cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers. Designed for implementation in primary healthcare settings, especially in low-resource environments, the package includes protocols for screening, diagnosis, treatment, and management of these diseases. The document emphasizes an integrated approach, supporting universal health coverage by empowering healthcare workers with practical tools to improve NCD care. It aims to reduce premature mortality from NCDs and enhance global health equity.
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The aim of this document is to contribute to the enhacement of hospital managment by improving the quality of annual hospital reports.
This article unites the latest guidelines on the management of arterial hypertension in primary health care in Portuguese speaking countries including Brazil, Angola, Mozambique, São Tomé e Prínc
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ipe, Cape Verde, among others.
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Schistosomiasis is a chronic disease linked to poverty and is widely endemic, particularly in sub-Saharan Africa. For decades, the World Health Organization has called for a larger role of the primary health
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care system in schistosomiasis control, and its integration within the routine activities of primary health care facilities. Here, we reviewed existing studies on the integration of schistosomiasis control measures within the primary health care system, more precisely at the health centre, and we analysed their outcomes.
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The COVID-19 pandemic has brought the need for well-functioning primary health care (PHC) into sharp focus. PHC is the best platform for providing basic health interventions (including effective man
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agement of non-communicable diseases) and essential public health functions. PHC is widely recognised as a key component of all high-performing health systems and is an essential foundation of universal health coverage
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Over one third of all deaths in Kenya in 2019 were attributed to NCDs (Vos et al., 2020). The four major NCDs – CVDs, cancer,
diabetes and chronic respiratory diseases – accounted for 57% of these deaths. Furthermore, the direct and indirect economic
impact of NCDs is significant- Kenya is sai
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d to have lost Ksh 230 billion or 3.4% of its gross domestic product in 2016 from rising
NCD-related medical costs and indirect productivity losses. At the household level, an estimated decrease of 28.6% in income
due to NCDs was reported in 2007 (Mwai & Muriithi, 2016; Mensah et al., 2020). Therefore, preventing and managing NCDs are
significant public health and economic priorities.
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Effective implementation of WHO PEN, combined with other very cost effective population-wide interventions, will help even resource constrained settings to attain the global voluntary targets related to reduction of premature mortality and preventionof heart attacks and strokes.
2006-2008 programme report
Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis
Mugisha J.; Abdulmalik, J.; Hanlon C; et al.
International Journal of Mental Health Systems; BioMed Central
(2017)
C1
Mugisha et al. Int J Ment Health Syst (2017) 11:7 DOI 10.1186/s13033-016-0114-2
The purpose of the Clinical Practice Guideline for Treatment of Patients with Anxiety Disorders in Primary Care is to provide professionals with practical recommendations based on scientific evidenc
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e to assist in the detection and effective treatment of these disorders
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The toolkit offers advice on how national public health authorities could engage with primary care prescribers so as to promote appropriate and responsible use of antibiotics. The toolki
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t contains template materials and some suggested key messages for health professionals, ideas for awareness raising activities, and suggested tactics for getting the messages across to both primary care providers and patients regarding prudent use of antibiotics.
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Defining Disability - A Guideline for Medical Doctors and Primary Health Care Workforce
Prof. AHM E. Hussain; Dr. N. Mohammad; Dr. Md. R. Karim; et al.
Government of the People's Republic of Bangladesh DGHS Directorate General of Health Services Ministry of Health and Family Welfare ; NCDC; drra; et al.
(2019)
C2
January 2019
Non Communicable Disease Control Programme Directorate General of Health Services Health Services Division, Ministry of Health & Family Welfare
Community health workers (CHWs) play a significant role in Primary health Care due to their proximity to households, communities and the health care
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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.
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The risk factors for CVD include behavioural factors, such as tobacco use, an unhealthy diet, harmful use of alcohol and inadequate physical activity, and physiological (metabolic) factors, including high blood pressure (hypertension), high blood cholesterol and high blood sugar or glucose. Both kin
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ds of factor are linked to underlying social determinants and drivers. This module focuses on the behavioural risk factors and provides information on: • tobacco use, unhealthy diet, insufficient physical activity and harmful use of alcohol as important contributors to CVDs • behavioural change, brief interventions for counselling and key points for motivational interviewing • the theory of the 5As for brief interventions, as well as sample brief interventions for each risk factor, using the 5As. Target users of this module This module is intended for trainers of primary health care workers, including physicians, nurses, and other health workers. Primary care workers should be trained on the risk factors and counselling approaches, adapting to local customs, culture and context. NCD programme managers may also use it for planning purposes.
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The incidence of circulatory disorders is increasing worldwide, affecting both low- and middle-income countries and some high-income countries. There is evidence of rising incidence and prevalence rates, even among younger individuals, along with an increasing prevalence of risk factors such as high
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blood pressure, diabetes, and obesity. These indicators suggest that current approaches are not
effective in managing and reducing the burden of conditions affecting circulatory health.
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Diabetes is one of the leading causes of death globally. India is home to the second-largest population suffering from diabetes. This underscores the need to build capacity of primary care physician
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s (PCPs) for better disease management. This narrative review article aims to describe the emergence of diabetes education and capacity-building programs for PCPs and its current situation in India. The review highlighted that major emphasis on diabetes was given only when the WHO estimated that morbidity and mortality due to diabetes would increase to 35% in India. As a result, National Diabetes Control Program was launched in 1987. Yet, very little attention was paid to diabetology in under-graduation. In the last decade, few public and private institutions have developed diabetes related capacity-building programs for PCPs independently or in collaborations. These programs include 16 fellowships, 4 diplomas, 12 certificate programs, and 6 other diabetes training programs, which have their own pros and cons. As medical science is changing rapidly, PCPs need to upgrade their skills and knowledge regularly to manage NCDs such as diabetes more effectively and efficiently. This can be possible only if scientific, evidence-based, and quality-oriented capacity-building programs are provided to the healthcare workforce.
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Infant Psychiatry
Chapter B.2
Petersenet al.International Journal of Mental Health Systems2011,5:8http://www.ijmhs.com/content/5/1/8
Development of cardiovascular disease (CVD) is influenced by risk factors such as:
tobacco use, an unhealthy diet, physical inactivity, obesity (which can result from
a combination of unhealthy diet, physical inactivity, and other factors), elevated
blood pressure (hypertension), abnormal blood l
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ipids (dyslipidaemia) and elevated blood glucose (diabetes mellitus). Continuing exposure to these risk factors leads
to further progression of atherosclerosis, resulting in clinical manifestations of these diseases, including angina pectoris, myocardial infarction, heart failure and stroke. Total CVD risk depends on the individual’s overall risk-factor profile.
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The HEARTS technical package provides a strategic approach to improving cardiovascular health in countries. It comprises six modules and an implementation guide. This package supports Ministries of Health to strengthen CVD management in primary heal
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th care settings. The practical, step-by step modules are supported by an overarching technical document that provides a rationale and framework for this integrated approach to the management of NCDs.
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In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles
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terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
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Procurement and supply management activities are fundamental to consistent and reliable access to essential medicines and health products. To reduce the impact of CVD, action needs to be taken to improve prevention, diagnosis, care and management of
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CVD diseases. Affordable essential medicines and technologies to manage CVD disease must be available where and when they are required. Medicines and technologies need to be managed appropriately to ensure that the correct medicines are selected, procured in the right quantities, distributed to facilities in a timely manner, and handled and stored in a way that maintains their quality. This needs to be backed up by policies that enable sufficient quantities to be procured in order to reduce cost inefficiencies, ensure the reliability and security of the distribution system, and encourage the appropriate use of these health products. In order to avoid stock-outs and the disruption of treatment, all related activities need to be conducted in a timely manner, with performance continually monitored, and prompt action taken in response to problems that may arise. Additionally, medication must be dispensed correctly and used rationally by the healthcare provider and patient alike. The purpose of this guide is to explain the necessary steps.
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Many low-resource settings have a shortage of physicians and health workers. (1) In order to provide patient-centred continuous care more effectively, primary
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care systems can include team-based care strategies in their clinic workflows and protocols. Team-based care uses multidisciplinary teams (which may involve new staff, or the shifting of tasks among existing staff). Teams can include patients themselves, primary care physicians, and other allied health professionals, such as nurses, pharmacists, counsellors, social workers, nutritionists, community health workers, or others. Teams reduce the burden on physicians by utilizing the skills of trained health workers. Strong evidence shows that team-based care is effective in improving hypertension control among patients in a cost-effective way. (2) Some amount of task shifting/team-based care is already taking place in many settings; this module provides further guidance on how to maximize this approach for greater impact.
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Monitoring is a crucial element in any successful programme. It is important to
know if health care facilities – and ultimately countries – are meeting the agreed
goals and objectives for preventing and managing cardiovascular diseases (CVD).
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Monitoring is the on-going collection, management and use of information to
assess whether an activity or programme is proceeding according to plan and/
or achieving defined targets. Not all outcomes of interest can be monitored. Clear
outcomes must be identified that relate to the most important changes expected to result from the project and to what is realistic and measurable within the timescale of the project. Once these outcomes have been articulated, indicators can be chosen that best measure whether the desired outcomes are being met.
To allow progress to be monitored, this module provides a set of indicators on
CVD management. Agreeing on a set of indicators allows countries to compare
progress in CVD management and treatment across different districts or
subnational jurisdictions, as well as at a facility level, identify where performance
can be improved, and track trends in implementation over time. Monitoring
these indicators also helps identify problems that may be encountered so that
implementation efforts can be redirected.
This module starts from the collection of data at facility level, which is then
“transferred up” the system: facility-level data are aggregated at subnational level
to produce reports that allow tracking of facility and subnational performance over time and allow for comparison among facilities. National-level data are obtained through population-based surveys.
Implementing a monitoring system requires action at many levels. At national and
subnational levels, staff can determine how best to integrate data elements into
existing data collection systems – such as the routine service-delivery data that are collected through facility-level Health Management Information Systems (HMIS).
In the facility setting, personnel must be aware of what data are needed. Sample
data-collection tools are included, recognizing that countries use different datamanagement systems for HMIS, so the CVD monitoring tools will be adapted to work with the HMIS system being used by the country, such that the indicators can be collected with minimal disruption/work to existing systems and tools
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HEARTS provides a set of locally adaptable tools for strengthening the
management of CVD in primary health care.
HEARTS is designed to enhance implementation of WHO PEN by providing:
• operatio
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nal guidance on further integrating CVD management
• technical guidance on evaluating the impact of CVD care on patient outcomes.
For countries not using WHO PEN, CVD management can still be integrated into
primary health care. The process of implementing HEARTS will vary, depending
on country context, and may require a significant reorienting and strengthening
of the health system. At some sites, existing CVD management services may be
reoriented toward a risk-based approach, while other sites may adopt a public
health approach, strengthening management of particular risk factors such as
hypertension. Whether or not introducing CVD management into primary care is a
new intervention, successful implementation will require engagement with national and local health planners, managers, service providers, and other stakeholders.
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Kenya : Clinical Guidelines for Management and Referral of Common Conditions at Levels 2-3: Primary Care
Ministry of Medical Services, Kenya; Ministry of Public Health & Sanitation
World Health Organization WHO
(2009)
C_WHO
Clinical Management and Refferal Guidelines Vol. 2.
In 2013, WHO and the Foundation for Innovative New Diagnostics convened a meeting of Buruli ulcer experts in Geneva, Switzerland (9) at which two priority unmet needs in diagnosis were identified:
a diagnostic test for early detection of Buruli ulcer in symptomatic patients with sufficient positive
...
predictive value to put patients on appropriate treatment; and
a screening test at the primary health care or community level for symptomatic patients with ulcer
In March 2018, they convened a global meeting with the aim of establishing an action plan to develop new diagnostic solutions for Buruli ulcer and to create a framework of collaboration to address unmet needs in diagnostics for the disease. The participants agreed to develop a target product profile (TPP) to address the need for a rapid diagnostic test for use at the primary health-care level.
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The course aims to cover the types of NCDs and risk factors, the challenges of delivering NCD services in primary health care, elements of WHO technical packages (PEN and HEARTS) for NCDs and how to
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adapt these packages in primary health care.
SEARO NCD PEN-HEARTS is a series of four courses with the other three courses focusing on NCDs interventions, diabetic foot care and palliative care that will enable the learner to plan and deliver NCD services.
more
Background: Community Health Workers (CHWs) have a positive impact on the provision of community-based
primary health care through screening, treatment, referral, psychosocial support, and accompan
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iment. With a
broad scope of work, CHW programs must balance the breadth and depth of tasks to maintain CHW motivation for
high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to
enhance their programmatic activities.
Methods: We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno
District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data
was collected in 8 focus group discussions with 90 CHWs in October 2018 and March–April 2019 in seven purposively
selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.
Results: Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in
the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive
patient outcomes, community respect, and recognition by the formal health care system but can lead to the chal-
lenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and
workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a posi-
tive work environment through supportive relationships between CHWs and supervisors enables the CHWs.
Conclusion: This study demonstrated enabling factors and challenges for CHW performance from their perspec-
tive within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance,
manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic empha-
sis can focus on enhancing motivational factors found in this study to improve the CHWs’ experience in their role. The
engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided
to the patients and communities, along with building supportive systems to recognize the work done by CHWs for
the primary health care systems.
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This publication aims to provide an overview of the state of developmental monitoring in selected countries across the Europe and Central Asia region (ECAR), to document the existing evidencebased approaches and models for developmental monitoring and to identify the key considerations necessary to
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guide discussions around introducing and enhancing developmental monitoring as a part
of primary health care.
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This book is one of fifteen modules of the “Noncommunicable disease education manual for primary health care professionals and patients”. This manual is intended to provide health information on
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the prevention and control of hypertension and diabetes. This will be used in the form of a flip chart for health professionals to educate their patients with either hypertension or diabetes.
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The course aims to cover the types of NCDs and risk factors, the challenges of delivering NCD services in primary health care, elements of WHO technical packages (PEN and HEARTS) for NCDs and how to
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adapt these packages in primary health care.
more
The purpose of the guideline is to provide evidence-based recommendations on nonsurgical interventions for chronic primary LBP (CPLBP) in adults, including older people, that can be delivered in primary
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and community care settings to improve CPLBP-related health and well-being outcomes. For this reason, the guideline does not consider interventions typically delivered in secondary or tertiary care settings (e.g. surgical or other invasive procedures) or workplace interventions.
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The purpose of the guideline is to provide evidence-based recommendations on nonsurgical interventions for chronic primary LBP (CPLBP) in adults, including older people, that can be delivered in primary
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and community care settings to improve CPLBP-related health and well-being outcomes. For this reason, the guideline does not consider interventions typically delivered in secondary or tertiary care settings (e.g. surgical or other invasive procedures) or workplace interventions.
more
In 2009, WHO’s Second International Conference on Buruli Ulcer Control and Research resolved to strengthen the capacity of national laboratories to confirm cases of the disease, but advised that “efforts are still needed to develop simple diagnostic tools usable in the field as well as disabilit
...
y prevention methods”.
In 2013, WHO and the Foundation for Innovative New Diagnostics convened a meeting of Buruli ulcer experts in Geneva, Switzerland (9) at which two priority unmet needs in diagnosis were identified:
a diagnostic test for early detection of Buruli ulcer in symptomatic patients with sufficient positive predictive value to put patients on appropriate treatment; and
a screening test at the primary health care or community level for symptomatic patients with ulcer
more
In Latin America and the Caribbean (LAC), one maternal death was registered every hour in 2020. That same year, the trend in the maternal mortality ratio (MMR) for the Region of the Americas regressed alarmingly and unprecedentedly to the levels seen two decades ago. In addition to indicating a wors
...
ening of health outcomes, these figures also signal a deepening of inequalities, representing thousands of individual, unacceptable tragedies that in most cases could have been preventable. Maternal death is the result of a multifactorial process in which structural elements such as the economic system, environmental conditions, and culture interact. Other factors related to social inequality are also present, such as racism, poverty, gender inequality, and lack of access to the education system. The current situation calls for urgent mobilization of the health systems of LAC countries in order to strengthen efforts to combat maternal mortality, especially in countries that are still far from achieving the SHAA2030 regional target. For this reason, a preventive, health-promoting, life-course-based approach is needed, with models of care centered on women, families, and the community Scientific evidence shows that health systems with a solid foundation in primary health care (PHC) achieve better outcomes, greater equity, and reduced health expenditures. To address this, PAHO proposes a strategy, aimed primarily at women who are in the most vulnerable situation, who are the ones who represent the greatest burden of maternal mortality, to accelerate the reduction of maternal mortality in the Region of the Americas, based on the expansion and strengthening of PHC.
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The third edition, released in 2018, has grown to include a total of 18 chapters, contributed by 20 experts and authors from many countries. The goal remains the same: to educate primary care provid
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ers on the best practices in TB diagnosis, treatment and follow-up. All articles are richly illustrated, and most include quizzes and CME questions for self learning. The 3rd edition includes new chapters on MDR-TB, adverse effects of TB drugs, adherence monitoring strategies, and nutritional support. There is also content on how to manage children with TB, care for patients co-infected with TB and HIV, how to read and interpret chest x-rays, and how to avoid common pitfalls in TB management.
To download book chapters or the whole book go to the website: http://www.letstalktb.org/download/
more
International Journal of Psychiatry in Clinical Practice, 2012; 16: 77–84
The objective of Critical Considerations and Actions for Achieving Universal Access to Sexual and Reproductive Health in the Context of Universal Health Coverage through a Primary Health Care Approa
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ch is to provide guidance to WHO Member States for ensuring progress towards universal access to comprehensive sexual and reproductive health (SRH) in the context of primary health care (PHC)- and universal health coverage (UHC)-related policy and strategy reforms.
more
Asthma is the most common chronic respiratory disease among school-going adolescents worldwide. However, the burden of severe asthma is highest in Sub-Saharan Africa. This study aimed to explore teachers’ perceptions of asthma care across six Afri
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can countries. We conducted focus group discussions (FGDs) using a semi-structured interview guide. Interviews were audio-recorded, transcribed verbatim and analysed thematically. FGDs were conducted in Kumasi(Ghana), Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda), and Harare (Zimbabwe) between 01 November 2020 and 30 June 2021. We identified two key themes related to asthma care; barriers to asthma care and suggestions to improve the care of adolescents with asthma. Barriers reported by teachers included a lack of knowledge and skills among themselves, adolescents, and caregivers. In addition, some traditional beliefs of teachers on asthma exacerbated challenges with asthma care in schools. Regarding suggestions, most teachers identified a need for all-inclusive asthma training programmes for teachers, adolescents and caregivers, focusing on acute episodes and mitigating triggers. Utilising teachers with personal experiences with asthma to advocate and support these initiatives was suggested. Further suggestions included the need for annual screening to enable early identification of adolescents with asthma and clarify restrictions on teachers administering asthma medications. Teachers across African schools identify multiple barriers to asthma care. Structured school education programs and annual asthma screening are key to addressing some barriers to care.
more
The International Primary Care Respiratory Group (IPCRG) is a clinically-led charitable organisation. The scope is research and education to improve prevention, diagnosis and
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care of respiratory diseases in global community and primary care settings.
more
Appropriate use and withdrawal of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD)
Román-Rodríguez, M.; Tsiligianni, I.; Wiliams, S.; et al.
International Primary Care - Respiratory Group
(2020)
CC2
The document "Appropriate use and withdrawal of inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD)" from the IPCRG provides guidance on when to start, adjust, or discontinue ICS in COPD treatment. It highlights the benefits and risks, emphasizing personalized
...
treatment based on patient history, exacerbation frequency, and eosinophil count, while detailing how to optimize bronchodilator use to manage symptoms effectively.
more
Introducing the IPCRG
International Primary Care - Respiratory Group
International Primary Care - Respiratory Group
(2024)
CC2
The International Primary Care Respiratory Group (IPCRG) is a clinically-led charitable company that works locally in primary
...
care and collaborates globally to improve respiratory health. Our vision is that, through universal access to the right care, everyone can breathe and feel well.
more
Under-diagnosis of asthma in ‘under-fives’ may be alleviated by improved inquiry into disease history. We assessed a questionnaire-based screening tool for asthma among 614 ‘under-fives’ with severe respiratory illness in Uganda. The questionnaire responses were compared to post hoc consensu
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s diagnoses by three pediatricians who were guided by study definitions that were based on medical history, physical examination findings, laboratory and radiological tests, and response to bronchodilators. Children with asthma or bronchiolitis were categorized as “asthma syndrome”. Using this approach, 253 (41.2%) had asthma syndrome. History of and present breathing difficulties and present cough and wheezing was the best performing combination of four questionnaire items [sensitivity 80.8% (95% CI 77.6–84.0); specificity 84.7% (95% CI 81.8–87.6)]. The screening tool for asthma syndrome in ‘under-fives’ may provide a simple, cheap and quick method of identifying children with possible asthma. The validity and reliability of this tool in primary care settings should be tested.
more
Adults and adolescents 12+ years. Asthma medication options: Adjust treatment up and down for individual patient needs
Human resources for health in Botswana
Nkomazana, O., Peersman, W., Willcox, M., et al.
African Journal of Primary Health Care & Family Medicine (PHCFM)
(2014)
CC
The results of in-country database and reports analysis
Undiagnosed tuberculosis in patients with HIV infection who present with severe anaemia at a district hospital
M. Mntonintshi; D. O’Mahony; S.Mabunda; et al.
African Journal of Primary Health Care & Family Medicine, AOSIS; NCBI (National Center for Biotechnology Information)
(2017)
CC
Original Research
African Journal of Primary Health Care & Family Medicine
ISSN: (Online) 2071-2936, (Print) 2071-2928
Open Access
