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1
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 systems are weak in many low- and middle-income countries and often fail to provide comprehensive, people-centred, integrated care. We analysed the primar
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y 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, 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 a
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pproach 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.
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This document describes the ethical values that are most important to the nursing profession in Ontario. It also provides scenarios of ethical situations in which there is a conflict of values. Nurses are encouraged to use these scenarios for reflection and discussion. No solutions are offered becau
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se there is no one solution that is best in all situations. The behavioural directives are intended to help nurses work through ethical situations and provide information about the College of Nurses of Ontario’s (CNO’s) expectations for ethical conduct. These are taken into account when CNO Committees assess nurses’ practices. Nurses need to consider behavioural directives carefully when making decisions about ethical care as this process will strengthen their practice.
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Nurses at present are facing various personal, interpersonal, professional, institutional and socio cultural challenges in their professional performance. Dealing with these issues may not be always clear. The lack of one correct approach in addressing different conte
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xtual issues may lead to ethical dilemmas. Responding to this complex issues demand nurses to acquire comprehensive ethical knowledge and skills in various decision making process. Although teaching materials have a pivotal role to play in helping nurses in this endeavor, comprehensive books inclusive of all the topics in the curriculum is scarce in Ethiopia. Therefore, this lecture note is prepared to overcome the acute shortage of reference materials reflecting the national context and be used as a teaching material for nurses at various levels. The lecture note is divided in to five units. Unit one of this lecture note deals with the history of nursing, unit two about philosophy of nursing, unit three health and illness, unit four Ethico-legal aspects to nursing, and unit five communication and interpersonal relationships in nursing,
more
Community-based strategies play a significant role in many health systems in low- and middle-income countries, especially in light of critical shortages in the health workforce. The term community health worker has been used to refer to volunteers and salaried, professional or lay health workers wit
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h a wide range of training, experience, scope of practice and integration in health systems. In the context of this study, we use the term community-based practitioner (CBPs) to reflect the diverse nature of these cadres of health workers.
CBPs provide preventive, promotive, curative and palliative services across a range of areas, including reproductive, maternal, newborn and child health, HIV, tuberculosis, malaria, control of other endemic diseases, and noncommunicable diseases. Significant evidence has emerged over the past two decades on their effectiveness, which has triggered interest in the potential to use their services to expand access to care, in particular in rural and underserved areas where deployment and retention of more qualified health workers is problematic. Calls have been made to integrate CBP programmes in human resources and health strategies, and to scale up rapidly the extent and coverage of CBP initiatives.
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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
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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.
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The State of the world’s nursing 2020 report provides the latest, most up-to-date evidence on and policy options for the global nursing workforce.
This toolkit was developed by the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention (DHDSP) to provide healthcare organizations, including those in resource-constrained settings, with the information and resources to implement the HMP and improve hyper
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tension control among their patients. CDC DHDSP developed an online toolkit that consists of interactive e-learning modules that are designed to guide learners through the key features of the ten HMP components and prepare them for implementation at their health system. The online e-learning modules are accompanied by a PDF toolkit document that can be used as an additional resource for users.
The purposes of this toolkit and the associated online e-learning modules are to provide healthcare organizations:
An overview of the HMP, its ten core components, and suggestions for implementing the HMP in clinical settings.
Guidance to staff, administrators, and other healthcare professionals on how to implement and adapt the HMP for their unique clinical setting.
The online e-learning modules you can find here:
https://www.cdc.gov/dhdsp/pubs/toolkits/hmp-toolkit/index.htm
accessed 29.07.2021
more
second edition
Included more self-measured blood pressure (SMBP)-focused content with tools and resources.
Showcased more tools to find patients with potentially undiagnosed HTN.
Added new strategies that focus on chronic kidney disease testing and identification.
This guidance document provides basic principles for a spokesperson of any health authority on how to respond to vocal vaccine deniers. The suggestions are based on psychological research on persuasion, on research in public health, communication studies and on WHO risk communication guidelines.
In order to meet changing global population needs and consumer expectations, healthcare systems worldwide are under transformation and face restructuring. As systems adapt and shift their emphasis in response to the disparate requests for healthcare services, oppor-tunities emerge for nurses, especi
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ally the APN, to meet these demands and unmet needs (Bryant-Lukosius et al. 2017; Carryer et al. 2018; Cassiani & Zug 2014; Cooper & Docherty 2018; Hill et al. 2017; Maier et al.2017). In 2002, the International Council of Nurses (ICN) pro-vided an official position on Advanced Practice Nursing (ICN 2008a). Since that time, worldwide development has increased significantly and simultaneously this field of nursing has matured. ICN felt that a review of its position was needed to assess the relevance of the definition and characteristics offered in 2002. This guid-ance paper defines diverse elements such as assump-tions and core components of the APN. The attributes and descriptors presented in this paper are intended to promote a common vision to continue to enable a greater understanding by the international nursing and healthcare communities for the development of roles commonly identified as Clinical Nurse Specialist (CNS) and Nurse Practitioner (NP).
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Standards for nursing practice are based on the following philosophy and principles:
•the client is the central focus of the professional service nurses provide, and is a partner in the decision-making process and ultimately makes his or her own decisions
•improvement is a necessary component
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of practice, and the public interest is best served when nurses continually improve their application of knowledge, skill and judgment
•the public has entrusted CRNPEI to honour the social contract that we have made with Canadians to act in the public interest through the licensing and regulation of its members •quality practice settings contribute to the provision of competent and professional service
•the goal of professional nursing service is the outcome desired by the client that poses noun necessary exposure of risk of harm
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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 throu
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gh 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.
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Epidemiologischen Bulletin 32/2021, 27 Juli 2021.Systematisches Testen auf SARS-CoV-2 in Kitas und Schulen kann einen wichtigen Beitrag leisten, um das dortige Infektionsgeschehen besser beurteilen zu können und das Übertragungsrisiko von Infektionen zu reduzieren. Die im Epidemiologischen Bulleti
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n 32/2021 veröffentlichte Studie stellt die Validierung der Lolli-Methode und die Implementierung des Testkonzeptes in 32 Kölner Kitas im Zeitraum September 2020 bis März 2021 vor. Das Testkonzept Lolli-Methode basiert auf der Kombination einer einfachen Probenentnahme und anschließender PCR-Pooltestung. Es wird seit April 2021 an allen Kitas und Schulen der Stadt Köln und seit Mai 2021 an allen Grund- und Förderschulen in Nordrhein-Westfalen durchgeführt.
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Medicina 2019, 55, 553; doi:10.3390/medicina55090553
Results: Twenty-one studies were analyzed, most of them demonstrating an association between the existence of burnout and the worsening of patient safety. High levels of burnout is more common among physicians and nurses, and it is associated wit
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h external factors such as: high workload, long journeys, and ineffective interpersonal relationships. Good patient safety practices are influenced by organized workflows that generate autonomy for health professionals. Through meta-analysis, we found a relationship between the development of burnout and patient safety actions with a probability of superiority of 66.4%. Conclusion: There is a relationship between high levels of burnout and worsening patient safety.
more
Don’t Leave Them Alone: The future of the cross-border response in north west Syria
ATAA Humanitarian Relief Association, BINAA for Development, Children Of One world, et al.
Save the Children
(2021)
C1
This report, written by ATAA Humanitarian Relief Association, BINAA for Development, Children Of One world, Hand in Hand for Aid and Development, Horan Foundation, Hurras Network, MARAM Foundation, Orange Organization, Syrian American Medical Society, Save the Children and Shafak Organization, provi
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des insights on the humanitarian situation on the ground in north west Syria.
more
PlosOne Published: July 14, 2021
https://doi.org/10.1371/journal.pone.0254339
he WHO South-East Region in 2019 accounted for nearly a million missing TB patients from the estimated incidence. Active case-finding (ACF) or systematic screening for tuberculosis is an important tool to reach out to missing TB patients. When appropriately implemented, the activity is cost effectiv
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e, helps to reduce diagnosis and treatment delays, and prevents the spread of the disease. This document presents an analysis of published ACF studies from the Region. It can be used by Member States for effective planning, implementation and monitoring of these activities.
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Investment in all the drivers and facilitators of hand hygiene action in health care to ensure that it occurs at the point of care and other critical moments requires a multidisciplinary, multifaceted approach. WHO describes such an approach as a “multimodal improvement strategy” (MMIS) which is
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at the core of its implementation models for hand hygiene and infection prevention and control (IPC) programmes. The focus of this document is on the resource considerations for investing in hand hygiene improvement in health care (primary, secondary and tertiary) using the MMIS approach.
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