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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 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.
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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 guide assumes the reader already has a general understanding of the Care Group methodology. It is highly recommended that all Care Group implementers familiarize themselves with the contents of theCare Groups: A Training Manual for Program Design and Implementation,and, ideally,to participate i
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n an in-person training on Care Groups, before commencing Care Group activities. This guide is meant to serve as a companion to the Care Group Training Manual; and additional details on all topics covered in this guide are provided in the Training Manual. This guide may also be used by program evaluators, as a means to assess the extent to which Care Groups were implemented in accordance with theevidence-based model and their potential contribution to program outcomes.
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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 Health sector and to promote and strengthen service delivery at the Community level.
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The law will regulate training, certification and registration and set minimum qualifications and standards and working conditions for the CHWs.
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Almost two years after the signing of the Political Accord for Peace and Reconciliation (APPR), the Central African population is still hostage to an unstable and unpredictable security environment. Continuing conflicts in several areas of the country, structural weaknesses combined with the socio-e
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conomic effects of the COVID-19 pandemic, and the devastating effects of natural disasters have plunged 2.6 million people into dire needs. Of this total, 1.6 million have severe humanitarian needs, a figure unmatched for five years, reflecting a deterioration in the physical and mental well-being and living conditions of populations across the country.
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The 2019 ANA’s Principles for Nurse Staffing, Third Edition, identifies major elements needed to achieve appropriate nurse staffing, which enhances the delivery of safe, quality health care. These principles are grounded in the substantive and growing body of evidence that demonstrates the link be
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tween appropriate nurse staffing and better patient outcomes and apply to all types of nurse staffing at every practice level in any healthcare delivery setting. Focused on addressing the complexities of appropriate nurse staffing decisions, the principles and supporting material in this publication will guide nurses and other decision-makers in identifying and developing processes and policies needed to improve nurse staffing.
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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
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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.
For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and
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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.
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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 t
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he 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.
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Moral emotions are a key element of our human morals. Emotions play an important role in the
caring process. Decision-making and assessment in emergency situations are complex and they frequently result in
different emotions and feelings among health-care professionals.
Mosby’s Pocket Guide to Nursing Skills and Procedures, eighth edition, is
a practical, portable reference for students and practitioners in the
clinical setting. Grouped alphabetically, 85 commonly performed skills
are presented in a clear, step-by-step format that includes:
■ Purpose for pe
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rforming each skill
■ Guidelines to help students in delegating tasks to assistive
personnel
■ List of equipment required
■ Rationales to explain why specific techniques are used
■ Full-color photographs and drawings to provide visual
reinforcement
In addition, Safety Alerts are included in the skills to highlight important
information about patient safety and effective performance.
Current Standard Precautions guidelines from the Centers for Disease
Control and Prevention are incorporated throughout. Preprocedure
and postprocedure protocols are conveniently located on the inside
back cover.
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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.
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March 2021. “A Decade of Destruction: Attacks on health care in Syria,” highlights with chilling detail how this 10-year war strategy has turned hospitals from safe havens into no-go zones where Syrian civilians now fear for their lives.
This new plan has been developed to build on successes made and lessons learnt from implementation of the two initial plans and to provide a short to medium term strategic anchor against which preparedness and response plans to the corona virus disease COVID-19 epidemic in the country should focus o
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n for the period June 2021 to June 2022.
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Recently, a renewed interest in large-scale community health worker (CHW) programs has been seen globally. This renewal provides an opportune moment to take stock of issues and challenges such programs face and what can be done to make them as effective as possible. With this in mind, this manual is
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intended to be used a practical guide for policymakers and program
managers wishing to develop or strengthen a CHW program, drawing lessons from other countries that have implemented CHW programs at-scale. Throughout, we discuss major policy and programmatic issues that decision-makers and planners need to consider when designing, implementing, scaling up or strengthening a national-level CHW program. We offer an overview
of specific challenges CHW programs face, country lessons, tools, and other resources that may be helpful, while incorporating relevant programmatic examples as much as possible.
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The Mtoto Mwerevu Stunting Reduction Toolkit is a resource for government and organisations involved in addressing stunting and broader nutrition issues in Tanzania. The toolkit was developed in conjunction with the Government of Tanzania (GoT) with funding from UK Aid as part of the Addressing Stun
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ting in Tanzania Early (ASTUTE) programme. Its goal is to provide government, donors, non-governmental organisations, and civil society organisations (CSOs) with programming recommendations and tools to help implement successful multi-sectoral social and behaviour change (SBC) interventions aimed at preventing and reducing stunting.
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The purpose of this Guideline is to provide evidence-based recommendations that promote and sustain the undergraduate nursing student’s application of knowledge to practice in a variety of clinical learning environments. The Guideline explores the relationships among and between students and nursi
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ng educators, nursing staff, preceptors, and diverse health-care team members, and it considers their influence on the quality of practice education, professional socialization, and nursing excellence.
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