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2
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
...
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
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
...
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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Modern healthcare has given rise to extremely complex and multifaceted ethical dilemmas. All too often physicians are unprepared to manage these competently. This publication is specifically structured to reinforce and strengthen the ethical mindset and prac
...
tice of physicians and provide tools to find ethical solutions to these dilemmas. It is not a list of “rights and wrongs” but an attempt to sensitise the conscience of the physician, which is the basis for all sound and ethical decision-making. To this end, you will find several case studies in the book, which are intended to foster individual ethical reflection as well as discussion within team settings.
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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
...
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,
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Bioethics - Medical, Ethical and Legal Perspectives
There’s evidence that implementing the four medical ethics principles may be challenging especially in low income country contexts with extreme resource scarcity and limited capacity to facilitate deliberations on the different ethical dilemmas.
...
These challenges can partly be explained by the social, economic, and political contexts in which the decisions are made, as well as the limited time, training and guidance to facilitate ethical decision making. Based on current literature, and using the example of bedside rationing; this chapter synthesizes the challenges clinicians face when operationalizing the four principle; identifying the opportunities to address them. We suggest that clinicians’ ability to implement the four principles are constrained by meso‐ and macro‐level decision making as well as their lack of training, explicit guidelines, and peer support. To ameliorate this situation, current efforts to strengthen the clinicians’ capacity to make ethical decisions should be complimented with developing of context relevant guidelines for ethical clinical decision making. The renewed global commitment to the sustainable development goals and universal healthcare coverage should be recognized as an opportunity to leverage resources and champion the integration of equity and justice as a core value in resource allocation at the bedside, meso-, macro- and global levels.
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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
The humanitarian situation in the Central African Republic (CAR) has further worsened over the past six months. Election-related violence that broke out in mid-December 2020 has had a devastating effect on civilians. Thousands of people have been forced to flee, human rights violations have surged,
...
hundreds of schools and dozens of hospitals have been forcibly closed and food prices have skyrocketed. This deterioration occurred in an already alarming context, with more than half of the population (2.8 million people) in need of humanitarian assistance and protection and 1.9 million people in acute need. In the past five years, there have never been as many people in humanitarian distress in CAR as today.
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This unit is written so that you will have the opportunity to learn from mistakes.The unit will take you on a journey of personal stress management, one step at a time
Each lesson covers a number of topics and provides various activities for you to complete. In Lesson 1, you will learn about what s
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tress is and its effects on your health and behaviour. In the next lesson, you will learn to recognise signs and symptoms of stress. Lessons 3 will outline I’ve been a caregiver for 12 years. I have passed through thick and thin. In the process, I think, I’ve destroyed myself—and perhaps people and things I care about. I wish someone had talked to me about it long ago. I wish I had asked them for help.
2ObjectivesCounselling for Caregivers the causes of stress, and Lessons 4 and 5 will discuss strategies for coping with stress for caregivers and for children, respectively. The unit also contains some important questions and activities, which can help you acquire understanding and knowledge that will enable you to develop positive, healthy ways of coping with stress in your life. You can complete this unit successfully. Enjoy your journey!
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This booklet is intended to heighten awareness of the mental health needs of nurses and provide useful exercises to assist nurses to manage stress at work.
This book is not designed to be a substitute for professional advice. It should be used in conjunction with specific health advice from your he
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alth care provider.
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Operating Department Practice - Clinical Pocket Reference - for nurses, students and other healthcare professionals - third edition,
supplemantary material Available from
www.clinicalpocketreference.com
ISBN: 978 1 908725 10 3
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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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.
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.
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Midwifery Capacity Building Strategy for Northern Syria
2017-2021
Available in Arabic
Anywhere But Syria: How 10 Years of Conflict Left Syria’s Displaced Children Without a Sense of Home
After ten years of war, the vast majority of Syria’s children cannot imagine a future in their country, according to a new report by Save the Children. On average, 86% of Syrian refugee children surveyed in Jordan, Lebanon, Turkey and the Netherlands said they would not want to return to their cou
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ntry of origin. Of children displaced inside Syria, one in three would rather be living in another country. Children who fled their homes are struggling to feel safe where they are now, as around two in five children of those surveyed by Save the Children said they face discrimination and a lack of education. Many feel they have no say over their future.
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The figures and findings reflected in the 2020 PMR represent the independent analysis of the United Nations (UN) and its humanitarian partners based on information available to them. Many of the figures provided throughout the document are estimates based on sometimes incomplete and partial data set
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s using the methodologies for collection that were available at the time. The Government of Syria has expressed its reservations over the data sources and methodology of assessments used to inform the 2020 Humanitarian Needs Overview (HNO) as well as on a number of HNO findings reflected in the 2020 HRP. This applies throughout the document.
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The aim of the SATG was to produce a triage scale for use throughout South Africa. The group was multi-disciplinary and comprised doctors, nurses and paramedics. The result of the SATG’s activities is the South African Triage Scale (SATS), a physiology and symptom based scale which prioritises int
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o one of four colours and can be used in hospital Emergency Centres as well as in the pre-hospital setting. The SATS has been validated in the public, private health care setting as well as pre-hospital.
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For the purpose of this document, Interprofessional is defined as: Multiple health disciplines with diverse knowledge and skills who share an integrated set of goals and who utilize interdependent collaboration that involves communication, sharing of knowledge and coordination of services to provide
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services to patients/clients and their care-giving systems. This best practice guideline, Developing and Sustaining Interprofessional Health Care: Optimizing patients/clients, organizational, and system outcomes is intended to foster healthy work environments. The focus in developing this guideline was identifying attributes of interprofessional care that will optimize quality outcomes for patients/clients, providers, teams, the organization and the system. This guideline identifies best practices to enable, enhance and sustain teamwork and interprofessional collaboration, and to enhance positive outcomes for patients/clients, systems and organizations. It is based on the best available evidence; where evidence was limited, the recommendations were based on the consensus of expert opinion.
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