A renewed focus on primary health care: revitalize or reframe?

Bhatia, Mrigesh; Rifkin, Susan B.

doi:10.1186/1744-8603-6-13

Cited by 29 publications

(21 citation statements)

References 14 publications

(16 reference statements)

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“…We propose that investing effort in producing country- or organisation-specific de novo CPGs (Tier 1) should be questioned in resource-constrained environments. The requisite rigorous evidence-searching required to establish Tier 1 is usually expensive and time-consuming [ 4 , 9 , 21 ]. ‘Recreating the evidence wheel’ (developing a new Tier 1) is inefficient, when information on ‘what to do’ is already available for many conditions, in current high quality CPGs written by experienced CPG developers elsewhere [ 4 – 8 , 12 – 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…There is no central, nationally-recognized and/ or accepted CPG development unit. Given the escalating numbers of South Africans requiring PHC for increasingly complex, comorbid health conditions [ 15 – 19 ], it is imperative that SA PHC providers are conversant with, and able to access and apply, current best evidence to diagnose and care for the patients presenting at PHC facilities [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

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Next generation clinical guidance for primary care in South Africa – credible, consistent and pragmatic

et al. 2018

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BackgroundAgreed international development standards underpin high quality de novo clinical practice guidelines (CPGs). There is however, no international consensus on how high quality CPGs should ‘look’; or on whether high quality CPGs from one country can be viably implemented elsewhere. Writing de novo CPGs is generally resource-intensive and expensive, making this challenging in resource-poor environments. This paper proposes an alternative, efficient method of producing high quality CPGs in such circumstances, using existing CPGs layered by local knowledge, contexts and products.MethodsWe undertook a mixed methods case study in South African (SA) primary healthcare (PHC), building on findings from four independent studies. These comprised an overview of international CPG activities; a rapid literature review on international CPG development practices; critical appraisal of 16 purposively-sampled SA PHC CPGs; and additional interrogation of these CPGs regarding how, why and for whom, they had been produced, and how they ‘looked’.ResultsDespite a common aim to improve SA PHC healthcare practices, the included CPGs had different, unclear and inconsistent production processes, terminology and evidence presentation styles. None aligned with international quality standards. However many included innovative succinct guidance for end-users (which we classified as evidence-based summary recommendations, patient management tools or protocols). We developed a three-tiered model, a checklist and a glossary of common terms, for more efficient future production of better quality, contextually-relevant, locally-implementable SA PHC CPGs. Tier 1 involves transparent synthesis of existing high quality CPG recommendations; Tier 2 reflects local expertise to layer Tier 1 evidence with local contexts; and Tier 3 comprises tailored locally-relevant end-user guidance.ConclusionOur model could be relevant for any resource-poor environment. It should reduce effort and costs in finding and synthesising available research evidence, whilst efficiently focusing scant resources on contextually-relevant evidence-based guidance, and implementation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Next generation clinical guidance for primary care in South Africa – credible, consistent and pragmatic

et al. 2018

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“…Furthermore, public health approaches targeted to a specific condition tend to hinder the development of more comprehensive strategies [23]. Failing to acknowledge and address the wider determinants of health and disease, and to take into account and respond to people's perceived needs, these approaches are likely to be unsuccessful when facing conditions which are multi-causal and have many interdependencies on the socioeconomic, cultural and political side, such as Chagas disease has proved to have.…”

Section: Why In Italy National Screening Might Not Be Enoughmentioning

confidence: 99%

Chagas disease at the crossroad of international migration and public health policies: why a national screening might not be enough

et al. 2011

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Since the year 2000, Chagas disease, traditionally known as a rural Latin American affliction, has been rising in the ranking of international health priorities due to the growing migration flows from endemic areas to non-endemic ones. Using the example of Italy and reporting preliminary results of a study carried out in the district of Bologna, the paper will argue that a disease-centred public health approach might be inadequate when dealing with complex and uncertain situations, in which complete statistical data are not available or not reliable, and in which the involved actors, health professionals on the one side, migrants on the other, appear to be unaware of the issue, or might even be denying it. In such a context, an effective public health approach should be capable of crossing disciplinary boundaries and bridging the gap between health services and communities, as well as between health and social issues.

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“…Canada has a more balanced PHC-specialist physician ratio than the United States of America (USA), with only 10% more secondary health care than the PHC physicians, in contrasts to over 50% more in the USA [4,20]. China is among the countries that inspired the PHC, focusing its attention to the rural health care and the use of local people called "barefoot doctors" locally referred to as community health workers (CHWs) to provide the first line health care [21]. Thailand adopted a "Basic Needs" approach in the 1970s and established a health care system based on an alliance between the government and NGOs that integrated their PHC programs into other development programs [21,22].…”

Section: Introductionmentioning

confidence: 99%

“…China is among the countries that inspired the PHC, focusing its attention to the rural health care and the use of local people called "barefoot doctors" locally referred to as community health workers (CHWs) to provide the first line health care [21]. Thailand adopted a "Basic Needs" approach in the 1970s and established a health care system based on an alliance between the government and NGOs that integrated their PHC programs into other development programs [21,22]. This alliance produced better health outcomes [23].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya

Nshimirimana¹

2016

AJHR

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The low health outcomes and inequities problems in developing countries are due to ineffective gate keeping at the Primary Health Care (PHC) level, non-adherence to policy and dysfunctional health infrastructure. This study was conducted at 100 PHC centres sampled using Taro Yamane formula, in Machakos County, Kenya, from March to May 2015. It involved 8 gender-based focus group discussions (FGDs) with patients and their caretakers. Qualitative and quantitative data were collected from emancipated children and adults aged 15-65 years excluding the disabled due to data integrity issues. The Statistical Package for Social Science (SPSS) version 20.0 and Atlas.ti 7 software were used for data analysis. Correlation was done using the Spearman rho test and significance was set at <0.05. A questionnaire return rate of 83% was achieved of whom 84.3% were nurses (p<0.001) nurses and 15.7% were diploma holders in clinical medicine (clinical officers). The health workers were young (P<0.001) and married (p<0.001). A proportional relationship (rho=0.383, p< .001) existed between the number of outpatients received and cases referred to hospitals. Most gatekeepers were ignorant (p=0.04) about the Policy on the patients' referral yet they did not officially refer patients (80.7%). Most (63.5%) of the hospitals receiving self-referrals did not ask for referral letters. Policy and referral letters were found to be necessary (p=0.004). The gatekeepers' non-adherence to policy, lack of laboratory services and shortages of drugs contributed to self-referral by patients, creating a burden on the resources for healthcare, resulting in inefficiency at the PHC level. This study recommends a review of the gatekeeping system at the PHC level, capacity building, quality assurance, redefinition and strengthening of the office of the gatekeepers, regularization of supplies and reinforcement of the patient referral policy, staff motivation and best practices in customer care.

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A renewed focus on primary health care: revitalize or reframe?

Cited by 29 publications

References 14 publications

Next generation clinical guidance for primary care in South Africa – credible, consistent and pragmatic

Next generation clinical guidance for primary care in South Africa – credible, consistent and pragmatic

Chagas disease at the crossroad of international migration and public health policies: why a national screening might not be enough

Effectiveness of the Devolved Primary Health Care Gatekeeper System in Machakos County, Kenya

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