The rising importance of family medicine

Keynote address at the 2013 World Congress of the World Organization of Family Doctors.

Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care.

The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is high in low-income and middle-income countries and is predicted to increase with the ageing of populations, urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is increasingly becoming a chronic disorder. An integrated approach to the management of chronic diseases, irrespective of cause, is needed in primary health care. Management of chronic diseases is fundamentally different from acute care, relying on several features: opportunistic case finding for assessment of risk factors, detection of early disease, and identification of high risk status; a combination of pharmacological and psychosocial interventions, often in a stepped-care fashion; and long-term follow-up with regular monitoring and promotion of adherence to treatment. To meet the challenge of chronic diseases, primary health care will have to be strengthened substantially. In the many countries with shortages of primary-care doctors, non-physician clinicians will have a ...

Primary health care: making Alma-Ata a reality

The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then. “Health for all” by the year 2000 was not achieved, and the Millennium Development Goals (MDGs) for 2015 will not be met in most low-income countries without substantial acceleration of primary health care. Factors have included insufficient political prioritisation of health, structural adjustment policies, poor governance, population growth, inadequate health systems, and scarce research and assessment on primary health care. We propose the following priorities for revitalising primary health care. Health-service infrastructure, including human resources and essential drugs, needs strengthening, and user fees should be removed for primary health-care services to improve use. A continuum of care for maternal, newborn, and child health services, including family planning, is needed. Evidence-based, integrated packages of community and primary curative and preventive care should be adapted to country contexts, assessed, and scaled up. Community participation and ...

Policy relevant determinants of health: an international perspective

Background: International comparisons can provide clues to understanding some of the important policy-related determinants of health, including those related to the provision of health care services. An earlier study indicated that the strength of the primary care infrastructure of a health services system might be related to overall costs of health services. The purpose of the current research was to determine the robustness of the findings in the light of the passage of 5–10 years, the addition of two more countries, and the findings of other research on the possible importance of other determinants of country health levels. Methods: Thirteen industrialized countries, all with populations of at least 5 million, were characterized by the relative strength of their primary care infrastructure, the degree of national income inequality, and a major manifestation of a behavioral determinant of health that is amenable to policy intervention (smoking), using international data sets and ...

Integrated health service delivery networks: concepts, policy options and a road map for implementation in the Americas

Health systems in the Americas are characterized by highly fragmented health services. Experience to date demonstrates that excessive fragmentation leads to difficulties in access to services, delivery of services of poor technical quality, irrational and inefficient use of available resources, unnecessary increases in production costs, and low user satisfaction with services received. (...) The region is home to several good practices in the creation of Integrated Health Service Delivery Networks (IHSDNs), especially in countries like Brazil, Canada, Chile, Costa Rica and Cuba, which have traditionally supported the development of networks. Other countries in Latin America and the Caribbean are adopting similar policies to organize their health services. Despite these efforts, addressing fragmentation and providing more equitable, comprehensive, integrated, and continuous health services remain significant challenges for the majority of countries in the Americas.

World health report 2008: primary health care; now more than ever

Why a renewal of primary health care (PHC), and why now, more than ever? Globalization is putting the social cohesion of many countries under stress, and health systems are clearly not performing as well as they could and should. People are increasingly impatient with the inability of health services to deliver. Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. PHC can do that.

Declaration of Alma-Ata

The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, hereby makes the following Declaration.

Ouagadougou declaration on primary health care and health systems in Africa: achieving better health for Africa in the new millennium

The International Conference on Primary Health Care and Health Systems in Africa, meeting in Ouagadougou, Burkina Faso, from 28 to 30 April 2008, reaffirms the principles of the Declaration of Alma-Ata of September 1978, particularly in regard to health as a fundamental human right and the responsibility that governments have for the health of their people. Having analysed the experience of Primary Health Care implementation in the countries of Africa in the last 30 years, the Conference expresses the need for accelerated action by African governments, partners and communities to improve health; the Conference, also reaffirming the importance of the involvement, participation and empowerment of communities in health development in order to improve their well-being; and recognizing the importance of a concerted partnership, in particular, civil society, private sector and development partners to translate commitments into action; hereby makes the following Declaration.

Resolution CD49. R22. Integrated health service delivery networks based on primary health care.

-

Evaluation of health care delivery integration: The case of the Russian Federation

This case study explores the current state of affairs within Russia's health system providing care for increasingly complex chronic conditions from the perspective of providers, namely physicians. A survey was developed by a group of experts and later distributed by the Russian center for public opinion research in August 2012. It focused on the interactions between providers at different levels of the health system often working in different organizational models such as primary care offices, polyspecialty clinics as well as hospitals. The survey focused on three areas crucial to integration, namely: teamwork, coordination and continuity of care. The results from the survey showed that the level of integration was low by nearly every measure across the different levels of the health system. The authors note that little emphasis has been placed on this issue since the 60/70's "when quite a lot of regulation was issued on district ...

Joining Up Care Where We Live

Joining Up Care Where We Live

The MDG To SDG Transition: the role of hospitals and integrated primary care.

In 2016, the world will be moving from the Millenium Development Goals (MDG) to the Sustainable Development Goals (SDG). Regarding health-related goals, most of the funding in recent years has been focusing on disease-specific programmes and strengthening primary care; nevertheless, public health, health promotion, prevention, and controlling risk factors through a broad range of policy interventions, both within and outside the health sector, must be an important focus in the era of SDGs.

In this post, integrated health services are seen as a main factor to achieve the health-related topics in the SDGs. The author defends not only strong primary care services to deliver broad quality care, but also that these services should be integrated with essential hospital services. The article emphasizes that this kind of integration would be even more important in countries with a weak health system, in order to build a strong system that could face the ...

Primary Care guideline for adults Western Cape, South Africa

The Knowledge Translation Unit (“KTU”) is a clinical research unit within the University of Cape Town Lung Institute (“UCTLI”) which has spent 15 years developing the Practical Approach to Care Kit (“PACK programme”) to support and empower nurses, doctors and other health workers working in primary healthcare.

PACK Adult is a comprehensive clinical practice guideline that aims at equipping nurses and other clinicians to diagnose and manage common adult conditions at primary level. The starting point is any of 40 common symptoms, each of which provides the opportunity to identify one or more of 20 important chronic conditions in the second half of the guideline. These include infectious diseases, chronic respiratory diseases, cardiovascular risk, hypertension and diabetes, mental health conditions, musculoskeletal disorders, epilepsy and women’s health. See sample pages and contents pages below.

BMJ has partnered with the KTU to make the PACK programme available to assist in improving ...

Primary Care guideline for adults Western Cape, South Africa

The Knowledge Translation Unit (“KTU”) is a clinical research unit within the University of Cape Town Lung Institute (“UCTLI”) which has spent 15 years developing the Practical Approach to Care Kit (“PACK programme”) to support and empower nurses, doctors and other health workers working in primary healthcare.

PACK Adult is a comprehensive clinical practice guideline that aims at equipping nurses and other clinicians to diagnose and manage common adult conditions at primary level. The starting point is any of 40 common symptoms, each of which provides the opportunity to identify one or more of 20 important chronic conditions in the second half of the guideline. These include infectious diseases, chronic respiratory diseases, cardiovascular risk, hypertension and diabetes, mental health conditions, musculoskeletal disorders, epilepsy and women’s health. See sample pages and contents pages below.

BMJ has partnered with the KTU to make the PACK programme available to assist in improving ...

A strategic approach to Reproductive, Maternal, Newborn, Child and Adolescent health (RMNCH+A) in India

India’s National Rural Health Mission (NRHM) launched its RMNCH+A approach in 2013, which essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages. Priority interventions for each thematic area have been included in this to ensure that the linkages between them are contextualized to the same and consecutive life stage. It also introduces new initiatives like the use of Score Card to track the performance, National Iron + Initiative to address the issue of anemia across all age groups and the Comprehensive Screening and Early interventions for defects at birth , diseases and deficiencies among children and adolescents. The RMNCH+A appropriately directs the States to focus their efforts on ...

New primary care model yielding early results

Several ways of shaping primary care are being developed all around the world. Improving the role of nurses or giving general practitioners new competences are just a couple of ways of moving primary care towards a more comprehensive way of working.

In this post in the NHS Confederation Blog, some of the initiatives performed to change primary care are explained and some of the challenges that future primary care will face are listed.

One of the main points outstanded is the need of integrating care and workforce from different levels of health care. As it is said in this post “Patients will benefit from easy access to a single integrated, multidisciplinary team drawn from a wide range of health and social care professionals”

Developing care for a changing population: Learning from GP-led organisations

The way a health system is organized may influence the care this system provides. In this Nuffield Trust report some GP-led experiences are described, analyzing what are the internal characteristics and external context that have affected GP-led progress.

The intra-organizational characteristics listed are: (I) strong links between clinical leaders and GP member practices, (II) sophisticated strategic and operational management support, (III) use of multiple forms of peer-led improvement, (IV) organizations are both entrepeneurial and pragmatic, (V) linked data between the organization’s own services and other providers.

In what concerns to external context, the three characteristics listed are: (I) a receptive context for change, (II) capability to transfer some of the commissioner role to providers through capitated budgets, (III) slow pace and short-term nature of decision-making.

The slow pace and short-term nature of decision-making in clinical commissioning groups may drive emerging organisations to focus on service developments outside of their ...

Reshaping the workforce to deliver the care patients need

Workforce structure is one of the most difficult things to modulate in health systems. Current transition to new models of care could be a good opportunity to make workforce structure match actual needs of systems and populations. In this report, published by the Nuffield Trust, it is analyzed how organizations could reshape their current workforce and what the benefits would be:

There is a need to evolve from an illness-based system to a patient-centred system.
Workforce should meet future needs by incorporating professionals with a vision aligned with future models of care.
There are opportunities to develop the current workforce at all grades: from redeploying support staff, extending the skills of registered professionals and training advanced practitioners.
There is good evidence that support workers can provide good-quality, patient-focused care as well as reduce the workload of more highly qualified staff. Investment here could provide a cost-effective and rapid solution to ...

Understanding pressures in general practice

“General practice is in crisis”; that is how this King’s Fund report start its analysis, pointing to funding and workforce as two of the main problems in general practice situation. Increasing needs and complexity, trends of moving patients from hospital to communities and rising expectations in population act as factors that increase pressures in general practice.

This report identifies some immediate priorities and some future challenges in order to protect general practice and to make it can face future needs.

Immediate priorities would be: (I) providing practical support to practices, (II) accelerating the uptake of technologies that can help practice deal with growing pressures more effectively, (III) encouraging reshaping of workforce in primary care, (IV) reducing bureaucratic burdens, (V) placing primary care at the heart of sustainability and transformation plans, (VI) supporting patients to use health services appropriately.
Long-term challenges pointed by this report are: (I) solving deficiencies in ...

No universal health coverage without primary health care

Correspondance

Universal health coverage is currently the aspiration of many countries worldwide. We commend Michael Reich and colleagues for analysing lessons learned from different country experiences, but we believe there is a crucial element neglected within the ongoing universal health coverage debate.

Health-care system development requires more than financing and human resource considerations. Although essential, these components must be integrated into an overall framework for organising and delivering care that best meets population needs. Primary health care provides such a framework, builds the backbone of an effective health-care system, and can improve health, reduce growth in costs, and lower inequality^. Strong orientation towards primary health care and its core principles (often outlined as first contact, continuous, comprehensive, and coordinated care) is shown to be stable over time and was often incorporated in the early days of many health-care systems that have a strong primary health-care orientation today. This observed stability ...

The creative potential of health work to develop an integrated care model in Brazilian primary health care  

In November 2015, at the 3rd World Congress on Integrated Care and 8th National Congress of Integrated Medicine, “Co-producing High Quality People-Centered Integrated Care for ALL”, Debora Santos presented her PhD research on primary health care teams in Alagoas, the most unequal state in Brazil. According to Debora Santos, while Brazil's Unified Health System (SUS) is headed by principles of integrated care, in practice a biomedical conception of health typically prevails instead of one focused on integrated care. Therefore, the objective of her research was to identify potential ways to develop an integrated care model of primary health care focused on the principles of social health rights, integrated access, equity, team work and health promotion. Through focus groups and interviews with primary health care teams she identified several challenges and potentialities for integrated care. For example,  the teams faced both objective (clinical) and subjective (emotional) needs but had limited ...

Can hospital services work in primary care settings?

In this post, the author analyzes how recent changes in primary care in the National Health Services could face the purpose of moving some services from hospital to primary care settings.

The author bases her discussion on a report published by RAND corporation (“Outpatient Services and Primary Care”) that identifies five main areas to be considered when moving services from hospital to primary care:

1. Transfer: The substitution of services delivered by specialists for services delivered by primary care clinicians.
2. Relocation: Shifting the venue of specialist care from hospitals to primary care settings.
3. Liaison: Joint working between specialists and primary care clinicians to provide care to individual patients.
4. Professional behaviour change: Changing the way GPs refer patients to specialists.
5. Patient behaviour change: Helping patients make informed decisions about their care.

There is not a unique way of moving these services; many studies suggest that patients’ satisfaction usually grows when services are ...

CMMI’s New Comprehensive Primary Care Plus: Its Promise And Missed Opportunities

The Center for Medicare and Medicaid Innovation (CMMI) has recently announced an initiative called Comprehensive Primary Care Plus (CPC+), evolved from the previous Comprehensive Primary Care (CPP) initiative. The initiative mainly consists on paying a fee to those primary care practices willing to introduce organizational changes centered in five primary care functions:  (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and, (5) planned care and population health.

In this post, the authors outline some of the promises and downsides of the PCC+. On the bright side, the authors analyse how financial incentives can make primary care practices introduce innovations that may lead to improvements in the quality of their clinical performance. On the other side, two main downsides are mentioned: (I) the lack of incentives to achieve good results in the care that takes place beyond the primary care services -hospital admissions ...

Break the Cycle of Violence: A Miami-Area Community Drives Change

Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was held in May 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health.

One highlight of the meeting was interviewing community collaborations funded by The BUILD Health Challenge. The BUILD Health Challenge is a national awards program designed to support community collaborations that are working to give everyone a fair chance to be healthy.

Overview

The Liberty City Community Collaborative for Change targets a Miami-area community that is characterized by poverty, lack of food access, low educational attainment levels, and violence, including disproportionately high rates of physical, sexual, and child abuse. These attributes lead to trauma, chronic stress, and mental and physical health outcomes, such as depression, anxiety, substance abuse, sleeping disorders, high blood pressure, and strokes. 

About the Practical Playbook National Meeting

Key stakeholders from across sectors – representing professional associations, community ...

Break the Cycle of Violence: A Miami-Area Community Drives Change

Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was held in May 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health.

One highlight of the meeting was interviewing community collaborations funded by The BUILD Health Challenge. The BUILD Health Challenge is a national awards program designed to support community collaborations that are working to give everyone a fair chance to be healthy.

Overview

The Liberty City Community Collaborative for Change targets a Miami-area community that is characterized by poverty, lack of food access, low educational attainment levels, and violence, including disproportionately high rates of physical, sexual, and child abuse. These attributes lead to trauma, chronic stress, and mental and physical health outcomes, such as depression, anxiety, substance abuse, sleeping disorders, high blood pressure, and strokes. 

About the Practical Playbook National Meeting

Key stakeholders from across sectors – representing professional associations, community ...

Healthy China : deepening health reform in China building high-quality and value-based service delivery

As many other countries, China faces big challenges to meet the health care needs of her citizens, associated with a rapidly aging society and increasing burden of non-communicable diseases (NCDs). Also, health costs have been growing at a rate higher than GDP growth since 2008.

Since the launch of health reform in 2009, China has invested significantly in health infrastructure at the grassroots level and made progress in building the primary care doctors system. Basic public health services capacity has been significantly enhanced. China is progressing quickly to achieving universal health coverage and some of the reform achievements have attracted worldwide attention.

The reform commanded many innovative pilots in health financing and service delivery at the local level and provided a strong foundation for the next stage of reform. This report aim to support China during this reform phase by recommending 8 sets of strategic reform directions, referred to as ...

Self-perception of leadership styles and behaviour in primary health care

The concept of leadership has been studied in various disciplines and from different theoretical approaches. 

In the primary health care (PHC) setting, managers´leadership style is defined as a set of acttitudes, behaviours, beliefs and values. The objetives of this study were to describe and learn about the self-perception of behaviours and leadership style among PHC managers; to determine the influence of the leadership style on job satisfaction, efficiency and willingness to work in a team; and to determine the relationship between transformational and transactional styles according age, gender, profession and the type of organization. 

Strengthening the model of primary health care in Estonia (2016)

Patient-Centered Care and People-Centered Health Systems in Sub-Saharan Africa: Why So Little of Something So Badly Needed?

Patient–centered care (PCC) is increasingly recognized as a key dimension of quality healthcare, but unfortunately remains poorly implemented in practice. This paper explores the current state of PCC in sub-Saharan Africa and potential barriers to its implementation, with a focus on public first line health services. They develop an analytical framework based on expert knowledge, field experience, and a conceptual literature review. Factors contributing to the (lack of) implementation of PCC are structured in three distinct but interacting layers. The first layer encompasses factors that influence and shape the performance of providers.  The training of health workers is key in that respect. Training models remain dominated by a biomedical perspective, with little attention for psychosocial dimensions of the illness experience. The second layer of determinants relates to the structural and organizational features of the health system. The emphasis in many African health care systems on specific programmatic outputs, and ...

Integrating primary care providers in the care of cancer survivors: gaps in evidence and future opportunities

Since the release of the Institute of Medicine report: From cancer patient to cancer survivor: lost in transition, in 2005, there has been a national call in the USA to provide coordinated, comprehensive care for cancer survivors, with an emphasis on the role of primary care. Several models of care have been described, which focus on primary care providers (PCPs) as receiving cancer survivors who are transferred after successful treatment, and who are given specific types of information from oncology-based care (eg, survivorship care plans), and not as active members of the cancer survivorship team. They provide recommendations for education, clinical practice, research, and policy initiatives that might advance the integration of PCPs in the care of cancer survivors in diverse clinical settings.

User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits.

Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits.

OBJECTIVE:

Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization.

METHODS:

We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care providers, followed by three design sessions with a 12-patient group. We audiorecorded and transcribed all discussions and categorized major themes. In addition, we met with 15 key health communication, education, and technology leaders within our health system to further review the design and plan for broader implementation of the tool ...

Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic  diseases. International evidence suggest that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA. 

Feasibility of an implementation strategy for the integration of health promotion in routine primary care: a quantitative process evaluation

Process evaluation is recommended to improve the understanding of underlying mechanisms related to clinicians, patients, contect and intervention delivery that may impact on trial or program results, feasibility and transferability to practice. The aim of this study was to assess the feasibility of the Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable") implementation strategy for enhancing the adoption and implementation of an evidence-based health promotion intervention in primary health care. 

Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia

The terms integration and integrated care describe the complex, patient-centred strategies to improve coordination of healthcare services. Frameworks exist to conceptualise these terms, but these have been developed from a professional viewpoint. 

The objetive of this study was to explore consumers and provider´s concepts, expectations and experience of integrated care. A key focus was whether frameworks developed from a professional perspective are effective models to explore people´s experiences. 

Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care

This study analysed the clinical impact of a home-based intermediate Care model in the Catalan health system, comparing it with usual bed-based care to check if the extended CGA-based hospital-at-home programme has an association with shorter stay and favourable clinical outcomes and if is needed to do studies to test this intervention to the whole Catalan integrated care system. 

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to strengthen African health systems in order to address communicable and non-communicable diseases. The aim of this study was to assess the position of civil society-led community unity home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demands arise. 

The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review

A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispending pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success. This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care. 

Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees

Social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services. In many countries, health facility committees (HFCs) provide the accountability interface between health providers and citizens or users of health services. This article explores the social accountability practices facilitated by HFCs in Benin, Guinea and the Democratic Republic of Congo. 

Managing multimorbidity: profiles of integrated care approaches targeting people with multiple chronic conditions in Europe

In response to the growing populations of people with multiple chronic deseases, new models of care are currently being developed in European countries to better meet the needs of these people. This paper aims to describe the occurrence and characteristics of various types of ntegrated care practices in European countries that target people with multimorbidity.

Using Information Communication Technology in Models of Integrated Community-Based Primary Health Care: Exploring ICT in the iCOACH Study

Information and communication technology (ICT) is a promising enabler to support delivery of integrated care by inter-disciplinary teams by supporting information sharing across professional and  organizational boundaries; arguably a crucial aspect of successful models of integrated care

The perceived impact of family physicians on the district health system in South Africa: a cross-sectional survey

The 2008 World Health Report "Primary Health Care-Now More Than Ever" defines strong Primary Health Care (PHC) systems as those systems which offer first contact care that is patient-centred with an orientation to the patient´s family and community context, embedded in a service that is comprehensive, integrated, continuos, and community-orientated, and in which patient-care is well co-ordinated. This report warned against oversimplified approaches to PHC in developing countries, which only focus on priority deseases or rely on unsupported health workers who are poorly equipped for the complexity of PHC. The World Health Assembly supports the report´s recommendation that PHC should be offered by a multidisciplinary team that includes a family physician. 

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to stregthen African health systems in order to address communicable and non-communicable diseases. The aim of this article was to assess the position of civil society-led community home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demand arise. 

Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation

Policy analysis on why women and children in low- and middle- income settings are still disadvantaged by access to appropiate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street- level bureaucracy theory, this article explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana´s community-based PHC implementation to the disadvantage of women and children accessing and using health services. 

Strategy for revitalization of the primary health care in Cuba

Despite the existence of an integrated model of health systems and services, the research conducted in the areas of management, support, health services and finances show some phenomena that weaken the capacity of responding to the population's health requirements, particularly the first care level. The range of possibilities offered by the transforming process in the health sector encourages putting forward a revitalizing strategy centered on the capacity and need of innovating and further developing the Cuban primary health care strategy. The bases supporting the proposal, the objectives and the strategic areas of development were presented, with the focus on revitalizing the capacities of the health care system to articulate an effective, sustainable and integrated strategy. Such strategy may respond to the existing problems and meet the new health challenges to guarantee access, equity and sustained quality in health services.

Authors: MSc. Pedro López Puig, MSc. Alina María ...

Characteristics of Indigenous primary health care service delivery models: a systematic scoping review

Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The experience of colonisation, and the long-term effects of being colonised, has caused inequalities in Indigenous health status, including physical, social, emotional, and mental health and wellbeing. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. 

Primary health services at district level in South Africa: a critique of the primary health care approach

The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite, South Africa´s progress and attempts at implementing primary health care, various factors still limit its success.

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries

Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. This paper describes and analyse the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC

Coordinating Mental and Physical Health Care in Rural Australia: An Integrated Model for Primary Care Settings

The "GP Clinic" providers primary health care to people using community mental health services in a small town in Australia. This article examines the factors that have driven successful integration in this rural location. Integrated physical and mental health service models that focus on building local service provider relationships and are responsive to community needs and outcomes may be more beneficial in rural settings than top down approaches that focus on policies, formal structures, and governance. 

Vertical integrated service model: an educational intervention for chronic disease management and its effects in rural China – a study protocol

Chronic diseases are becoming a huge threat to the Chinese health system. Although the New Round of Medical Reform aims to improve this, the chronic disease management in rural China is still worrying as it relies highly on hospital care instead of primary care. The vertical integrated care model has proven to be effective for chronic disease patients in many high-income countries, while few studies have been conducted in China. In this project, vertical integrated care will be applied to optimize the care of patients with type 2 diabetes mellitus (T2DM) and primary hypertension in rural China, and to shift the care from hospital to primary care.

Implementation and clinical effectiveness of a community-based non-communicable disease treatment programme in rural Mexico: a difference-in-differences analysis

Non-communicable diseases (NCDs) account for the five largest contributors to burden of disease in Mexico, with diabetes representing the greatest contributor. However, evidence supporting chronic disease programmes in Mexico is limited, especially in rural communities. Compañeros En Salud (CES) partnered with the Secretariat of Health of Chiapas, Mexico to implement a novel community-based NCD treatment programme. This article describe the implementation of this programme and conducted a population-based, retrospective analysis, using a difference-in-differences regression approach to estimate the impact of the programme

Strengthening decentralized primary healthcare planning in Nigeria using a quality improvement model: how contexts and actors affect implementation

Quality improvement models have been applied across various levels of health systems with varying success leading to scepticisms about effectiveness. Health systems are complex, influenced by contexts and characterized by numerous interests. Thus, a shift in focus from examining whether improvement models work, to understanding why, when and where they work most effectively is essential

Designing a framework for primary health care research in Canada: a scoping literature review

Despite significant investments to improve primary health care (PHC) delivery in Canada, provincial health care systems remain fragmented and uncoordinated. Canada’s commitment to strengthening PHC should be driven by robust research and evaluation that reflects our health policy priorities and responds to the needs of the population. One challenge facing health services researchers is developing and sustaining meaningful research priorities and agendas in an overburdened, complex health care system with limited capacity for PHC research and support for clinician researchers.

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries.

Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available.
This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC.

Community Health Worker Programs to Improve Healthcare Access and Equity: Are They Only Relevant to Low- and Middle-Income Countries?

Community Health Workers (CHWs) are proven to be highly effective in low- and middle-income countries with many examples of successful large-scale programs. There is growing interest in deploying CHW programs in high-income countries to address inequity in healthcare access and outcomes amongst population groups facing disadvantage. This study is the first that examines the scope and potential value of CHW programs in Australia and the challenges involved in integrating CHWs into the health system. The potential for CHWs to improve health equity is explored.

Towards universal health coverage and sustainable financing in Afghanistan: progress and challenges

Afghanistan has made impressive progress in introducing primary health care across the country over the last fifteen years. In the face of the diverse challenges ranging from persistent insecurity, conservative social norms, weak public financing, and reducing donor aid, Afghanistan is arguably among one of the most challenging contexts to achieve universal health coverage (UHC). Therefore, it is important to consider additional avenues towards UHC while building on the progress in coverage and financing of primary health care to date.
The right to health is considered a fundamental human right and UHC has gained prominence globally as a goal for countries in the Sustainable Development Goals (SDGs). UHC is defined by the World Health Organization (WHO) as: “access to key promotive, preventive, curative and rehabilitative health
interventions for all at an affordable cost, thereby achieving equity in access.

How Equity-Oriented Health Care Affects Health: Key Mechanisms and Implications for Primary Health Care Practice and Policy

Significant attention has been directed toward addressing health inequities at the population health and systems levels, yet little progress has been made in identifying approaches to reduce health inequities through clinical care, particularly in a primary health care context. Although the provision of equity?oriented health care (EOHC) is widely assumed to lead to improvements in patients’ health outcomes, little empirical evidence supports this claim. To remedy this, this study tested whether more EOHC predicts more positive patient health outcomes and identified selected mediators of this relationship

WHO European High-level Conference on Noncommunicable Diseases “Achieving Sustainable Development Goal targets in the WHO European Region through prevention and management of noncommunicable diseases over the life-course”

The year 2018 witnessed incredible global mobilization for the prevention and management of noncommunicable diseases (NCDs). Member States, WHO and partners expanded their commitments and the scope of their work to achieve ambitious targets. The third United Nations high-level meeting on NCDs and a series of high-level international meetings and conferences on the health system response to NCDs, primary health care, global mental health and air pollution will serve as context and background for the WHO European High-level Conference on Noncommunicable Diseases. The event will take place in Ashgabat, Turkmenistan, on 9–10 April 2019.

Continuity of care and referral rate: challenges for the future of health care

Continuity of care could reduce health care consumption by patients and reduce the number of referrals to specialist care, but it is unknown if there is a difference in referral rates to specific medical specialties. The aim was to determine the relationship between continuity of care and both the referral rate (referrals per patient per year) and the medical specialties for which this relationship was strongest.

Community health extension program of Ethiopia, 2003–2018: successes and challenges toward universal coverage for primary healthcare services

The Alma-Ata Declaration of 1978 identified primary health care (PHC) as the key approach to the attainment of the goal of “Health for All”. The PHC approach tackles the main health problems in the community through the provision of essential health services. The implementation of the PHC approach relies on health workers, including community health workers (CHWs) Ethiopia has been implementing a community health extension program (HEP) since 2003. The aim of this studya was to assess the successes and challenges of the HEP over time, and develop a framework that may assist the implementation of the program toward universal primary healthcare services

Public health law coverage in support of the health-related sustainable development goals (SDGs) among 33 Western Pacific countries

A resilient health system is inevitable in attaining the health-related Sustainable Development Goals (SDGs). One way of strengthening health systems is improving the coverage of public health laws for better health governance. The aim of this study is to describe the public health law situation in the Western Pacific Region and analyse the association of public health law coverage with health-related SDGs statistics.

Continuity of care and referral rate: challenges for the future of health care

As health care costs rise, an increasingly greater proportion of the gross domestic product is spent on health care. In this context, Continuity of care could reduce health care consumption by patients and reduce the number of referrals to specialist care, but it is unknown if there is a difference in referral rates to specific medical specialties.

The aim of this study was to determine the relationship between continuity of care and both the referral rate (referrals per patient per year) and the medical specialties for which this relationship was strongest.

Impact of health care reform on enrolment of immigrants in primary care in Ontario, Canada

Health is driven by the conditions in which people live and work. Immigrant populations face many challenges and disruptions in living conditions during their settlement process, including the loss of regular health services. Establishing a direct relationship with a family physician is an important aspect of the settlement process for immigrant populations

In 2003, Ontario introduced a patient enrolment system as part of health care reforms, aimed at enhancing primary health care services, but it is unclear whether immigrants have benefited from this health care reform. Therefore, this article studied whether this reform changed the extent of immigrants’ enrolment in primary care services in Ontario between 2003 and 2012.

What is Important to Older People with Multimorbidity and Their Caregivers? Identifying Attributes of Person Centered Care from the User Perspective

Health systems are striving to design and deliver care that is ‘person centered’—aligned with the needs and preferences of those receiving it; however, it is unclear what older people and their caregivers value in their care. This paper captures attributes of care that are important to older people and their caregivers.

The core components of Community Paramedicine – integrated care in primary care setting: a scoping review

Since the beginning of 2000, the primary healthcare services around the globe are challenged between demands of home care and number of staff delivering it. The delivery of healthcare needs new models to reduce the costs, patient's readmission and increase their possibilities to stay at home. Several paramedicine programmes have been developed to deliver home care as an integral part of the local healthcare system. The programmes varied in nature and the concept of Community Paramedicine (CP) has not been established, demanding clarity. The aim of this review was to identify and describe the core components of CP, and identify research gaps for the further study.

A qualitative appraisal of stakeholders’ perspectives of a community-based primary health care program in rural Ghana

The Ghana Community-based Health Planning and Services (CHPS) initiative is a national strategy for improving access to primary health care services for underserved communities. Following a successful trial in the North Eastern part of the country, CHPS was adopted as Ghana’s flagship programme for achieving the Universal Health Coverage. Recent empirical evidence suggests, however, that scale-up of CHPS has not necessarily replicated the successes of the pilot study. This study examines the community’s perspective of the performance of CHPS and how the scale up could potentially align with the original experimental study.

Primary Health Care: The Engine to Universal Health Coverage

The Global Conference on Primary Health Care hosted in Astana, Kazakhstan, in October 2018, renewed the core principles included in Alma Ata Declaration in 1978, emphasizing the essential role of primary health care (PHC) around the world. The Declaration of Astana focused on primary health care to ensure that everyone everywhere is able to achieve a good standard of health.

On 23 September 2019, the United Nations General Assembly held a high-level meeting on universal health coverage.  This meeting, held under the theme “Universal Health Coverage: Moving Together to Build a Healthier World,” identifies primary health care as the route to universal health coverage (UHC).

UHC shouldn´t be a luxury that only high-income countries can afford. However, it needs some levers that must be strengthened everywhere. One of the most important ways to achieve UHC is to prioritize PHC as a crucial strategy in health systems. PHC is the ...

Model for integrated care for chronic disease in the Australian context: Western Sydney Integrated Care Program.

The aim of this study was to describe the implementation of a model of integrated care for chronic disease in Western Sydney. This model was established on the basis of a partnership between the Local Health District and the Primary Health Network.

Thinking outside the system: the integrated care experience in Queensland, Australia

Health policy-makers are faced with a demand for health care that exceeds supply, driven in part by an ageing population and an increased prevalence of chronic disease. An integrated ‘people-centred’ model of care across primary, secondary and tertiary health care can strengthen the health system by streamlining services to improve the patient journey and outcomes.

The spirit of the declaration of Astana 

In 1978, a pivotal conference was held in Almaty, Kazakhstan, bringing together health experts and world leaders to commit to health for all. The Declaration of Alma-Ata, endorsed at that conference, formed the foundation for the last 40 years of global primary health care efforts.

Implementing Integrated Community-Based Primary Healthcare: Applying the iCoach-Approach to Case Selection to Denmark

The iCoach approach to case selection focuses on innovative models of community-based primary healthcare (CBPHC) and their contexts. The aim of this study was to assess the possibilities and limitations of the approach based on Denmark, which differs in significant ways from the jurisdictions initially included.

Implementation of Off-Site Integrated Care for Children: A Scoping Review.

As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. The goal of this study was to review the existing literature on implementing off-site pediatric integrated care

Evaluation of the primary care for chronic diseases in the high coverage context of the Family Health Strategy

This cross-sectional study evaluated the adequacy of the Family Health Strategy for the primary care model for chronic noncommunicable diseases and the changes that occurred between the two cycles of external evaluations of the National Program for Improving Access and Quality of Primary Care, which took place in 2012 and 2014, in the higher coverage context of the Family Health Strategy of Brazil, in the state of Tocantins, Brazil.

General practitioners’ views on use of patient reported outcome measures in primary care: a cross-sectional survey and qualitative study

Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented.

The aim of this study was to investigate how PROMs are currently being used in primary care, the barriers and facilitators of this use and if appropriate how it might be optimised.

Can Organisational Culture of Teams Be a Lever for Integrating Care? An Exploratory Study

Organisational culture is believed to be an important facilitator for better integrated care, yet how organisational culture impacts integrated care remains underspecified. In an exploratory study, we assessed the relationship between organisational culture in primary care centres as perceived by primary care teams and patient-perceived levels of integrated care

Levers for integrating social work into primary healthcare networks in Austria

The integrated healthcare of patients with support needs in primary healthcare in Austria has insufficient structural and procedural features in terms of the quality and security of care. The aim is therefore to develop solution- and patient-oriented services that take into account both the patients’ requirements as well as the medical, nursing, therapeutic and economic perspectives. 

Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines

Community health workers (CHWs) are an important cadre of the primary health care (PHC) workforce in many low- and middle-income countries (LMICs). The Philippines was an early adopter of the CHW model for the delivery of PHC. This study aims to address this gap by examining the lived experiences and roles of BHWs in urban and rural sites in the Philippines.

Lessons on the COVID-19 pandemic, for and by primary care professionals worldwide

During the early stage of the pandemic, primary care continued as the first point of contact to the health system but was poorly informed by policy makers on how to fulfil its role and ill equipped to provide care while protecting staff and patients against further spread of the infection. The pandemic presents important lessons to strengthen health systems through better connection between public health, primary care, and secondary care to cope better with future waves of this and other pandemics.

Quantitative evaluation of an outreach case management model of care for urban Aboriginal and Torres Strait Islander adults living with complex chronic disease: a longitudinal study

Chronic diseases are the leading contributor to the excess morbidity and mortality burden experienced by Aboriginal and Torres Strait Islander (hereafter, respectfully, Indigenous) people, compared to their non-Indigenous counterparts. The Home-based Outreach case Management of chronic disease Exploratory (HOME) Study provided person-centred, multidisciplinary care for Indigenous people with chronic disease. This model of care, aligned to Indigenous peoples’ conceptions of health and wellbeing, was integrated within an urban Indigenous primary health care service.

Patient-centred care: The patients’ perspective – A mixed-methods pilot study

Patient centredness is a broad concept, a moral philosophy. Patient-centred care can be viewed as the actions of patient-centredness. One of the most pertinent actions that a healthcare practitioner can utilise to deliver patient-centred care is empathic communication. Whilst many medical programmes include empathetic communication skills as part of their curricula, the recipients of this care are not asked about the relevance of this teaching.

Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC)

Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC) are the most promising solution for health systems to satisfy the health needs of the population and to address access, efficiency, quality and equity challenges faced by health systems of the world. PHCs essential attributes (people and family centred care, comprehensiveness, continuity, longitudinality) position this approach as one of the key strategies for countries to meet the aspiration of achieving universal health coverage.

Creating care networks has been a common thread running through Latin America and the Caribbean health policy agendas. In terms of actually putting the IHSDN model in action, there is a wide range of interpretations and experiences, with designs, scales, organizational methods, and maturity levels that vary within and between countries.

Health Network in Action, a publication from the Inter-American Development Bank, shares evidence of the progress made in forming and launching IHSDN in Latin ...

ICOPH: 6th International Conference on Public Health 2020

ICOPH 2020 is a premier event that brings together 250+ academicians, public health specialists, health professionals, healthcare providers, researchers, scientists, policymakers, pharmaceutical developers, and health workers from countries around the world to present their latest research ideas, development, and applications in all areas of Public Health.

The key intention of ICOPH 2020 is to facilitate interaction and the exchange of knowledge and ideas across professional constituencies pertaining to all areas of public health. In addition, this gathering will help the delegates to establish research as well as to find international linkage for future collaborations in their career path.

• Primary Health Care

• Metabolic Syndrome

• Maternal, Infant and Child health

• Family Planning

• Occupational and Safety Health

• Environmental Health

• Epidemiology

• Mental Health

• Adolescent & Young Adults Health

• Social Determinants of Health

• Non Communicable Diseases

• Health Economics

• Sexual and Reproductive Health

• Health Communication and Health Information Technology

• Oral Health

How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization’s African regional targets

In Africa, mortality due to NCDs is projected to overtake the combined mortality from communicable, maternal, neonatal, and nutritional diseases by 2030. To address this growing NCD burden, PHC systems will require substantial re-orientation. In this tudy published, researchers reviewed progress of African countries towards integrating essential NCD services into PHC. The study found that no country met all the recommended indicators to integrate NCD services into PHC, and seven countries met none of the indicators.

Communities, universal health coverage and primary health care

Universal health coverage (UHC) depends on a strong primary health-care system. To be successful, primary health care must be expanded at community and household levels as much of the world’s population still lacks access to health facilities for basic services. Abundant evidence shows that community-based interventions are effective for improving health-care utilization and outcomes when integrated with facility-based services. Community involvement is the cornerstone of local, equitable and integrated primary health care.

Primary health care, the Declaration of Astana and COVID-19

Abstract Four decades after the Declaration of Alma-Ata, its vision of health for all and strategy of primary health care are still an inspiration to many people. In this article we evaluate the current status of primary health care in the era of the Declaration of Astana, the sustainable development goals, universal health coverage and the coronavirus disease 2019 pandemic.

Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa

Cape Town is currently one of the hotspots for COVID-19 on the African continent. The Metropolitan Health Services have re-organised their primary health care (PHC) services to tackle the epidemic with a community-orientated primary care perspective. Two key goals have guided the re-organisation, the need to maintain social distancing and reduce risk to people using the services and the need to prepare for an influx of people with COVID-19. Facilities were re-organised to have ‘screening and streaming’ at the entrance and patients were separated into hot and cold streams.

“It’s Difficult, There’s No Formula”: Qualitative Study of Stroke Related Communication Between Primary and Secondary Healthcare Professionals

The proportion of people living with stroke is growing. In England, National Institute for Health and Care Excellence (NICE) Guidelines for stroke recommend that a person with suspected or confirmed stroke event is admitted to a specialist stroke unit, in order to receive required treatment promptly. Stroke rehabilitation follows, which involves providing stroke survivors with support and treatment from a multidisciplinary rehabilitation team. Stroke survivors’ transition from acute settings to rehabilitation can take place either in hospital, at home or the community.

One model of care is Early Supported Discharge (ESD), which offers community-based health and social care as an alternative to inpatient care. NICE recommend that transfers of care from hospital to community should include all pertinent health and social care information, given to relevant health and social care professionals and patients promptly.Long-term care led by generalists in the community is recommended and stroke survivors are encouraged to ...

Primary health care: transforming vision into action

Marking the two-year anniversary of the Declaration of Astana, this event, hosted by WHO, UNICEF and the Ministry of Health of Kazakhstan, brings together national experiences from across the globe to launch the operational framework and discuss its relevance for strengthening PHC both in the COVID-19 pandemic context and as part of building better.

 Agenda:

11:00 – 12:00 Ministerial Plenary Session (streamed in the six UN languages)

• Welcome & opening remarks - H.E. Alexey Tsoi, Minister of Healthcare of Kazakstan
• WHO Remarks - Dr Tedros Adhanom Ghebreyesus, Director-General, WHO
• UNICEF Remarks - Dr Henrietta Fore, Executive Director
• Presentation of PHC Operational Framework - Dr Suraya Dalil, Director, Special Programme on PHC
• Ministerial Panel – moderator: Dr Hans Kluge, WHO Regional Director for Europe
• Featuring Ministers of Health
• Reflections on two years since the Declaration of Astana - Zsuzsanna Jakab, Deputy Director-General, WHO

Participants will be able to join one of five roundtable discussions focusing on ...

Primary Health Care for Universal Health Coverage

The PHC for UHC webinar will present the 2020 achievements of the Regional Joint Workplan 2020-2021 for East Mediterranean Region Global Action Plan Accelerators 1 partners. The achievements are products of the joint collaboration between the World Health Organization (WHO) Regional Office for the Eastern Mediterranean (EMRO) and United Nations partners, including United Nations Programme on HIV/AIDS (UNAIDS), United Nations Population Fund (UNFPA), United Nations High Commissioner for Refugees (UNHCR), United Nations Children's Fund (UNICEF) and the World Organization of Family Doctors (WONCA) in the East Mediterranean Region.

Patient engagement, autonomy, access to mental care services – the case for integrated care in Crete

Access to comprehensive primary care (PC) services is imperative to address the complex biopsychosocial needs of patients with mental illness and their families, while it holds the potential to safeguard mental health and enhance resilience in communities. Integration of mental health and social care services in primary care has not yet been achieved, while access to such services for the mentally ill is still hindered by patient-, provider- and system-oriented barriers. Improving service integration, quality and access requires active engagement of patients and families in the design and planning of services.

Interprofessional collaboration, interdisciplinary approaches and sound deliberative processes are only the start of initiating discussions to establish the needs of local communities. Mapping care paths, involving stakeholders and engaging in practice-based research are impeded by the organisation and design of care provision, including siloed processes and semantic ambiguity in establishing common ground. Academic centres ought to act as hubs ...

Physician Assistants and Nurse Practitioners in Primary Care Plus: A Systematic Review

Shifting specialist care from the hospital to primary care/community care (also called primary care plus) is proposed as one option to reduce the increasing healthcare costs, improve quality of care and accessibility.

The aim of this systematic review was to get insight in primary care plus provided by physician assistants or nurse practitioners.

Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review

Millions of people worldwide have complex health and social care needs. Care coordination for these patients is a core dimension of integrated care and a key responsibility for primary healthcare. Registered nurses play a substantial role in care coordination.

This review draws on previous theoretical work and provides a synthesis of care coordination interventions as operationalized by nurses for complex patient populations in primary healthcare.

Putting patients first: development of a patient advocate and general practitioner-informed model of patient-centred care

Patients, providers and health care organisations benefit from an increased understanding and implementation of patient-centred care (PCC) by general practitioners (GPs). This study aimed to evaluate and advance a theoretical model of PCC developed in consultation with practising GPs and patient advocates.

Stakeholders’ Perceptions of the Implementation of a Patient-Centric Digital Health Application for Primary Healthcare in India

Health systems are shifting from traditional methods of healthcare delivery to delivery using digital applications. This change was introduced at a primary care centre in Chandigarh, India that served a marginalised population. The usefulness of the digital health application was appreciated by various primary healthcare stakeholders.

Linkage to TB care: A qualitative study to understand linkage from the patients’ perspective in the Western Cape Province, South Africa

Delayed linkage to tuberculosis (TB) treatment leads to poor patient outcomes and increased onward transmission. Between 12% and 25% of people diagnosed with TB are never linked to a primary health care facility for continued care. The health care system, especially in hospitals, should focus on strengthening patient-centred care. Communication and clear messaging on TB processes is key, to prepare patients in transitioning from a hospital setting to PHC facilities for continuation of care. 

Proposals for person-centred care in the COVID-19 era. Delphi study

In this COVID-19 era, we need to rethink the criteria used to measure the results of person-centred care strategies. The objective of this study is to identify priorities, and criteria that health services can use to pursue actually the goal of achieving person-centred care.

UN Decade of Healthy Ageing – The Platform

The United Nations has proclaimed 2021–2030 the Decade of Healthy Ageing, with WHO leading international action to improve the lives of older people, their families and communities. The UN Decade of Healthy Ageing is a global collaboration that brings together diverse sectors and stakeholders including governments, civil society, international organizations, professionals, academic institutions, the media and the private sector to improve the lives of older people, their families and communities. The collaboration focuses on four action areas that are strongly interconnected:

Area 1. Combatting Ageism: changing how we think, feel and act towards age and ageing;

Area 2. Age-friendly Environments: developing communities in ways that foster the abilities of older people;

Area 3. Integrated Care: delivering person centred integrated care and primary health services responsive to older people; and

Area 4. Log-term Care: providing older people who need it with access to long-term care. To make the Decade of ...

The contribution of family physicians to primary health care: Experiences from southwest Nigeria

Although an emerging speciality in Africa, family medicine contributes significantly to African health systems. Leadership from family physicians can enable the delivery of high-quality primary health care that is accessible, comprehensive, coordinated, continuous and person-centred. This short report chronicles how family physicians from a university teaching hospital in Ibadan, Nigeria, adopted a health post located in a home for persons with mild physical and mental disabilities and changed it into a hub of comprehensive, holistic and person-centred care for residents and staff of the home, as well as individuals and families in the neighbouring communities and its environs.