Primary Health Care in the 21st century: primary care providers and people’s empowerment

Olmen, Josefien van; Criel, Bart; Devadasan, Narayanan; Pariyo, George; Vos, Pol De; Damme, Wim Van; Dormael, Monique Van; Marchal, Bruno; Kegels, Guy

doi:10.1111/j.1365-3156.2010.02475.x

Cited by 43 publications

(71 citation statements)

References 30 publications

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“…Our proposed intervention shares some characteristics of a complex intervention:

Path-dependence and resistance to change: The mere availability of generic drugs in PHCs will not automatically change public prescriber behaviour or community behaviour of seeking more expensive branded drugs from private pharmacies. Changes in prescription practices as well as health seeking behaviour are crucial to improving access to drugs.

Multiple interacting sub-components within open systems: Health systems are characterised by several interacting elements that have a dynamic relationship amongst themselves [30, 31]. For example, community driven and/or socio-political factors could push the services into organising care for chronic diseases.…”

Section: Methodsmentioning

confidence: 99%

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Improving access to medicines for non-communicable diseases in rural India: a mixed methods study protocol using quasi-experimental design

Prashanth

Elias

Pati

et al. 2016

BMC Health Serv Res

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BackgroundIndia has the distinction of financing its healthcare mainly through out-of-pocket expenses by individual families contributing to catastrophic health expenditure and impoverishment. Nearly 70 % of the expenditure is on medicines purchased at private pharmacies. Patients with chronic ailments are especially affected, as they often need lifelong medicines. Over the past years in India, there have been several efforts to improve drug availability at government primary health centres. In this study, we aim to understand health system factors that affect utilisation and access to generic medicines for people with non-communicable diseases.MethodsThis study aims to understand if (and how) a package of interventions targeting primary health centres and community participation platforms affect utilisation and access to generic medicines for people with non-communicable diseases in the current district context in India. This study will employ a quasi-experimental design and a qualitative theory-driven approach. PHCs will be randomly assigned to one of three arms of the intervention. In one arm, PHCs will receive inputs to optimise service delivery for non-communicable diseases, while the second arm will receive an additional package of interventions to strengthen community participation platforms for improving non-communicable disease care. The third arm will be the control. We will conduct household and facility surveys, before and after the intervention and will estimate the effect of the intervention by difference-in-difference analysis. Sample size for measuring effects was calculated based on obtaining at least 30 households for each primary health centre spread across three distance-based clusters. Primary outcomes include availability and utilisation of medicines at primary health centres and out-of-pocket expenditure for medicines by non-communicable disease households. Focus group discussions with patients and in-depth interviews with health workers will also be conducted. Qualitative and process documentation data will be used to explain how the intervention could have worked.DiscussionBy taking into consideration several health system building blocks and trying to understand how they interact, our study aims to generate evidence for health planners on how to optimise health services to improve access to medicines.Trial registrationProtocol registered on Clinical Trials Registry of India with registration identifier number CTRI/2015/03/005640 on 17th March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1680-3) contains supplementary material, which is available to authorized users.

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“…Our proposed intervention shares some characteristics of a complex intervention:

Section: Methodsmentioning

confidence: 99%

“…5) [26, 30]. The objective of the assessment was to exclude talukas , which do not have the basic conditions needed for a medicines-related health systems intervention such as the one being implemented.…”

Section: Methodsmentioning

confidence: 99%

Improving access to medicines for non-communicable diseases in rural India: a mixed methods study protocol using quasi-experimental design

Prashanth

Elias

Pati

et al. 2016

BMC Health Serv Res

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“…Although many actors have an influence on governance, there is a central role for the state in ensuring equity, efficiency and sustainability of the health system (Van Olmen 2010). …”

Section: Additional Tablesmentioning

confidence: 99%

Governance arrangements for health systems in low-income countries: an overview of systematic reviews

Herrera

Lewin

Paulsen

et al. 2017

Cochrane Database of Systematic Reviews

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BackgroundGovernance arrangements include changes in rules or processes that determine authority and accountability for health policies, organisations, commercial products and health professionals, as well as the involvement of stakeholders in decision-making. Changes in governance arrangements can affect health and related goals in numerous ways, generally through changes in authority, accountability, openness, participation and coherence. A broad overview of the findings of systematic reviews can help policymakers, their technical support staff and other stakeholders to identify strategies for addressing problems and improving the governance of their health systems.ObjectivesTo provide an overview of the available evidence from up-to-date systematic reviews about the effects of governance arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on governance arrangements and informing refinements of the framework for governance arrangements outlined in the overview.MethodsWe searched Health Systems Evidence in November 2010 and PDQ Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of governance arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use (health expenditures, healthcare provider costs, out-of-pocket payments, cost-effectiveness), healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment) and that were published after April 2005. We excluded reviews with limitations that were important enough to compromise the reliability of the findings of the review. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low-income countries.Main resultsWe identified 7272 systematic reviews and included 21 of them in this overview (19 primary reviews and 2 supplementary reviews). We focus here on the results of the 19 primary reviews, one of which had important methodological limitations. The other 18 were reliable (with only minor limitations).We grouped the governance arrangements addressed in the reviews into five categories: authority and accountability for health policies (three reviews); authority and accountability for organisations (two reviews); authority and accountability for commercial products (three reviews); authority and accountability for health professionals (seven reviews); and stakeholder involvement (four reviews).Overall, we found desirable effects for the following interventions on at least one outcome, with moderate- or high-certainty...

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“…Moreover, service delivery models in developing countries are labour-intensive and very much relying on physicians, in spite of the lack of highly qualified health workers in these countries [22-24]. It is therefore important that health systems in these countries adapt their health service organisation and delivery in line with the health systems realities of the countries and the life-long needs of chronic patients: delivery models which require less doctor-time and allow rational redistribution of tasks, and respond to the life-long needs of patients [22,25-29]. …”

Section: Discussionmentioning

confidence: 99%

How to improve patient retention in an antiretroviral treatment program in Ethiopia: a mixed-methods study

Assefa

Lynen

Wouters

et al. 2014

BMC Health Serv Res

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BackgroundPatient retention, defined as continuous engagement of patients in care, is one of the crucial indicators for monitoring and evaluating the performance of antiretroviral treatment (ART) programs. It has been identified that suboptimal patient retention in care is one of the challenges of ART programs in many settings. ART programs have, therefore, been striving hard to identify and implement interventions that improve their suboptimal levels of retention. The objective of this study was to develop a framework for improving patient retention in care based on interventions implemented in health facilities that have achieved higher levels of retention in care.MethodsA mixed-methods study, based on the positive deviance approach, was conducted in Ethiopia in 2011/12. Quantitative data were collected to estimate and compare the levels of retention in care in nine health facilities. Key informant interviews and focus group discussions were conducted to identify a package of interventions implemented in the health facilities with relatively higher or improving levels of retention.ResultsRetention in care in the Ethiopian ART program was found to be variable across health facilities. Among hospitals, the poorest performer had 0.46 (0.35, 0.60) times less retention than the reference; among health centers, the poorest performers had 0.44 (0.28, 0.70) times less retention than the reference. Health facilities with higher and improving patient retention were found to implement a comprehensive package of interventions: (1) retention promoting activities by health facilities, (2) retention promoting activities by community-based organizations, (3) coordination of these activities by case manager(s), and (4) patient information systems by data clerk(s). On the contrary, such interventions were either poorly implemented or did not exist in health facilities with lower retention in care. A framework to improve retention in care was developed based on the evidence found by applying the positive deviance approach.ConclusionA framework for improving retention in care of patients on ART was developed. We recommend that health facilities implement the framework, monitor and evaluate their levels of retention in care, and, if necessary, adapt the framework to their own contexts.

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Primary Health Care in the 21st century: primary care providers and people’s empowerment

Cited by 43 publications

References 30 publications

Improving access to medicines for non-communicable diseases in rural India: a mixed methods study protocol using quasi-experimental design

Improving access to medicines for non-communicable diseases in rural India: a mixed methods study protocol using quasi-experimental design

Governance arrangements for health systems in low-income countries: an overview of systematic reviews

How to improve patient retention in an antiretroviral treatment program in Ethiopia: a mixed-methods study

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