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Journal articles on the topic 'Primary health care – Botswana'

Author: Grafiati

Published: 4 June 2021

Last updated: 13 February 2022

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1

Tapela, Neo M., Gontse Tshisimogo, Bame P. Shatera, Virginia Letsatsi, Moagi Gaborone, Tebogo Madidimalo, Martins Ovberedjo, et al. "Integrating noncommunicable disease services into primary health care, Botswana." Bulletin of the World Health Organization 97, no. 2 (January 8, 2019): 142–53. http://dx.doi.org/10.2471/blt.18.221424.

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Boonstra, E., M. Lindbaek, P. Khulumani, E. Ngome, and P. Fugelli. "Adherence to treatment guidelines in primary health care facilities in Botswana." Tropical Medicine and International Health 7, no. 2 (February 2002): 178–86. http://dx.doi.org/10.1046/j.1365-3156.2002.00842.x.

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3

Popli, Pallvi, Mansi R. Shah, Tlotlo B. Ralefala, Deborah Toppmeyer, Roger Strair, Refeletswe Lebelonyane, Atlang Mompe, et al. "Reducing Oncologic Disparities by Standardizing Cancer Care." JCO Global Oncology 6, Supplement_1 (July 2020): 64. http://dx.doi.org/10.1200/go.20.61000.

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PURPOSE Shortages in oncology-trained health care providers pose a major challenge in low- and middle-income countries (LMICs) and contribute to delays in the diagnosis and treatment of cancer. Presently, the sole oncologist in the public sector at Princess Marina Hospital, Botswana’s largest oncology referral center, is overextended, causing medical officers to be the primary providers for patients with cancer. Medical officers do not possess formal oncology training, which can potentially lead to imprecise management and suboptimal treatment. In addition, there is no standardized patient interview process in the hematology clinic, leading to inadequately captured patient records. These realities highlight the need for the dissemination and implementation of evidence-based guidelines and intake forms to standardize the delivery of cancer care for practitioners with varying degrees of training. METHODS To serve as a reference for medical officers and oncologists, we reviewed clinical guidelines for the most prevalent cancers in Botswana, namely breast, cervical, prostate, colorectal, and head and neck cancer. We incorporated American Joint Committee on Cancer 8th edition staging criteria into the preexisting guidelines approved by Ministry of Health and Wellness Botswana. We further customized them on the basis of radiology, pathology, and pharmaceutical resource availability in Botswana. Finally, to streamline patient visits, we created intake forms to capture comprehensive hematology-pertinent information. As a quality improvement project, we will record the use and impact of these forms as a tool to standardize the medical records. RESULTS Standardized cancer care guidelines were updated and are under review by the Ministry of Health and Wellness Botswana before circulation. In addition, feedback regarding the new intake forms and their use is currently being recorded. CONCLUSION In low- and middle-income countries, the development of cancer-specific treatment guidelines optimizes disease management through incorporation of evidence-based, resource-adjusted recommendations for clinicians and may aid in reducing global oncologic disparities. As the next phase in the implementation of guidelines, we plan to develop quick-reference cancer pathways for use in public institutions without existing oncologic expertise.

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Bamidele, AR, ME Hoque, and H. Van der Heever. "Patient satisfaction with the quality of care in a primary health care setting in Botswana." South African Family Practice 53, no. 2 (March 2011): 170–75. http://dx.doi.org/10.1080/20786204.2011.10874080.

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Boonstra, E. "Labelling and patient knowledge of dispensed drugs as quality indicators in primary care in Botswana." Quality and Safety in Health Care 12, >3 (June 1, 2003): 168–75. http://dx.doi.org/10.1136/qhc.12.3.168.

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Bodilenyane, Keratilwe, and Baakile Motshegwa. "Nurses Perception Of Their Workload And Pay In The Era Of HIV/AIDS In Gaborone And The Surrounding Areas Of Botswana." International Journal of Human Resource Studies 2, no. 1 (March 24, 2012): 188. http://dx.doi.org/10.5296/ijhrs.v2i1.1440.

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AbstractThe purpose of this research paper was to explore how HIV/AIDS manipulate nurses’ perception of their workload and pay in the era of HIV/AIDS in Gaborone and the surrounding areas of Botswana. The health care sector in Botswana is overwhelmed by HIV/AIDS, and this takes a toll on the nurses because they are the ones at the forefront in the fight against this demanding and risky illness at the workplace. The focus in this study was on the workload and pay in the era of HIV/AIDS. The general picture that emerges from the current study is that nurses are dissatisfied with their pay and to some extent the workload and this supports some of the earlier studies which reinforce their importance in the workplace. The study used both primary and secondary sources of information. For the purpose of this study convenience sampling was used. A questionnaire was used for data collection. The study adapted Index of Organizational Reactions (IOR). The findings of the current study will help the government to design strategies that will increase the level of job satisfaction among the nurses in the public health care sector of Botswana.

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Tapela, Neo M., Malebogo Pusoentsi, Kerapetse Botebele, Michael Peluso, Isaac Nkele, Jason Efstathiou, Tomer Barak, and Scott Dryden-Peterson. "Tackling Health System Delays for Cancer Patients in LMICs: An Innovative Multicomponent Programmatic Intervention in Botswana." Journal of Global Oncology 2, no. 3_suppl (June 2016): 41s—42s. http://dx.doi.org/10.1200/jgo.2016.003715.

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Abstract 67 Background: Health system delays are a major contributor to poor outcomes among cancer patients in low- and middle-income countries (LMICs). In Botswana, while median time from cancer-related symptom onset to first presentation at local health facility is 29 days, median time to initiation of cancer treatment is 401 days. Challenges to timely diagnosis and care include clinicians' lack of knowledge, limited diagnostic capacity, poor coordination between facilities, and socioeconomic barriers of patients that impede follow-up. We sought to develop an intervention to improve access to prompt cancer care. Methods: Participating facilities are all public health facilities (21 health posts, 14 clinics, 2 hospitals) in Botswana's Kweneng-East district as well as the national referral hospital. The five components of intervention are a) training of clinicians at primary facilities on evaluation of patients with suspected cancer, b) implementation of a standardized referral algorithm for cancer suspects, c) introduction of care-coordinator role to support patient and clinician navigation of the health system, d) use of SMS-based platform to support follow-up, e) provision of transport support for vulnerable patients. The primary endpoints are stage at cancer diagnosis and time from initial presentation to initiation of cancer treatment. Evaluation of the intervention's impact will include comparing endpoints following intervention with those at baseline and those among patients residing outside the Kweneng-East district. Results: Implementation of the above multi-component intervention will be presented, including a standardized algorithm to guide the evaluation, triage and referral of patients, an intensive one-day didactic training program that adapts curricula employed in the region, and the impact of training on knowledge. Conclusion: In conducting this study, we hope to identify effective program-based measures to reduce delays and improve cancer outcomes in Botswana. These measures may be scaled to other districts, and may be applicable to similar settings in the region. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: Neo M. Tapela No relationship to disclose Malebogo Pusoentsi No relationship to disclose Kerapetse Botebele No relationship to disclose Michael Peluso No relationship to disclose Isaac Nkele No relationship to disclose Jason Efstathiou Honoraria: Medivation/Astellas, Bayer Healthcare Pharmaceuticals Consulting or Advisory Role: Medivation/Astellas, Bayer Healthcare Pharmaceuticals Tomer Barak No relationship to disclose Scott Dryden-Peterson No relationship to disclose

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Sabone, Motshedisi, Pelonomi Mazonde, Francesca Cainelli, Maseba Maitshoko, Renatha Joseph, Judith Shayo, Baraka Morris, et al. "Everyday ethical challenges of nurse-physician collaboration." Nursing Ethics 27, no. 1 (April 23, 2019): 206–20. http://dx.doi.org/10.1177/0969733019840753.

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Background: Collaboration between physicians and nurses is key to improving patient care. We know very little about collaboration and interdisciplinary practice in African healthcare settings. Research question/aim: The purpose of this study was to explore the ethical challenges of interdisciplinary collaboration in clinical practice and education in Botswana Participants and research context: This qualitative descriptive study was conducted with 39 participants (20 physicians and 19 nurses) who participated in semi-structured interviews at public hospitals purposely selected to represent the three levels of hospitals in Botswana (referral, district, and primary). Ethical considerations: Following Institutional Review Board Approval at the University of Pennsylvania and the Ministry of Health in Botswana, participants’ written informed consent was obtained. Findings: Respondents’ ages ranged from 23 to 60 years, and their duration of work experience ranged from 0.5 to 32 years. Major qualitative themes that emerged from the data centered on the nature of the work environment, values regarding nurse–doctor collaboration, the nature of such collaboration, resources available for supporting collaboration and the smooth flow of work, and participants’ views about how their work experiences could be improved. Discussion: Participants expressed concerns that their work environment compromised their ability to provide high-quality and safe care to their patients. The physician staffing structure was described as consisting of a few specialists at the top, a vacuum in the middle that should be occupied by senior doctors, and junior doctors at the bottom—and not a sufficient number of nursing staff. Conclusion: Collaboration between physicians and nurses is critical to optimizing patients’ health outcomes. This is true not only in the United States but also in developing countries, such as Botswana, where health care professionals reported that their ethical challenges arose from resource shortages, differing professional attitudes, and a stressful work environment.

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Cornick, Ruth, Sandy Picken, Camilla Wattrus, Ajibola Awotiwon, Emma Carkeek, Juliet Hannington, Pearl Spiller, et al. "The Practical Approach to Care Kit (PACK) guide: developing a clinical decision support tool to simplify, standardise and strengthen primary healthcare delivery." BMJ Global Health 3, Suppl 5 (October 2018): e000962. http://dx.doi.org/10.1136/bmjgh-2018-000962.

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For the primary health worker in a low/middle-income country (LMIC) setting, delivering quality primary care is challenging. This is often complicated by clinical guidance that is out of date, inconsistent and informed by evidence from high-income countries that ignores LMIC resource constraints and burden of disease. The Knowledge Translation Unit (KTU) of the University of Cape Town Lung Institute has developed, implemented and evaluated a health systems intervention in South Africa, and localised it to Botswana, Nigeria, Ethiopia and Brazil, that simplifies and standardises the care delivered by primary health workers while strengthening the system in which they work. At the core of this intervention, called Practical Approach to Care Kit (PACK), is a clinical decision support tool, the PACK guide. This paper describes the development of the guide over an 18-year period and explains the design features that have addressed what the patient, the clinician and the health system need from clinical guidance, and have made it, in the words of a South African primary care nurse, ‘A tool for every day for every patient’. It describes the lessons learnt during the development process that the KTU now applies to further development, maintenance and in-country localisation of the guide: develop clinical decision support in context first, involve local stakeholders in all stages, leverage others’ evidence databases to remain up to date and ensure content development, updating and localisation articulate with implementation.

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Cornick, Ruth, Camilla Wattrus, Tracy Eastman, Christy Joy Ras, Ajibola Awotiwon, Lauren Anderson, Eric Bateman, et al. "Crossing borders: the PACK experience of spreading a complex health system intervention across low-income and middle-income countries." BMJ Global Health 3, Suppl 5 (October 2018): e001088. http://dx.doi.org/10.1136/bmjgh-2018-001088.

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Developing a health system intervention that helps to improve primary care in a low-income and middle-income country (LMIC) is a considerable challenge; finding ways to spread that intervention to other LMICs is another. The Practical Approach to Care Kit (PACK) programme is a complex health system intervention that has been developed and adopted as policy in South Africa to improve and standardise primary care delivery. We have successfully spread PACK to several other LMICs, including Botswana, Brazil, Nigeria and Ethiopia. This paper describes our experiences of localising and implementing PACK in these countries, and our evolving mentorship model of localisation that entails our unit providing mentorship support to an in-country team to ensure that the programme is tailored to local resource constraints, burden of disease and on-the-ground realities. The iterative nature of the model’s development meant that with each country experience, we could refine both the mentorship package and the programme itself with lessons from one country applied to the next—a ‘learning health system’ with global reach. While not yet formally evaluated, we appear to have created a feasible model for taking our health system intervention across more borders.

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Masupe, Tiny, Yohana Mashalla, Esther Seloilwe, Harun Jibril, and Heluf Medhin. "Integrated management of HIV/NCDs: knowledge, attitudes, and practices of health care workers in Gaborone, Botswana." African Health Sciences 19, no. 3 (November 4, 2019): 2312–23. http://dx.doi.org/10.4314/ahs.v19i3.3.

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Background: The epidemiologic transition and double disease burden from chronic infections and Non-communicable diseases (NCDs) worldwide requires re-engineering of healthcare delivery systems. Healthcare workers (HCWs) need to adapt to new integrated disease management approaches and change from current disease-specific management. Objectives: The study aimed to determine HCWs knowledge, capacity and skills for management of NCDs among HIV patients and their attitudes towards integrated HIV/NCDs disease management approaches for future clinical practice. Methods: Descriptive cross-sectional survey among HCWs attending to HIV patients at selected government facilities. Results: One hundred out of 105 responses were analysed. Only 6% could fully define NCDs. Awareness levels of NCDs were high: Diabetes and hypertension 98%; cancer 96%; cardiovascular diseases 86%. However, 11.8% and 58% classified HIV and malaria respectively as NCDs. Most respondents (88%) believe that integrating HIV/NCDs care would be good use of resources while 62% disagreed with current separate facility management of HIV patients with NCDs. Over 60% routinely screened HIV patients for NCDs risk factors: Smoking (87.2%), alcohol (90.8%), diet (84.9%) and physical activity (73.5%). Conclusion: There were gaps in detailed knowledge on NCDs, but positive attitude towards routine primary care integrated HIV/NCDs management, showing likely support for implementation of such policy.Keywords: Non-communicable diseases, knowledge, attitude, HIV, integration.

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Cheng, T. A. "Development Psychiatry: Mental Health and Primary Health Care in Botswana. By D. I. Ben-Tovim. (Pp. 233; illustrated; £12.95.), Tavistock Publications: London. 1987." Psychological Medicine 18, no. 4 (November 1988): 1029–30. http://dx.doi.org/10.1017/s0033291700009983.

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Pansiri, Jaloni, and Rebana N. Mmereki. "Using the Servqual Model to Evaluate the Impact of Public Service Reforms in the Provision of Primary Health Care in Botswana." Journal of African Business 11, no. 2 (September 22, 2010): 219–34. http://dx.doi.org/10.1080/15228916.2010.509005.

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Boonstra, E., M. Lindbaek, E. Klouman, E. Ngome, M. Romoren, and J. Sundby. "Syndromic management of sexually transmitted diseases in Botswana's primary health care: quality of care aspects." Tropical Medicine and International Health 8, no. 7 (July 2003): 604–14. http://dx.doi.org/10.1046/j.1365-3156.2003.01076.x.

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Meaney, Peter Andrew, Christine Lynn Joyce, Segolame Setlhare, Hannah E. Smith, Janell L. Mensinger, Bingqing Zhang, Kitenge Kalenga, et al. "Knowledge acquisition and retention following Saving Children’s Lives course for healthcare providers in Botswana: a longitudinal cohort study." BMJ Open 9, no. 8 (August 2019): e029575. http://dx.doi.org/10.1136/bmjopen-2019-029575.

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ObjectivesMillions of children die every year from serious childhood illnesses. Most deaths are avertable with access to quality care. Saving Children’s Lives (SCL) includes an abbreviated high-intensity training (SCL-aHIT) for providers who treat serious childhood illnesses. The objective of this study was to examine the impact of SCL-aHIT on knowledge acquisition and retention of providers.Setting76 participating centres who provide primary and secondary care in Kweneng District, Botswana.ParticipantsDoctors and nurses expected by the District Health Management Team to provide initial care to seriously ill children, completed SCL-aHIT between January 2014 and December 2016, submitted demographic data, course characteristics and at least one knowledge assessment.MethodsRetrospective, cohort study. Planned and actual primary outcome was adjusted acquisition (change in total knowledge score immediately after training) and retention (change in score at 1, 3 and 6 months), secondary outcomes were pneumonia and dehydration subscores. Descriptive statistics and linear mixed models with random intercept and slope were conducted. Relevant institutional review boards approved this study.Results211 providers had data for analysis. Cohort was 91% nurses, 61% clinic/health postbased and 45% pretrained in Integrated Management of Childhood Illness (IMCI). A strong effect of SCL-aHIT was seen with knowledge acquisition (+24.56±1.94, p<0.0001), and loss of retention was observed (−1.60±0.67/month, p=0.018). IMCI training demonstrated no significant effect on acquisition (+3.58±2.84, p=0.211 or retention (+0.20±0.91/month, p=0.824) of knowledge. On average, nurses scored lower than physicians (−19.39±3.30, p<0.0001). Lost to follow-up had a significant impact on knowledge retention (−3.03±0.88/month, p=0.0007).ConclusionsaHIT for care of the seriously ill child significantly increased provider knowledge and loss of knowledge occurred over time. IMCI training did not significantly impact overall knowledge acquisition nor retention, while professional status impacted overall score and lost to follow-up impacted retention.

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Boonstra, Eelco, Morten Lindbæk, and Enoch Ngome. "Adherence to management guidelines in acute respiratory infections and diarrhoea in children under 5 years old in primary health care in Botswana." International Journal for Quality in Health Care 17, no. 3 (June 1, 2005): 221–27. http://dx.doi.org/10.1093/intqhc/mzi020.

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Grover, Surbhi, Sidrah Shah, Rohini Bhatia, Sandra Urusaro, Barati Monare, Tlotlo Ralefala, Alexander Seiphetlheng, Sherman Preet Singh, and Givy Dhaliwal. "Development and Usability of a Smartphone Application for Tracking Oncology Patients in Gaborone, Botswana." Methods of Information in Medicine 59, no. 01 (February 2020): 031–40. http://dx.doi.org/10.1055/s-0040-1713129.

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Abstract Background The majority of new cancer cases are expected to be diagnosed in low- and middle-income countries (LMICs) by 2025, and 65% of cancer deaths currently occur in LMICs. Treatment adherence, patient monitoring, and follow-up are essential to cancer care but are often not possible in these settings. Out Patient (OP) Care, a smartphone application (app) developed to fill this gap, texts appointment reminders to patients and electronically stores medical records confidentially. Objectives This study aims to present the development of this app and evaluate its usability and feasibility as defined by provider and patient experiences in the context of a multidisciplinary cancer clinic in Gaborone, Botswana. Methods OP Care was piloted at a multidisciplinary team gynecologic oncology clinic in Gaborone, Botswana. The app was developed through an iterative process with feedback from clinic staff and physicians. The usability was evaluated using a cross-sectional survey. All staff members in the gynecologic oncology clinic, which typically consists of one doctor and four nurses, as well as a portion of the staff in the (Princess Marina Hospital general) oncology ward used the app. All providers using the app were surveyed, along with all patients who attended the gynecologic oncology clinic during the 3-week survey period. Staff demographics, reactions, and opinions on usability, as well as patients' reactions to the appointment reminders were collected. Agreement to the ease-of-usability statements was recorded on a 1 (not at all) to 7 (extremely so) scale. Primary outcomes were the app's usability and the feasibility of text reminders from the patient's perspective. Results Nine staff and 15 patients were surveyed. Staff included three doctors and six nurses and encompassed all of the staff in the gynecologic oncology clinic as well as a portion of the general oncology ward. All surveyed staff owned a smartphone and used a computer at home. Most (78%) staff did not feel that OP Care would increase their work burden and were willing to use the app if implemented permanently (median: 6; interquartile range [IQR]: 1). Seventeen out of the nineteen usability questions, such as “I feel comfortable using this system,” scored a median of 6, corresponding to “very much so.” Patients reported that the reminder text messages were helpful (median: 6; IQR: 1) and preferred the text reminders to be in Setswana (median: 7; IQR: 1). Conclusion High usability scores indicate that the app can be scaled up to usage in this clinic and others. Although patients appreciate OP Care, the option for call and text reminders in Setswana is indicated.

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Littlewood, Roland. "Development Psychiatry: Mental Health and Primary Care in Botswana. By David I. Ben-Tovim. London: Tavistock. 1987. 233 pp. £27.95 (hb), £12.95 (pb)." British Journal of Psychiatry 152, no. 3 (March 1988): 446–47. http://dx.doi.org/10.1192/s0007125000219326.

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Shah, Sidrah, Barati Monare, Sandra Urusaro, Rohini Bhatia, Sherman Preet Singh, Tlotlo Ralefala, Givy Dhaliwal, and Surbhi Grover. "Usability and Effectiveness of a Smartphone Application for Tracking Oncology Patients in Gaborone, Botswana." Journal of Global Oncology 5, Supplement_1 (October 2019): 11. http://dx.doi.org/10.1200/jgo.19.20000.

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PURPOSE Most cancer diagnoses are expected to be in low- and middle-income countries (LMICs) by 2025, and 65% of cancer deaths occur in LMICs. Treatment adherence and patient monitoring are essential to cancer care but are often not possible in LMICs. OP Care, a smartphone application developed to fill this gap, stores medical records virtually and texts appointment reminders to patients. This study assessed its usability and effectiveness. METHODS OP Care was piloted at Princess Marina Hospital in Gaborone, Botswana. The study was a cross-sectional study using surveys. All providers using the application were surveyed, along with all patients who were previously enrolled in the application and attended the gynecologic oncology clinic during the 3-week survey period. Staff demographics, reaction, opinions on usability, and patients’ reactions to appointment reminders were collected. Answers were recorded on a 1 (not at all) to 7 (extremely so) scale. Primary outcomes were the application’s usability and the effectiveness of the text reminders. The University of Pennsylvania Institutional Review Board and the Ministry of Health and Wellness in Botswana gave approval for the study. Patients provided written consent before enrollment. RESULTS Nine staff and 15 patients were surveyed. Staff included three doctors and six nurses, all of whom own a smartphone and use a computer at home. Most staff (78%) did not feel OP Care would increase their work burden and were willing to use the application if implemented permanently (median response, 6; interquartile range [IQR], 1). Most usability questions (17 of 19), such as “I feel comfortable using this system,” scored a median of 6. Most patients believed that the reminder text messages were helpful (median, 6; IQR, 1) but wanted the text reminders to be in the Setswana language (median, 7; IQR, 1). CONCLUSION High usability scores indicate the application is adaptable to other clinics. Although patients appreciate OP Care, the option for call and text reminders in Setswana is indicated. A potential limitation is that patients for whom the appointment reminders were not helpful were not necessarily included, because only patients in the clinic were surveyed. Strengths were inclusion of all involved staff, uniformity in survey administration, and inclusion of numerical analysis.

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Yohana, James Mashalla, Sepako Enoch, Setlhare Vincent, Chuma Mpho, Bulang Maureen, and Yared Massele Amos. "Availability of guidelines and policy documents for enhancing performance of practitioners at the Primary Health Care (PHC) facilities in Gaborone, Tlokweng and Mogoditshane, Republic of Botswana." Journal of Public Health and Epidemiology 8, no. 8 (August 31, 2016): 127–35. http://dx.doi.org/10.5897/jphe2016.0812.

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Ganiyu, A. B., and L. Mason. "P3.358 Syphilis Sero-Positivity Amongst Pregnant Women Attending Public Antenatal Clinics: A 5 Year (2004–2008) Analysis from 15 Public Primary Health Care Facilities in Gaborone, Botswana." Sexually Transmitted Infections 89, Suppl 1 (July 2013): A261.1—A261. http://dx.doi.org/10.1136/sextrans-2013-051184.0811.

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Maphisa, J. Maphisa. "Mental health legislation in Botswana." BJPsych International 16, no. 03 (September 11, 2018): 68–70. http://dx.doi.org/10.1192/bji.2018.24.

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The Mental Disorders Act of 1969 is the primary legislation relating to mental health in Botswana. Despite the country not being a signatory to the United Nations Convention on the Rights of Persons with Disabilities, its Act has a self-rated score of four out of five on compliance to human rights covenants. However, it can be argued that the Act does not adequately espouse a human rights- and patient-centred approach to legislation. It is hoped that ongoing efforts to revise the Act will address the limitations discussed in this article.

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Wright, Dolores J. "Home Care in Kanye, Botswana." Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional 29, no. 7 (July 2011): 402–7. http://dx.doi.org/10.1097/nhh.0b013e31821febb6.

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Novitsky, V., E. Woldegabriel, C. Wester, E. McDonald, R. Rossenkhan, M. Ketunuti, J. Makhema, G. R. Seage, and M. Essex. "Identification of primary HIV-1C infection in Botswana." AIDS Care 20, no. 7 (August 2008): 806–11. http://dx.doi.org/10.1080/09540120701694055.

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Ben-Tovim, David I. "Therapy Managing in Botswana." Australian & New Zealand Journal of Psychiatry 19, no. 1 (March 1985): 88–91. http://dx.doi.org/10.3109/00048678509158819.

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Varied and apparently ideologically incompatible systems of health care are available in many developing countries. Patients move freely between them, receiving care serially or simultaneously from different types of healers. Therapy managing is an anthropological term used to describe how choice of health care is made by an informal group that forms around the patient. The author's experiences while running a community-based psychiatric treatment program in Botswana are discussed in terms of his interaction with patients' managing groups.

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Seloilwe, E. S., and G. Thupayagale-Tshweneagae. "Community mental health care in Botswana: approaches and opportunities." International Nursing Review 54, no. 2 (June 2007): 173–78. http://dx.doi.org/10.1111/j.1466-7657.2007.00525.x.

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Wilkin, David. "Primary Health Care." Ageing and Society 6, no. 3 (September 1986): 359–61. http://dx.doi.org/10.1017/s0144686x00006024.

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Plant, Paul. "Primary Health Care." Ageing and Society 10, no. 1 (March 1990): 109–12. http://dx.doi.org/10.1017/s0144686x0000790x.

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Wilkin, David. "Primary Health Care." Ageing and Society 5, no. 4 (December 1985): 470–73. http://dx.doi.org/10.1017/s0144686x00012046.

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MCELMURRY, BEVERLY J. "Primary Health Care." Annual Review of Nursing Research 17, no. 1 (January 1999): 241–68. http://dx.doi.org/10.1891/0739-6686.17.1.241.

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Primary Health Care (PHC) has been promulgated for over two decades as a global strategy for ensuring basic health care for all people. PHC is characterized by equity, accessibility, availability of resources, social participation, intersectoral community action, and cultural sensitivity. While PHC can be discussed as philosophy or a process, it is critical that PHC be understood as a community focus in health care that differs from a primary care focus on individuals. Capturing PHC components in community-based interventions in order to advance the development of a rigorous research base requires a shift in thinking about what constitutes acceptable methods and evidence for evaluating changes in health care. To this end, the authors of this review discuss perspectives and available research that inform practice within multidisciplinary teams, highlight the importance of social discourse, and review participatory evaluation issues for achieving a working relationship with communities. Particular attention is focused on education for nurses’ roles in PHC activities within implementation models fostering community mobilization and development. An action plan is suggested as a means for situating discrete research activity within a PHC framework.

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Kar, S. B. "Primary health care." Academic Medicine 65, no. 5 (May 1990): 301–6. http://dx.doi.org/10.1097/00001888-199005000-00006.

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Davidson, Patricia, Judith MacIntosh, Dianne McCormack, and Evelyn Morrison. "Primary Health Care." Holistic Nursing Practice 16, no. 4 (July 2002): 65–74. http://dx.doi.org/10.1097/00004650-200207000-00010.

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Fleetwood, Tony, Vi Wagner, Ben Brazellc, and Bernie Callan. "Primary health care." Nursing Standard 4, no. 23 (February 28, 1990): 41. http://dx.doi.org/10.7748/ns.4.23.41.s47.

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Leslie, Laurel K., Christopher J. Mehus, J. David Hawkins, Thomas Boat, Mary Ann McCabe, Shari Barkin, Ellen C. Perrin, et al. "Primary Health Care." American Journal of Preventive Medicine 51, no. 4 (October 2016): S106—S118. http://dx.doi.org/10.1016/j.amepre.2016.05.014.

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Sharan, Sudhir. "Primary Health Care." Journal of Health Management 7, no. 2 (October 2005): 295–302. http://dx.doi.org/10.1177/097206340500700209.

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Goodman, Mark. "Primary health care." Veterinary Record 177, no. 1 (July 2, 2015): 24.3–24. http://dx.doi.org/10.1136/vr.h3571.

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Allan, Ross. "Primary health care." Veterinary Record 177, no. 3 (July 16, 2015): 80.2–80. http://dx.doi.org/10.1136/vr.h3842.

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Goodyear, Rosemary. "The Nurse Practitioner in Botswana: The Primary Care Provider for a Nation." Journal for Nurse Practitioners 8, no. 7 (July 2012): 579–80. http://dx.doi.org/10.1016/j.nurpra.2012.05.018.

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&NA;. "Primary health care to include primary eye care?" Inpharma Weekly &NA;, no. 956 (September 1994): 5. http://dx.doi.org/10.2165/00128413-199409560-00004.

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Gofin, Jaime, and Rosa Gofin. "COMMUNITY-ORIENTED PRIMARY CARE AND PRIMARY HEALTH CARE." American Journal of Public Health 95, no. 5 (May 2005): 757. http://dx.doi.org/10.2105/ajph.2004.060822.

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Isman, RE. "Integrating primary oral health care into primary care." Journal of Dental Education 57, no. 12 (December 1993): 846–52. http://dx.doi.org/10.1002/j.0022-0337.1993.57.12.tb02816.x.

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Muldoon, Laura K., William E. Hogg, and Miriam Levitt. "Primary Care (PC) and Primary Health Care (PHC)." Canadian Journal of Public Health 97, no. 5 (September 2006): 409–11. http://dx.doi.org/10.1007/bf03405354.

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Kuo, M. S. C. "Integrating primary oral health care into primary care." Journal of Oral and Maxillofacial Surgery 52, no. 8 (August 1994): 888. http://dx.doi.org/10.1016/0278-2391(94)90247-x.

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Jacques, Gloria, and Christine Stegling. "HIV/AIDS and Home Based Care in Botswana." Social Work in Mental Health 2, no. 2-3 (November 8, 2004): 175–93. http://dx.doi.org/10.1300/j200v02n02_11.

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Cueto, Marcos. "The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care." American Journal of Public Health 94, no. 11 (November 2004): 1864–74. http://dx.doi.org/10.2105/ajph.94.11.1864.

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Macdonald, John. "Primary Health Care or Primary Medical Care: In Reality." Australian Journal of Primary Health 13, no. 2 (2007): 18. http://dx.doi.org/10.1071/py07019.

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Despite considerable rhetoric, comprehensive primary health care remains largely a matter of a paper exercise. The theory promotes horizontal and vertical integration and the active participation of people in planning. Experience in Australia and elsewhere indicates that what is in place in health services is often primary medical care: the management of the needs of presenting individuals. The arguments for upstream interventions remain valid, bolstered by research on the social determinants of health. Two examples are given of primary health care that attempt to work upstream, before clinical interventions become necessary and illustrate the need for both horizontal and vertical integration. Consequences for policy and training are drawn.

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Crowley, Des, Walter Cullen, and Marie Claire Van Hout. "Transgender health care in primary care." British Journal of General Practice 71, no. 709 (July 29, 2021): 377–78. http://dx.doi.org/10.3399/bjgp21x716753.

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Rowlands, Gill, Tessa Crilly, Mark Ashworth, Joan Mager, Catherine Johns, and Sean Hilton. "Linking research and development in primary care: primary care trusts, primary care research networks and primary care academics." Primary Health Care Research and Development 5, no. 3 (July 1, 2004): 255–63. http://dx.doi.org/10.1191/1463423604pc201oa.

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Rofman, Ethan S. "Primary Care Mental Health." Journal of Clinical Psychiatry 72, no. 07 (July 15, 2011): 1018. http://dx.doi.org/10.4088/jcp.11bk06894.

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Roos, J. L. "Primary health care psychiatry." South African Journal of Psychiatry 14, no. 1 (March 1, 2008): 1. http://dx.doi.org/10.4102/sajpsychiatry.v14i1.85.

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<div style="left: 73.788px; top: 351.428px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.886868);" data-canvas-width="406.22999999999996">Much needs to be done to improve psychiatric care in South</div><div style="left: 73.788px; top: 374.757px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.905417);" data-canvas-width="406.16999999999996">Africa. Resources need to be developed, particularly in rural</div><div style="left: 73.788px; top: 398.087px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.914111);" data-canvas-width="406.16999999999985">areas, and psychiatric services need to be better integrated</div><div style="left: 73.788px; top: 421.416px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.855137);" data-canvas-width="406.2899999999999">into primary health care services. This process will include the</div><div style="left: 73.788px; top: 444.746px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.905584);" data-canvas-width="406.24499999999995">intensive training of mental health care workers. If we look at the</div><div style="left: 73.788px; top: 468.075px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.893698);" data-canvas-width="406.27500000000015">training of primary care physicians, their rotation during the 2-year</div><div style="left: 73.788px; top: 491.405px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.9028);" data-canvas-width="406.21500000000003">internship falls short in psychiatry. It is not seen as a mainstream</div><div style="left: 73.788px; top: 514.734px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.886965);" data-canvas-width="406.21500000000015">rotation point like disciplines such as surgery or internal medicine.</div><div style="left: 73.788px; top: 538.064px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.921503);" data-canvas-width="406.26000000000005">This fact, as well as a more student-centred approach and</div><div style="left: 73.788px; top: 561.393px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.923528);" data-canvas-width="406.26">emphasis on self-learning in medical curricula, make the search</div><div style="left: 73.788px; top: 584.723px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.910728);" data-canvas-width="406.20000000000005">for an appropriate prescribed textbook in psychiatry an important</div><div style="left: 73.788px; top: 608.052px; font-size: 15.45px; font-family: sans-serif; transform: scaleX(0.845747);" data-canvas-width="34.14000000000001">issue.</div>

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