Dissertations / Theses: 'Primary health care (PHC)'

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Selden, Suzanne M. "PHC : unravelling a maze." University of Sydney, 2009. http://hdl.handle.net/2123/5976.

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Doctor of Philosophy(PhD)
The thesis explores the complexities of primary health care in a setting characterised as being both isolated and remote, and in the process identifies factors critical for developing successful PHC programs in such settings and more broadly. The four questions underpinning the study are 1) is a PHC approach relevant to the chosen small remote Australian community; 2) to what extent was a PHC approach being implemented; 3) what are the barriers and enablers to developing and implementing a PHC approach; and 4) what are the crucial factors for PHC programs in similar communities. The first chapter provides the background to the study, beginning with the range of descriptions of primary health care and the many themes needed to understand how it plays out in a small community. The Menindee community and some of the local health service players are introduced. Chapter Two explores complexity theory and complex adaptive systems and its relevance to organisations and managing change, particularly in complex environments. Chapter Three examines the evolution of primary health care, its philosophy, principles and elements as both a model of health care and of development. Chapter Four addresses social determinants, the life course and the long-term effects of inequity, before considering current factors that impact on health and health services. These include the beginning and end of the life course and those in the ‘middle’ where the effects of the obesity and diabetes epidemics are being played out at a younger age. The chapter concludes by noting common themes across the three chapters. Chapter Five describes the research design and methods. A case study using mixed methods was chosen and the theoretical framework provides an exploration of complexity and transdisciplinarity. What changed during the course of the study, questions of scope and its limitations are stated. Chapter Six is a quantitative analysis of the study community, which examines community demographics, the life course, a summary of adult and child health, and service use. These enable an understanding of the community profile, its uniqueness and its similarity to other communities that might benefit from a comprehensive PHC approach. The questions to be explored in the qualitative phase are identified. Chapter Seven is a qualitative study of the community in the midst of change. An individual interview guide approach was used and representatives from the community, local and regional health service providers were interviewed. Chapter Eight provides a synthesis of the two studies as they address themes from the complexity, PHC and social inequity literature. Five themes had particular significance to the study community: social determinants and Indigenous health; community size, resilience and change; chronic disease programs and prevention; vulnerable groups; and a complex adaptive systems perspective. The second section answers the four study questions. The thesis concludes with a discussion of PHC rhetoric and reality, the relevance of the study and its limitations, and issues requiring further research when considering primary health care in smaller communities.

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Matsheke, Thembakazi. "A cost analysis of rural primary health care (PHC) services in KwaZulu-Natal." Master's thesis, University of Cape Town, 2004. http://hdl.handle.net/11427/9322.

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Includes bibliographical references.
It has been found that South Africa has very limited costing information of health services at both primary and higher levels of care. Therefore, a study was conducted in Ingwavuma health district, a rural setting in KZN, evaluating costs of primary health care (PHC) services. The primary objective of the study was to evaluate the costs of providing PHC services in a rural setting and to compare costs of providing PHC services at different levels of care. Costs data were collected through interview and record reviews from Manguzi hospital, a district hospital, and nine clinics operating within the hospital's catchment area. Cost comparisons between Manguzi clinics and between the clinic and hospital levels were undertaken. Variations in terms of costs between similar facilities (clinics) were discovered, with some clinics being more costly compared to others. Such variations can be explained by some input costs, e.g. personnel which varied considerably between facilities. Variations in the personnel costs between similar facilities were found to be linked with staff distribution patterns and facility utilisation. In addition, variations in terms of costs were also discovered between services provided within one facility. For instance, expenditure ﬁgures revealed that the largest proportion of resources was spent on curative services. Tuberculosis and mental health services consumed a minimum amount of resources, namely about 1%. Further comparison of Manguzi results with those of the Centre for Health Policy (CHP) was undertaken. Costs analyses of PHC services provided at Manguzi clinics with similar facilities compared to other sites. namely Agincourt (a rural setting), and Alexandra Health Centre (AHC) (an urban setting), were undertaken. Manguzi and Agincourt have similar costs of PHC services. However, AHC has relatively higher costs compared to the other two sites. This is probably because Manguzi and Agincourt are both rural. Finally, analysis on scaling-up PHC services in Manguzi to the essential package target of 3.5 utilisations per person per year shows that there would be no additional staff costs required. The current staffing levels in Manguzi seem to be sufficient to provide a comprehensive PHC package of 3.5 visits per person per year.

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Obioha, EE, and MG Molale. "Functioning and Challenges of Primary Health Care (PHC) Program in Roma Valley, Lesotho." Ethno Med, 2011. http://encore.tut.ac.za/iii/cpro/DigitalItemViewPage.external?sp=1000710.

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Primary Health Care (PHC) plays a vital role in decentralization of health care services. PHC is designed to ensure health care coverage at the community level through the involvement of the community in improving their healthy living. PHC offers treatment and care in continuum that is supported by a facility-linked home- based care system and a referral system. While PHC is global, its operation and functioning in the area of community health provisioning varies across communities. The main objective of this study is to find out whether PHC is effective or not in Roma Valley, Lesotho. The study was carried out in Roma Valley, in the Maseru district of Lesotho. The population for this study includes the nurses under the department of PHC, village health workers, Chiefs and out-patients from four different villages. Out of this, a sample of thirty individuals was selected. The data for this study was collected through qualitative research technique, particularly oral interviews and written records or secondary data sources. The analysis revealed that nurses and village health workers respond to the social needs and health problems of the community and community members are also involved in improving their health status. Village health workers face many challenges in their engagement in this system such as not being given incentives for what they do and often uncooperative disposition of some community members including their leaders. It was also found that they operate under a lot of stress due to lack of resources.

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Sahito, Hadi Bakhsh Wirat Kamsrichan. "Participation of village health volunteers in PHC in Phuttamonthon Distric, Nakhonpathom Province, Thailand /." Abstract, 2005. http://mulinet3.li.mahidol.ac.th/thesis/2548/cd375/4737960.pdf.

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Belanger, Marc Andrew. "Determinants of health care seeking behaviour in the Pahou PHC project in the People's Republic of Benin : an exploratory study." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=68072.

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The goal of this study is to identify factors which may be preventing use of an experimental health care program in the People's Republic of Benin. While previous surveys have focused more specifically on the impact of fees on use and demand, our aim to identify a wider range of factors.
There are two principle methods by which this can be done. One is to extract possible factors from a review of the relevant literature. The other is to carry out an exploratory, qualitative study in the field. We have used both these methods.
A qualitative study is a necessary prelude to a survey, since we initially have no specific idea about which factors to measure and investigate. The aim is to identify factors which may be relevant so that a subsequent survey, with a larger number of cases, could quantify and measure their influence and statistical significance.

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Coovadia, Mohamed Yusuf. "Identification and evaluation of patient satisfaction determinants in medical service delivery systems within the South African private healthcare industry." Diss., University of Pretoria, 2008. http://hdl.handle.net/2263/23094.

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The aim of the study was to identify, evaluate and compare the determinants of patient satisfaction in fee-for-service, and health maintenance organisation (HMO), medical service delivery centres. Staff at both centres, who were also patients, were surveyed to determine the congruence with patients’ quality improvement priorities. The survey was conducted using a questionnaire consisting of closed questions given to patients as they departed from the medical centres. The questionnaire was tested for convergent and divergent validity, content analysis and reliability. A rating scale was then applied to yield the scores for each determinant. The unique Patient Satisfaction Priority Index was determined using determinants that were rated low on satisfaction but high on importance. The results revealed that patients at the fee- for- service medical centre were significantly more satisfied than patients at the HMO. The priority index for patients were found to be different to that of the staff at both medical centres, proving that staff and patient priorities were incongruent. Accordingly, the recommendations were that patient satisfaction be continuously evaluated at medical service delivery centres, in order to achieve a competitive advantage, sustainability and growth in South Africa’s highly competitive private healthcare industry. Copyright
Dissertation (MBA)--University of Pretoria, 2010.
Gordon Institute of Business Science (GIBS)
unrestricted

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Cakata, Zethu. "Epidemiology of sexually transmitted infections in selected primary health care centres in the Eastern Cape Province." Thesis, University of the Western Cape, 2004. http://hdl.handle.net/11394/4599.

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Magister Psychologiae - MPsych
An epidemiological study was conducted with the main goal of describing the occurrences of the various STIs in the Eastern Cape province as well as biographical factors such as age, gender, and geographical location influencing them. Ten primary health care (PHC) centres located throughout the province served as sentinel sites for surveillance data collection for a period of 3 months using Daily and Monthly Report Forms. The surveillance data was analysed using relative frequencies to determine STIs prevalence. The main findings from the present study suggest that the most frequently encountered female syndromes were vaginal discharge and lower abdominal pains and most frequent male syndrome was Urethral discharge. Other syndromes accounted for less than 10% of the STI cases observed at the PHC centres during the study. The study also indicate that more STI patients were seen at urban PHC centres compared to rural ones and that most of the STI patients seen at PHC centres were women. These findings are helpful for the Health Department in the Eastern Cape Province to effectively plan for the control and prevention of all STIs including HIV I AIDS.

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Louskieter, Lance. "Centering Primary Health Care (PHC) Nurses' experiences in their practice of policy implementation - TB diagnostic policy reform in the Western Cape, South Africa." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29488.

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This project focused on the recent global reforms in TB diagnostic policy and the implementation of Xpert MTB/RIF (GeneXpert) diagnostic technology into the health system, as a case to assess the extent to which software issues - particularly the human qualities of the system – mediates policy implementation. It centres the experiences of frontline workers in local implementation contexts as imperative because of frontline workers’ have discretionary power and influence in their practice. The premise of this mini-dissertation is that researchers and policy makers should centre the lived experiences of service delivery level health workers when implementing policy or programmatic reforms. This may deepen people-centred approaches which is essential for health systems strengthening. This mini-dissertation is structured into three parts: Part A: This is the research protocol that was submitted for ethical review and approval to the Faculty of Health Science Ethical Review Committee (FHSERC). The protocol frames the study objectives and the initial intentions of the research study. The justifications for the research question, theoretical framework, the research design, methods for data collection and analysis and timelines are clearly presented and discussed. Part B: Using GeneXpert policy reform implementation as a pathfinder, this section presents an undertaking of a structured narrative review of the existing literature addressing the major barriers and enablers for health systems implementation reform. This review assesses the extent to which people issues and people-centred practices are considered in policy implementation research of GeneXpert. The aim of this section of the dissertation is to identify and map-out literature considering the human experiences and relationships of frontline health workers and how these may intersect with hardware, contextual and social systemic factors, that may potentially mediate the implementation of GeneXpert TB diagnostic policy. Part C: This section presents the background, methodology, findings and interpretations from the research, as a journal-ready manuscript. This paper seeks to contribute to the policy implementation literature in the field of HPSR from the perspective of centering nurses' lived experience – especially nurses who are overburdened and undervalued – as imperative in the field of inquiry. The main findings reflect that nurses are burdened by the pressure to meet policy targets, the encumbrance to enforce administrative and bureaucratic procedure, and the minimal platforms or pathways to input on challenges and innovations back to higher level management and decision makers. Within the context of top-down, target-driven and highly structured and standardized operational processes for diagnosing TB, nurses navigate multiple overlapping and contradictory modes of being in their interactions with patients as a response to these pressures. This paper seeks to offer voice to nurses’ experiences of implementing TB diagnostic policy in PHC settings in SA considering its relationship with broader systemic and contextual influences. It also raises particular issues about tensions between efforts to achieve efficiency and effectiveness through enforcing the system, and facilitating people-centered and responsive practices in implementation.

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Ameermia, Miriam Ginette. "The integration of psychological services into primary health care (PHC) in South Africa : tensions in theory, policy and practice." Thesis, Stellenbosch : University of Stellenbosch, 2009. http://hdl.handle.net/10019.1/4878.

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Thesis (MA (Psychology))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: This literature review follows the early origins of the integration of psychological services into Primary Health Care (PHC) to its promulgation by law under the new dispensation in South Africa post-1994. With a recent re-commitment in 2008 by government to PHC for health service delivery, the biomedical orientation of PHC is inherently problematic as the location for psychological services and runs contrary to a comprehensive discourse of care as envisioned locally and by the World Health Organisation (WHO). With such shifts in policy at a macro level and in a context in which the relevance of psychological theorising and praxis is under scrutiny, this review has highlighted that a bottom-up approach is necessitated; specifically one that will facilitate a convergence between policy, theory and practice, with its foundations informed by research.
AFRIKAANSE OPSOMMING: Hierdie literatuuroorsig begin by die vroeë beginpunt waar sielkundige dienste by Primêre Gesondheidsorg (PHC) ingelyf is, en volg die gebeure tot waar nuwe wetgewing hieroor in die nuwe post-1994-dispensasie in Suid-Afrika uitgevaardig is. Met die regering wat homself in 2008 herverbind het tot PHC vir gesondheiddiensverskaffing is die biomediese fokus van PHC vir sielkundige dienste inherent problematies, omdat dit in teenstelling met omvattende diskoers oor versorging staan, soos dit plaaslik en deur die Wêreldgesondheidsorgorganisasie (WHO) in die vooruitsig gestel word. Met makrovlakverskuiwings in beleid en in konteks waarin die toepaslikheid van teoretisering en praktyk op die gebied van die sielkunde onder die loep is, beklemtoon hierdie verslag dit dat onder-na-bo-benadering nodig is; spesifiek een wat sameloping tussen beleid, teorie en praktyk sal fasiliteer, en wat gegrond is op navorsing.

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Ntayiya, Witness Sakumzi. "Evaluating the quality of care for sexually transmitted infections (STI) in 14 primary health care (PHC) facilities in Umjindi local municipality, Mpumalanga Province." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&amp.

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The overall aim of this study was to evaluate quality of STI services in Umjindi local municipality. A concrete objective was to investigate the health system issues that may have a negative impact in the provision of quality STI service in the local municipality. These include accessibility of the STI services to the community, training of health workers in syndromic management, availability of necessary equipment and supplies for STI management, turn-around time for blood results and infrastructure of the facilities.

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Ferry, Sven. "Urinary tract infections in primary health care in northern Sweden : epidemiological, bacteriological and clinical aspects." Doctoral thesis, Umeå universitet, Klinisk bakteriologi, 1988. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-99337.

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The epidemiology of urinary tract infection (UTI) in the population of Vännäs (8 000 inhabitants) was studied during one year. The annual incidence increased from 0.5% in the first decade of life to more than 10% in the age group 90-100 years. Male UTI comprised only 13% of the episodes, increased after middle age and contributed 4 0% by > 80 years of age. At 17 PHC centres (PHCCs) a prevalence study (McPHC) of mainly uncomplicated UTI was performed. Most episodes were acutely symptomatic (lower 75%, upper 5%). Microscopy of wet-stained urinary sediment with a minimum of moderate amount of bacteria and/or 5 leukocytes per high power field (4 00 x) as breakpoint resulted in a desired high sensitivity (97%) and 86% efficacy in acutely symptomatic patients. Diagnosis of bacteriuria using Uricult dipslides yielded acceptable results with an overall efficacy of 88%. Nitrite test and Uriglox showed an unacceptable low mean sensitivity ofR56 and 69%, respectively. A positive nitrite, sediment or Uricult , when used in combination, was optimal in diagnosing UTI with a sensitivity of 98% in acutely symptomatic patients during their office visits. The average risk of drug resistance was 17% in the Vännäs study. Sensicult satisfactorily predicted drug sensitivity (93%) but not bacterial drug resistance (50%). Using Uricult with classification of bacteriuria by Gram-grouping, lactose and catalase reactions for targeting UTI therapy, according to local guidelines, resulted in a similar low risk (6 %) of prescribing drugs to which the organisms were resistagt as when using Sensicult (7%). This development of the Uricult method is simple and can be recommended for office practice in PHC. The spectrum of bacteria causing UTI and their drug resistance was more associated with the selection of patients, sex and age than with symptoms. The pattern of drug resistance was little influenced by UTI history and the mean pretherapy resistance for the seven drugs tested in McPHC was low (7%). Drug resistance was increased in failure (mean 24%) but not in early or repeated recurrence. In McPHC therapy resulted in 8% bacteriological failure and 12% early recurrence, irrespective of whether the bacteria were classified as sensitive or resistant in vitro to the drug given. Thus, in order to be of prognostic value for therapy of uncomplicated UTI, high-level breakpoints focusing more on peak urinary drug concentrations need to be studied. UTI symptoms in McPHC were eradicated in only 2/3 of the bacterio- logically cured episodes and in 1/3 of the failures at control 1-3 days posttherapy showing that symptoms are an unreliable indicator of UTI. From current literature, it seems unlikely that asymptomatic bacteriuria (ABU) plays a major role in the development of uremia due to chronic pyelonephritis. With the exception of ABU in pregnancy, therapy seems to yield no benefit. Omitting posttherapy bacteriuria controls in patients with symptoms eradicated, at least in women with uncomplicated UTI, would lead to considerable savings both for patients and the health care system.

Diss. (sammanfattning) Umeå : Umeå universitet, 1988, härtill 6 uppsatser.

digitalisering@umu

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Khunga, Helen. "Factors affecting detection and referral of malnourished children to Primary Health Care (PHC) level in Kanchele community of Kalomo District, Zambia." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4508.

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Magister Public Health - MPH
Background: Malnutrition in children under the age of 5 years is a global public Health problem. The UNICEF report states that 10.9 million children under five die in developing countries each year due to malnutrition. According to the Zambia Demographic and Health Survey of 2008 malnutrition is one of the main childhood illnesses in Zambia with almost 50% of the under five children being stunted. The referral system in Zambia is organized in a way that starts at the Primary Health Care (PHC) level within the community and managed by the Community Health Workers (CHW). At this level, Community Health Workers screen and identify children that have childhood illnesses which require treatment and they refer them to the Rural Health Centre (RHC). When the problem cannot be handled at the RHC level the child is referred to the district hospital or provincial hospital level within a particular province. However, most children with malnutrition arrive late at the hospital for treatment. Some of them die soon after admission. It was not clear what prevent the mothers from bringing these children early to the hospital for treatment. Methods: The main aim of the study was to explore factors that are associated with detection and referral of malnourished children from Primary Health Care (PHC) at community level to the Health centres in Kalomo district. The study was conducted in Kanchele community of Kalomo in Southern Province of Zambia. Kanchele is a rural community with most basic services such as health facilities not being easily accessed. The study focused on two PHCs which had the highest prevalence of malnutrition. All participants were asked to sign a consent form after the purpose of study had been explained to them. They were informed that all information would be treated with confidentiality and that participation was voluntary and that they had the right to chose not to participate in the study. Furthermore each participant was asked if they agreed to maintain the confidentiality of the information discussed by participants and researchers during the focus group session. The study was qualitative in nature and focus group discussions were conducted with mothers or caregivers of children under five years, community members who have lived in the community for more than one year and community health workers who have also worked in the community for more than one year. Focus group discussions were used to collect data from mothers and community members. While in-depth interviews were used to collect data from CHWs and nutrition group leaders working at the PHC and community leaders. The data collected from the focus group discussions was analysed using thematic approach. Barriers or hindrances to rehabilitating a malnourished child mentioned by the respondents included lack of knowledge on malnutrition, failure to link malnutrition to poor feeding and bad health seeking habits, poor response to referral as a result of a system which is not supported with adequate resource such as transport, a system that does not support parents with food in-case of the child being hospitalised, the current hospital system only provides food to the patient. The failure by health staff to see that malnutrition is a key childhood disease. Data from this study will be used to develop interventions to improve the management of malnourished children. Conclusion: The study shows that mothers and community members are misinformed about the causes and treatment of malnutrition. It also clearly showed that traditional healers and grandparents played an important role in the diagnosis and treatment of malnourished children in this community. Interventions to improve identification and referral of these malnourished children needs to taken into consideration.

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Taye, Mami Dorothy. "Pain assessment of children under five years in a primary health care setting / Mami Dorothy Taye." Thesis, North-West University, 2012. http://hdl.handle.net/10394/9844.

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Pain is a very common problem experienced by the general population and children in particular. It goes beyond personal suffering and affects all dimensions of the quality of life and general functioning of both adults and children, be it the physiological, psychological or financial aspects. Children may suffer from pain that may either be chronic or acute, depending on the diagnosis. Assessment of pain in children is equally important as that of adults, except that they lack the verbal fluency and cognitive development to communicate their pain. Children’s experience of pain is similar to that of adults. Pain assessment is a key aspect in the nursing management of children and delivery of care within the Primary Health Care (PHC) setting. Effective pain assessment is thus reliant on comprehensive assessment of the child and his or her pain. The aim of this research was to explore and describe practices and perceptions of professional nurses working in a PHC facility regarding pain assessment of children under five years in the Mangaung Metropolitan Municipality and to formulate recommendations for professional nurses in PHC facilities to facilitate pain assessment in PHC settings. A qualitative study design was used and data was collected with the use of focus groups. A purposive sampling was conducted to select participants who represent the target population. The sample used for the study included all the professional nurses working in PHC facilities registered with the South African Nursing Council and that have at least one year of experience. The practical training of the researcher to conduct an interview was done prior to the actual research. A pilot focus group was conducted and the interview schedule was finalised. Semi-structured focus groups were used to obtain data from the participants. The researcher conducted 6 focus group interviews attended by 32 professional nurses. Data was collected until data saturation was achieved. Trustworthiness was ensured in accordance with the principles of credibility, transferability, dependability and confirmability. Data was captured on a digital voice recorder and transcribed verbatim. Field notes were taken during each focus group. Data analysis was done by means of content analysis by the researcher and an independent co-coder. After consensus and saturation, three major themes emerged. Each theme was identified and divided into sub-themes and was consequently discussed together with the relevant data obtained from literature. The findings indicated that professional nurses perceive the assessment of pain in children under five years as a challenge. The combination of signs and symptoms to make decisions with pain assessment was identified as an area of concern. The participants further p erceived the history provided by the parent as important in the process of pain assessment. The conclusions drawn are that the professional nurses acknowledge that they don’t take sufficient notice of pain in children under five, which means that children with pain are neglected. Professional nurses maintain that there is a need for sufficient pain assessment and the need for guidelines and tools to assess pain in children under five, especially in the PHC setting. These professional nurses support the availability of guidelines to assist them to conduct effective and comprehensive pain assessment. The research report concluded with the researcher’s recommendations for nursing education, nursing research and nursing practice with specific formulation of guidelines for the facilitation of professional nurses to truly render effective and comprehensive pain assessment in PHC settings.
Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

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Karkee, Shiba Bahadur. "Issues in antibacterial provision in primary health care in Nepal /." [Cph.] : The Royal Danish School of Pharmacy, Department of Social Pharmacy, 2002. http://www.dfh.dk/phd/defences/shibabahadurkarkee.htm.

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Hamdulay, Goolam. "A cost-analysis study of primary diabetes treatment at day-hospitals and a provincial hospital in the Western Cape." University of Western Cape, 1996. http://hdl.handle.net/11394/7517.

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Masters of Commerce
The provision of health care in South Africa is undergoing major restructuring. The aim is to achieve substantial, visible and sustainable improvements to the efficiency and accessibility of primary healthcare (PHC) services for all South Africans. One of the country's most critical problems is the weak and fragmented public sector PHC system. The most critical problems contributing to this are the maldistribution of resources (financial, physical and human) between hospitals and the primary care system, and between rural and urban areas. The health sector, therefore, faces the challenge of a complete restructuring and transformation of the national health care delivery system and related institutions. Choices need to be made about which services to cut, which to streamline and where savings can be made. Ways need to be found to use ALL of South Africa's resources optimally. This process of restructuring would be facilitated by the availability of accurate information on resource utilisation in the health sector. This study estimates the difference in the cost of primary diabetes treatment at dayhospitals and a provincial hospital in the Western Cape in 1992/93. Health economics is in its infancy in South Africa and serious data limitations exist. This study is therefore a pioneering effort in many ways. An appropriate methodological framework in which to conduct the costing had to be developed. The South African health sector, health spending arid the cost of primary diabetes treatment at day-hospitals and the provincial hospital are reviewed. Theoretical perspectives of the health care market and the methodologies of cost analysis are discussed. The cost analysis method of study is chosen, and arguments are advanced for its suitability in the South African context. A simple method of calculating the direct costs to obtain the average cost is proposed for the purpose of the study. Direct costs consist of staff costs and other related costs, such as medical supplies, non-medical supplies, building operations, equipment etc. These costs are then used to calculate the average costs per diabetic patient at the day-hospitals and the provincial hospital. The average cost per diabetic patient at day-hospitals amounted to R18.76, while at the provincial hospital the cost was R59.60. https://

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Bizimenyera, Edmund Senkike. "The potential role of antibacterial, antioxidant and antiparasitic activity of Peltophorum africanum Sond. (Fabaceae) extracts in ethnoveterinary medicine." Thesis, University of Pretoria, 2007. http://hdl.handle.net/2263/26331.

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There is an increasing interest in ethnomedical and ethnoveterinary practices, especially as it relates to the use of medicinal plants for treating various ailments. As a result, the current trend in government health authorities is to integrate herbal medicine with primary healthcare. This arises because nearly 80% of people in the developing world, particularly those from rural communities where modern drugs are unaffordable, inaccessible or, unavailable, depend on phytomedicine for primary healthcare. Despite this, however, most medical and veterinary professionals distrust herbal medicines due to concerns of scientific evidence of efficacy and safety. Hence, there is need for their validation, before herbal medicines gain wider acceptance and use. Traditional healers and rural farmers use extracts of Peltophorum africanum (a medicinal plant wide-spread in southern Africa and other tropical regions), to treat diarrhoea, helminths and abdominal parasites, dysentery, HIV-AIDS, acute and chronic pain, anxiety and depression, infertility, and to promote well-being and resistance to diseases. To evaluate these ethnobotanical leads, dried leaves, bark and root from mature P. africanum (Fabaceae) trees were extracted with acetone, ethanol, dichloromethane and hexane. Chromatograms were made on silica gel plates. Thin layer chromatograms (TLC) were sprayed with 0.2% 2, 2-diphenyl-1-picryl hydrazyl (DPPH) for qualitative screening for antioxidants. Quantification of antioxidant activity was done in comparison with L-ascorbic acid and Trolox (6-hydroxy-2, 5, 7, 8-tetranethylchromane-2-carboxylic acid). With regard to the extracts, minimum inhibitory concentrations (MIC) were determined for Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Enterococcus faecalis. The total antibacterial activity (TAA), signifying the volume to which active compounds present in 1 g of plant material can be diluted and still inhibit bacterial growth, was also determined. In vitro anthelmintic activity was evaluated by effects of acetone extracts on the egg hatching and larval development of parasitic nematodes Haemonchus contortus and Trichostrongylus colubriformis. The eggs and larvae of the two parasites were incubated in various concentrations of the leaf, bark and root extracts for two and five days respectively. Furthermore the efficacies of the acetone extracts were tested on lambs artificially induced with H. contortus and T. colubriformis infections. Toxicity was performed in brine shrimp and MTT assay on Vero monkey kidney cells. The extracts had substantial activity against both Gram-positive and Gram-negative bacteria, with MIC values of 0.08 mg ml-1 for Staphylococcus aureus and 0.16 mg ml-1 for Pseudomonas aeruginosa ; the corresponding TAA values were 1263 and 631 ml g-1. The acetone extracts the bark, and root of P. africanum had higher antioxidant activity than L-ascorbic acid (Vitamin-C) and Trolox (6-hydroxy-2, 5, 7, 8-tetramethylchromane-2-carboxylic acid), a synthetic vitamin-E analogue, and much higher than Ginkgo biloba extract (EGb 761). The standardized extract of Ginkgo biloba (EGb 761) is widely employed for its significant benefit in neurological disorders. The respective EC50 for the P. africanum root , bark and leaf extracts, L-ascorbic acid, and EGb761 were 3.82 µg ml-1, 4.37 µg ml-1, 6.54 µg ml-1, 5.04 µg ml-1, and 40.72 µg ml-1. The extracts inhibited egg hatchability and larval development (from L1 to infective stage L3) of both H. contortus and T. colubriformis (both parasitic nematodes of ruminants) at concentrations of 0.2-1.0 mg ml-1. The plant extracts, at concentrations of 5-25 mg ml-1 completely lysed larval forms (L1) and eggs of the nematodes. In all assays, the root extracts had higher antibacterial, antioxidant and anthelmintic activity than the bark and leaf. Although the extracts were safe and non-toxic, the reduction in faecal egg and adult worm counts in lambs infected with H. contortus and T. colubriformis was not statistically significant (P=0.073). From the acetone extracts of the root, a brownish crystalline compound, bergenin was isolated. Bergenin was also assayed for toxicity with brine shrimp and Vero monkey kidney cells like the extracts, where the compound was found to be not toxic. In a disc diffusion test, the inhibitory activition of bergenin was determined for the bacteria E. coli, P. aeruginosa, Mycobacterium vaccae, and the fungi Sporobolomyces salmonicolor and Penicillium notatum. Bergenin had reasonable antimicrobial activity against S. salmonicolor, moderate activity against M. vaccae, E. coli and P. aeruginosa, but non inhibitory against P. notatum. P. africanum extracts have therefore, potential for treatment of infection-related diseases by either directly inhibiting bacterial growth or by stimulating the immune system of the host. The traditional use of P. africanum concoctions against diarrhoea, dysentery and unthriftness, may be also due to anthelmintic activity as these signs are consistent with parasitic astroenteritis. Antioxidants are also important in boosting the immunity, critical in the management of helminthosis. There is ample scientific and empirical evidence supporting the use of plantderived antioxidants in the control of human immunodeficiency virus (HIV) and neurological diseases. Synergistic activity of plant antioxidants has been proposed as a mechanism by which viral replication and immune cell killing in HIV infection can be inhibited. Antioxidants may have neuro-protective (preventing apoptosis), as well as neuro-regenerative roles. Due to the high antioxidant activity of its extracts, P. africanum has prospects in the chemotherapy of HIV and management or control of neurodegenerative diseases. Thus there is great potential of P. africanum extracts in medicine. Further isolation and bioassay characterization of bioactive compounds from P. africanum is recommended as well as refinement of in vivo tests in target livestock, or clinical trials. Better methods of plant extraction easily adaptable to rural communities for sustainable exploitation of the tree, may have to be devised especially those using the leaves instead of bark or root.
Thesis (PhD(Paraclinical Sciences))--University of Pretoria, 2007.
Paraclinical Sciences
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Rode, Noluvo. "The prevalence of depression in HIV positive individuals who are on anti retro-viral treatment (ART) conducted at a selected primary health care (PHC) clinic in Khayelitsha, Cape Town." University of the Western Cape, 2020. http://hdl.handle.net/11394/7279.

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Magister Curationis - MCur
Depression is defined as a psychiatric condition, wherein a person experiences extreme sadness, social withdrawal, and expresses self-deprecating thoughts. Across the world, millions of people with Human Infectious Virus (HIV) suffer from depression each year. Depression is regarded as the most common disabling medical condition that affects both HIV-positive and HIV-negative individuals, globally. It is further reported that depression is the most common neuropsychiatric disturbance observed in HIV infected individuals. In South Africa, the prevalence of depression symptoms among Antiretroviral Therapy (ART) clients is reported to be 25.4%. However, depression among this group is often underdiagnosed and untreated in Primary Health Care settings. The need for routine screening is encouraged by studies confirming that depression and anxiety disorders accelerate the progression of HIV disease. Methods A quantitative descriptive research design was used. The study population included 1 440 males and females, aged eighteen years and over, who were HIV positive and received ART at the Clinic. A randomly selected sample of 372 respondents were recruited, but 110 had to be excluded because of eligibility issues; therefore, 262 respondents completed the Beck Depression Inventory (BDI) questionnaire. Mann-Whitney U test, Fisher’s exact test and the Spearman Rank test were used to analyse the data, using GraphPad Prism software. Depression symptoms were evaluated, using BDI, and a score of -> 10 indicated depression. Results Of the 262 respondents, 52% had club membership, compared to 48%, who were only on ART. There were significantly more female respondents (44%) involved in Adherence Clubs, as opposed to their male counterparts (8%), a difference of 36% overall (p=0.016). In summary, the number of individuals, who were suffering from some form of depression, enrolled in ART Adherence Clubs was 8.4% of the total sample, compared to 10% of those who were not in ART adherence clubs. The overall prevalence of depression in this current study was 18.4 %, which was in line with other studies conducted in a South African context, and a similar setting. Clinical depression status represents the main outcome of interest in this research project. The model category was 0-10, which indicated that a significant majority, 69.5%, n= 182, of the enrolled respondents were classified as healthy, in terms of clinical depression status. Beck depression scores were consistent across gender. Depression seemed to be more severe in the 35-44 age category. Fisher’s exact test confirmed the absence of any statistical difference between ART club membership and their depression status. Spearman rank correlation coefficient of -0.02 indicates a very low association between length of HIV seropositivity and Beck Depression score. Conclusion This is the first study reporting on the prevalence of depression, in relation to HIV infection, as well as ART treatment, and the associated adherence programme in Cape Town. Further research on a similar topic is recommended, using other instruments in the same geographic area.

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Grigoletto, Marcus Vinicius Diniz. "Avaliação dos programa odontologicos para o paciente idoso nos municipios que compoem a DIR-XV - Piracicaba/SP." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/289882.

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Orientador: Marcelo de Castro Meneghim
Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
Made available in DSpace on 2018-08-07T06:29:16Z (GMT). No. of bitstreams: 1 Grigoletto_MarcusViniciusDiniz_M.pdf: 371253 bytes, checksum: d9f34e180ed751cdda4c4b8e3e314b77 (MD5) Previous issue date: 2006
Resumo: Nos últimos 35 anos observou-se um envelhecimento demográfico nos países em desenvolvimento, atingindo um crescimento de 123%, segundo a Organização das Nações Unidas. Com a diminuição da doença cárie na população jovem e com a necessidade de um atendimento universal e equânime da população, os serviços de saúde devem buscar atingir todas as faixas etárias e não apenas os grupos em idade escolar como vinha sendo feito por inúmeras equipes de saúde bucal em vários estados do Brasil. Nesta forma, buscou-se analisar e discutir as políticas públicas implantadas na área odontológica, em relação à população idosa, nos municípios da região da Direção Regional de Saúde XV (DIR ¿ XV/Piracicaba/SP) no estado de São Paulo. Foi elaborado um questionário com perguntas de planejamento, atenção e assistência em saúde e processo de trabalho envolvendo a população com mais de 60 anos de idade, encaminhado às Coordenadorias de Saúde Bucal das Secretarias Municipais dos 20 municípios que compõem a DIR, sendo que 19 responderam ao questionário. Os dados foram analisados de forma descritiva e os resultados apresentados através de tabelas. Ficou demonstrado que 68% dos municípios ainda tem a atenção à saúde bucal voltada a escolares e pré ¿ escolares, 31% dos municípios utilizam critérios epidemiológicos para planejamento de suas ações, sendo que apenas 26% fazem uso deste recurso para o planejamento das ações para a população entre 65 e 74 anos e 89,47% dos municípios utilizam a UBS como local para desenvolvimento de ações para a população idosa. Concluiu-se que apesar de evidências epidemiológicas apontarem para o envelhecimento da população, ainda é necessário a adequação dos serviços à esta nova realidade com a reorganização do processo de trabalho dentro das diretrizes dos municípios que compõem a DIR XV/Piracicaba/SP
Abstract: In the last 35 years a great demographic aging in the developing countries was observed, reaching a growth of 123% according to Organization of United Nations. With the reduction of the illness caries in the country and with the necessity of a universal attendance and equal form of the population, the health services must search to reach all not only the bands and the groups of children in pertaining to school age as it came being made for innumerable teams of buccal health in some states of Brazil. In this form, searchs to analyze and to argue the implanted public politics in the buccal health area, in relation to the aged population, the cities of the region of the Regional Direction of Health XV (DIR - XV/Piracicaba/SP) in the state of São Paulo. It was elaborated a questionnaire with questions of planning, attention and assistance in health and process of work having involved the population with more than 60 years of age, directed to the Coordination of Buccal Health of the City departments of the 20 cities that compose the DIR, being that 19 they had 19 answered to the questionnaire. The data had been analyzed of descriptive form and the results presented through tables. He was demonstrated that the majority of the cities still has the attention to the buccal health directed the pertaining to school and daily pay - pertaining to school, the great majority of the cities, does not use criteria epidemiologists for planning of its action with the aged population, as well as for the adult population. If it makes necessary the adoption on the part of the cities, of criteria of familiar and individual risk for the band of the aged ones in the planning of the basic attention. The service must be organized in the development of the work process so that the clinic increases its resolutive capacity and the education in buccal health better is worked, having the actions of health with the aged ones not to be restricted only to the Basic Unit of Health
Mestrado
Mestre em Saude Coletiva

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Weber, Ingrid Brigitte. "Evaluation of the notifiable disease surveillance system in Gauteng Province, South Africa." Diss., University of Pretoria, 2007. http://hdl.handle.net/2263/26850.

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Objectives. To describe the qualitative aspects of the notifiable diseases surveillance system of the Gauteng Province, South Africa; to conduct a cross-sectional survey on knowledge and practices pertaining to disease notification among private sector primary health care providers in Gauteng Province; to measure the degree of underreporting of notifiable diseases versus positive laboratory diagnoses using malaria as a cases study; and to identify the correctible short-comings in the Gauteng Health Department’s diseases surveillance system and to recommend ways of addressing these to improve the system and its performance. Design. This is an evaluation study consisting of both the qualitative aspects and quantitative descriptive components of the notifiable disease system in Gauteng Province. The study designs used for the qualitative description were literature and policy review and a semi-structured interview with communicable disease coordinators. The quantitative research comprised of a telephonic questionnaire administered to a random sample of private general practioners and secondary data analysis comparing malaria cases notified to the Gauteng Provincial Department of Health with public and private sector laboratory data and clinical surveillance data. Setting. The study setting was the Gauteng Provincial Health Department and public and private health care service providers in Gauteng Province. The study period extended from 1 January to 30 June 2006. Subjects. The subjects of the study were the Gauteng Health Department’s disease surveillance system, public and private sector health care providers including private primary health care practitioners. Outcome measures. Outcome measures for the qualitative system description were the status of selected system attributes namely usefulness, simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness and stability. Outcome measures for the knowledge and practice survey of private general practitioners were reporting compliance and knowledge of notifiable conditions. The primary outcome measure for the secondary data analysis was the proportion of laboratory diagnosed cases of malaria notified to the provincial health department. Results. The notifiable disease surveillance system in Gauteng is deemed useful by the public sector communicable disease coordinators but less so by the private sector general practitioners. Data quality as indicated by completeness of residential detail reporting on meningococcal notifications varied between 29% and 57% by district. Thirty seven percent of general practitioners report compliance with notifications and the mean score for knowledge on notification status of medical conditions was 56%. The sensitivity of notifications of malaria compared with laboratory notifications was 26% with relatively higher notification rates where cases occurred in children under 15 years of age. Conclusions. The notifiable disease surveillance system in Gauteng Province is relatively flexible and reasonably structured however this research suggests that there is suboptimal use of the information for local action in certain areas. Private General Practitioners self-report a low level of compliance citing time constraints and lack of motivation; knowledge of the notification status of selected medical conditions is lower than expected. The completeness and accuracy of notification data, as demonstrated in malaria notifications, is insufficient to gauge a true picture of burden of disease in the province.
Dissertation (MMed)--University of Pretoria, 2007.
School of Health Systems and Public Health (SHSPH)
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Sebastian, Paige Dement. "Examining the Use of Mental Health Screening in Rural Primary Care Settings." Xavier University Psychology / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=xavier1588687699173069.

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Almalki, Mohammed Jubran. "Quality of work life and turnover intention in primary healthcare organisations : a cross-sectional study of registered nurses in Saudi Arabia." Thesis, Queensland University of Technology, 2012. https://eprints.qut.edu.au/50766/1/Mohammed_Almalki_Thesis.pdf.

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Purpose: The purpose of this study was to improve the retention of primary healthcare (PHC) nurses through exploring and assessing their quality of work life (QWL) and turnover intention. Design and methods: A cross-sectional survey design was used in this study. Data were collected using a questionnaire comprising four sections (Brooks’ survey of Quality of Nursing Work Life [QNWL], Anticipated Turnover Intention, open-ended questions and demographic characteristics). A convenience sample was recruited from 143 PHC centres in Jazan, Saudi Arabia. A response rate of 87% (n = 508/585) was achieved. The SPSS v17 for Windows and NVivo 8 were used for analysis purposes. Procedures and tests used in this study to analyse the quantitative data were descriptive statistics, t-test, ANOVA, General Linear Model (GLM) univariate analysis, standard multiple regression, and hierarchical multiple regression. Qualitative data obtained from responses to the open-ended questions were analysed using the NVivo 8. Findings: Quantitative findings suggested that PHC nurses were dissatisfied with their work life. Respondents’ scores ranged between 45 and 218 (mean = 139.45), which is lower than the average total score on Brooks’ Survey (147). Major influencing factors were classified under four dimensions. First, work life/home life factors: unsuitable working hours, lack of facilities for nurses, inability to balance work with family needs and inadequacy of vacations’ policy. Second, work design factors: high workload, insufficient workforce numbers, lack of autonomy and undertaking many non-nursing tasks. Third, work context factors: management practices, lack of development opportunities, and inappropriate working environment in terms of the level of security, patient care supplies and unavailability of recreation room. Finally, work world factors: negative public image of nursing, and inadequate payment. More positively, nurses were notably satisfied with their co-workers. Conversely, 40.4% (n = 205) of the respondents indicated that they intended to leave their current employment. The relationships between QWL and demographic variables of gender, age, marital status, dependent children, dependent adults, nationality, ethnicity, nursing tenure, organisational tenure, positional tenure, and payment per month were significant (p < .05). The eta squared test for these demographics indicates a small to medium effect size of the variation in QWL scores. Using the GLM univariate analysis, education level was also significantly related to the QWL (p < .05). The relationships between turnover intention and demographic variables including gender, age, marital status, dependent children, education level, nursing tenure, organisational tenure, positional tenure, and payment per month were significant (p < .05). The eta squared test for these demographics indicates a small to moderate effect size of the variation in the turnover intention scores. Using the GLM univariate analysis, the dependent adults’ variable was also significantly related to turnover intention (p < .05). Turnover intention was significantly related to QWL. Using standard multiple regression, 26% of the variance in turnover intention was explained by the QWL F (4,491), 43.71, p < .001, with R² = .263. Further analysis using hierarchical multiple regression found that the total variance explained by the model as a whole (demographics and QWL) was 32.1%, F (17.433) = 12.04, p < .001. QWL explained an additional 19% of the variance in turnover intention, after controlling for demographic variables, R squared change =.19, F change (4, 433) = 30.190, p < .001. The work context variable makes the strongest unique contribution (-.387) to explain the turnover intention, followed by the work design dimension (-.112). The qualitative findings reaffirmed the quantitative findings in terms of QWL and turnover intention. However, the home life/work life and work world dimensions were of great important to both QWL and turnover intention. The qualitative findings revealed a number of new factors that were not included in the survey questionnaire. These included being away from family, lack of family support, social and cultural aspects, accommodation facilities, transportation, building and infrastructure of PHC, nature of work, job instability, privacy at work, patients and community, and distance between home and workplace. Conclusion: Creating and maintaining a healthy work life for PHC nurses is very important to improve their work satisfaction, reduce turnover, enhance productivity and improve nursing care outcomes. Improving these factors could lead to a higher QWL and increase retention rates and therefore reinforcing the stabilisation of the nursing workforce. Significance of the research: Many countries are examining strategies to attract and retain the health care workforce, particularly nurses. This study identified factors that influence the QWL of PHC nurses as well as their turnover intention. It also determined the significant relationship between QWL and turnover intention. In addition, the present study tested Brooks’ survey of QNWL on PHC nurses for the first time. The qualitative findings of this study revealed a number of new variables regarding QWL and turnover intention of PHC nurses. These variables could be used to improve current survey instruments or to develop new research surveys. The study findings could be also used to develop and appropriately implement plans to improve QWL. This may help to enhance the home and work environments of PHC nurses, improve individual and organisational performance, and increase nurses’ commitment. This study contributes to the existing body of research knowledge by presenting new data and findings from a different country and healthcare system. It is the first of its kind in Saudi Arabia, especially in the field of PHC. It has examined the relationship between QWL and turnover intention of PHC nurses for the first time using nursing instruments. The study also offers a fresh explanation (new framework) of the relationship between QWL and turnover intention among PHC nurses, which could be used or tested by researchers in other settings. Implications for further research: Review of the extant literature reveals little in-depth research on the PHC workforce, especially in terms of QWL and organisational turnover in developing countries. Further research is required to develop a QWL tool for PHC nurses, taking into consideration the findings of the current study along with the local culture. Moreover, the revised theoretical framework of the current study could be tested in further research in other regions, countries or healthcare systems in order to identify its ability to predict the level of PHC nurses’ QWL and their intention to leave. There is a need to conduct longitudinal research on PHC organisations to gain an in-depth understanding of the determents of and changes in QWL and turnover intention of PHC nurses at various points of time. An intervention study is required to improve QWL and retention among PHC nurses using the findings of the current study. This would help to assess the impact of such strategies on reducing turnover of PHC nurses. Focusing on the location of the current study, it would be valuable to conduct another study in five years’ time to examine the percentage of actual turnover among PHC nurses compared with the reported turnover intention in the current study. Further in-depth research would also be useful to assess the impact of the local culture on the perception of expatriate nurses towards their QWL and their turnover intention. A comparative study is required between PHC centres and hospitals as well as the public and private health sector agencies in terms of QWL and turnover intention of nursing personnel. Findings may differ from sector to sector according to variations in health systems, working environments and the case mix of patients.

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Al-Hosan, Ibraheem. "Patients' views on the service quality of primary health care services : a comparative study of PHC services provision by the security forces and general public sectors in Riyadh City, Kingdom of Saudi Arabia." Thesis, University of Bristol, 2005. http://hdl.handle.net/1983/dbcd28e9-9e27-4579-88b5-9e4e11b3d8b5.

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Ijezie, Echey. "An exploration of male participation in a PMTCT programme in West Itam, Akwa Ibom State, Nigeria." University of the Western Cape, 2017. http://hdl.handle.net/11394/5590.

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Magister Public Health - MPH
Since the introduction in 2005 of prevention of mother-to-child transmission of HIV (PMTCT) services in Akwa Ibom State in Nigeria the PMTCT programme has faced several challenges including that of poor male participation in the PMTCT programme. To date no research has focused on the issue of male participation in PMTCT programmes in Akwa Ibom State, and there is thus a limited understanding of why so few male partners of HIVpositive pregnant women participate in the State's PMTCT programme. It is therefore important to explore the factors affecting male involvement in PMTCT programmes in Akwa Ibom State, so that strategies can be put in place to help improve the overall health of their families and themselves. The overall aim of the study was thus to explore the factors affecting male participation in the PMTCT programme at a primary health care center in West Itam, Akwa Ibom State, in Nigeria. This explorative study was conducted using a descriptive qualitative research approach. The research study approach helped to understand the perspectives of the male partners of HIV positive pregnant women who received the PMTCT intervention, as well as key informants in the Primary Health Care (PHC) facility where these PMTCT services are offered. The study population consisted of all males living within the catchment area of the West Itam PHC, Akwa Ibom State, Nigeria. In the research study, 11 men were purposively sampled: five of whom were the partners of HIV-positive women who had attended, or were currently attending the PMTCT services at the West Itam PHC with their partner. The other six interviewees were local male community members – who would be eligible to potentially accompany their partner to PMTCT services at the facility. The data was collected through individual, in-depth interviews with the male partners and community members using a semi-structured interview guide. One focus group discussion (FGD) was conducted with key personnel working in the West Itam PHC using a semistructured interview guide. All interviews and the FGD were tape-recorded and transcribed. Thematic analysis was used to analyse the data. Ethical approval was first obtained from the UWC Research Ethics Committee and the Ethics Committee of the Akwa Ibom State Ministry of Health before proceeding with the study. From this study, it is suggested that most of the respondents knew that PMTCT services are offered at the PHC West Itam. They knew their partner's next antenatal appointment, but only very few accompany their pregnant partners to the antenatal clinic. The striking reason being a lack of time/being busy. The key means of support of the partners' antenatal visits was giving their pregnant partners money for transport, and money for food/snacks (at the clinic). Inter-spousal communication was found to be good, and there appeared to be a perception by the men that antenatal clinic (ANC)/PMTCT is not only for women, with most of the men agreeing that it is useful for men to participate in PMTCT. The barriers to male participation in the PMTCT programme that were elicited in this study include lack of belief about HIV/AIDS and lack of awareness about PMTCT and the perception of PMTCT as a "women's affair". Another barrier to male participation in the PMTCT programme was the men being busy with their jobs/lack of time, and fear. Facility-based barriers include delays/time wasting at the clinic, and the nurses, who were identified as having an unaccommodating attitude towards the clients. Finally, the fact that the nurses and counsellors at the PHC West Itam were all female was a problem for men. It is recommended that there is need for advocacy and education to raise awareness about HIV/AIDS, and encourage male participation in PMTCT. It is also important to encourage the disclosure of HIV status by the women to their male partners. Furthermore, a separate male counselling unit needs to be created, as well as ensuring the employment of male nurses and counsellors. Additionally, the female nurses at the facility need to be trained/re-trained on proper attitude and confidentiality, and efforts must be made to avoid delays at the clinic.

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Bornman, Juan 1968. "The development of a primary level communication intervention protocol for children with severe disabilities." Diss., University of Pretoria, 2001. http://hdl.handle.net/2263/27719.

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Service delivery to children with severe disabilities (CSDs) in developing countries share some common characteristics. These include inaccessible services due to the fact that the majority of services are located in a few large cities, the focus of services are usually on school-age children (with few for pre-schoolers), many services require specialised staff and high technology equipment that is not always available and professionals who tend to work in isolation with minimal integration between services. A particularly vulnerable group within the sphere of CSDs are beginning communicators because of their inability to articulate their needs, feelings and rights. Programmes to specifically address these communication needs by equipping them with the necessary skills to interact and participate in society, are very limited. Often the first contact that primary caregivers of a CSD have with professionals, is with the community health nurse. Furthermore, they often remain the only professionals who provide continuous support and assistance to these caregivers. It is therefore clear that these nurses need to be equipped with the necessary knowledge and skills in order to assist caregivers in dealing with their children with severe disabilities. This can be done by training these nurses (through multiskilling) to function as transdisciplinary professionals. Furthermore, a need for appropriate materials for service delivery to this population also exists. Consequently the BCIP (Beginning Communication Intervention Protocol) was developed. The BCIP addresses four important communication domains, namely communication means (including objects, photographs, manual signs, PCS symbols and a simplified 4-option digital speaker), functions (namely informational functions e.g. requesting more, requesting help, etc. and social functions, e.g. greeting, drawing attention to self, etc.), partners (both adults and peers) and the deliberate creation of communication opportunities (e.g. by providing small portions, placing desired items out of research) etc. Care was taken to ensure culture sensitivity and the authenticity of the BCIP. Twenty community health nurses were trained in the application of the BCIP. Training employed adult learning principles and was one week long, followed by three follow-ups that were conducted in situ (at two weeks, six weeks and five months post-training). Multiple measurements were used to evaluate the knowledge and skills acquired after training, namely questionnaires, structured interviews, skill demonstrations (which were video recorded and rated by the researcher and an independent rater) and a focus group. Results indicated that the BCIP training is relevant in bringing about a significant change in the targeted domains, namely knowledge and skills. Peripheral behaviours (namely attitudes, job satisfaction and type of service delivery provided) were all rated high at the onset of the research and thus quantitative data failed to show improvement. On the other hand, qualitative data from the focus group suggested improvement.
Dissertation (PhD (Augmentative and Alternative Communication))--University of Pretoria, 2004.
Centre for Augmentative and Alternative Communication (CAAC)
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Hansson, Maja. "Depression in primary care detection, treatment, and patients' own perspectives /." Doctoral thesis, Umeå : Division of Psychiatry, Umeå Universitet, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-30516.

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Assegaai, Tumelo. "Supervision and trust in community health worker programmes at scale: Developing a district level supportive supervision framework for ward-based outreach teams in North West Province, South Africa." University of Western Cape, 2021. http://hdl.handle.net/11394/8262.

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Philosophiae Doctor - PhD
National community health worker (CHW) programmes are to an increasing extent being implemented in health systems globally, mirrored in South Africa in the ward-based outreach team (WBOT) strategy. In many countries, including South Africa, a major challenge impacting the performance and sustainability of scaled-up CHW programmes is ensuring adequate support from and supervision by the local health system. Supervisory systems, where they exist, are usually corrective and hierarchical in nature, and implementation remains poor. In the South African context, the absence of any guidance on CHW supportive supervision has led to varied practices across the country. Improved approaches to supportive supervision are considered critical for CHW programme performance. However, there is relatively little understanding of how this can be done sustainably at scale, and effective CHW supervisory models remain elusive. Research to date has mostly positioned supervision as a technical process rather than a set of relationships, with the former testing specific interventions rather than developing holistic approaches attuned to local contexts.

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McCrindle, Cheryl Myra Ethelwyn. "A veterinary perspective on the use of animals in preschool education." Thesis, University of Pretoria, 1995. http://hdl.handle.net/2263/30212.

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The aim of this study was to investigate human-animal interactions in the triad comprising the veterinarian, the animal and the preschool and in so doing to elucidate the role of the veterinarian in the health and education of preschool children. The area of focus was a comparison of preschools in high and low income areas in and around Pretoria by means of qualitative and quantitative observational methods. It was found that all preschools investigated, included animals in the curriculum and a majority visited the zoo. Interactions included direct contact between children and animals kept permanently or temporarily at school, animal themes and topics, animal protagonists in books, videos, toys and games and excursions to the zoo, urban farms, agricultural museums and animal welfare societies. Teachers felt that child-animal interactions contributed positively to the holistic development of the preschool child, but were worried about management of animals at school and the possibility of zoonotic diseases. As protein of animal origin, such as milk, eggs, meat and fish, formed part of the diet of preschool children, this could also result in a risk of zoonotic disease, particularly in developing areas, where meat and milk hygiene were found to be inadequate. In order to address these fears, the literature was reviewed with regard to zoonotic diseases which could affect preschool children in South Africa. Incidence and prevalence were not well documented and the comparative significance could not be assessed. Therefore the comparative morbidity of diseases diagnosed by the paediatric department of a hospital serving the low income areas studied and a private practice serving the high income areas, were investigated. It was discovered that zoonotic disease formed a very minor proportion of diseases diagnosed. The diagnoses were, however, based on symptoms rather than aetiology and zoonotic causes for, in particular, respiratory and gastro-intestinal disease, could not be excluded. In the light of this, criteria were proposed for the prevention of zoonotic disease outbreaks at preschools. An outbreak of zoonotic disease at a preschool was documented and the application of primary health care principles suggested. Constraints were found to be mainly administrative. Co-operation between the departments of Health and Agriculture was complicated by financial implications which had not been budgeted. Despite this, the intervention was successful in controlling the disease and preventing further outbreaks. The presence of a veterinarian as part of the primary health care team was advocated. Within the preschool it was found that teachers lacked knowledge in the fields of animal ethology and management. Cost, ease of management and appeal to children were taken into account in the choice of animals by preschools. Rodents and birds were considered preferable to carnivores. Housing was evaluated and criteria suggested for management systems which would benefit both children and animals. Death and euthanasia of animals kept permanently at preschool was investigated and suggestions made for a teaching strategy to facilitate understanding by children of the abstract concepts of life, death and grief. A method was developed for the analysis of animal content in literature, games and toys at preschools. It was found that animals were central to the theme of a majority of the books and toys. Realistic fiction where anthropomorphic animals were the central protagonists, had most appeal for children and it was suggested that these could be used in veterinary extension materials for prevention of zoonotic diseases or promotion of animal welfare. An evaluation system was proposed which included the input of veterinary ethologists. Animal facilities visited by preschools during excursions were evaluated. It was found that they were not sufficiently child-centred and environmen¬tally safe for young children. It was suggested that veterinary public health officials should become involved in order to improve animal well-being, particularly with regard to handling facilities and hygiene. In conclusion, a schematic representation of the multitude of roles for veterinarians in the holistic development of the preschool child was drawn up. The roles for different veterinary specialities were also tabulated in order to illustrate the important part played by this profession in the health and education of preschool children.
Die doel van die studie was om mens-dier-interaksies in die driehoek tussen veearts, dier en die kleuterskool te ondersoek om sodoende die rol van die veearts in die gesondheid en opvoeding van die voorskoolse kind aan te dui. Kwalitatiewe en kwantitatiewe navorsingsmetodes is gebruik om kleuterskole in die lae en hoë inkomste-gebiede in en om Pretoria te vergelyk. Alle kleuterskole wat ondersoek is, het diere in die kurrikulum ingesluit en die meerderheid skole het uitstappies na die dieretuin onderneem. Kind-dierinteraksies het die volgende ingesluit: direkte kontak tussen kind en dier op skool; diere in temas, stories, boeke, speletjies en speelgoed; asook uitstappies na die dieretuin, landelike museums, stedelike plase en dierwelsynsorganisasies. Onderwyseresse het gemeen dat die interaksies positief bygedra het tot die holistiese ontwikkeling van die voorskoolse kind, maar het kommer uitgespreek oor bestuur en siektes van diere. Omdat proteïene van dierlike oorsprong deel uitmaak van die dieet van voorskoolse kinders, was soönose ook 'n moontlikheid, veral in kinders van ontwikkelende areas waar dit uitgewys was dat higiëne met betrekking tot vleis en melk, nie na wense was nie. 'n Literatuurstudie het aangetoon dat die algemeenheid en omvang van soönotiese siektes, wat moontlik gevaarlik kon wees vir voorskoolse kinders, nie volledig genoeg omskryf was nie. Die vergelykende morbiditeit van siektes by Ga-Rankuwa Hospitaal se kinderafdeling (pasiënte van lae-inkomste gebiede) en 'n private praktyk in die oostelike voorstede van Pretoria (hoë inkomste gebied), is dus ondersoek. Soönotiese siektes het 'n klein deel uitgemaak van die siektes wat gediagnoseer was, maar die diagnose was op simptome, eerder as die etiologie van die siektes, gebaseer. Die vermoede bestaan dat veral siektes wat gediagnoseer is as respiratories en gastro-enteries, 'n soönotiese oorsprong kon gehad het. 'n Uitbreek van 'n soönotiese siekte by 'n kleuterskool is ondersoek en daar is voorgestel dat primêre gesondheidsorgmetodes gebruik word om dit te bekamp. Teenkanting op administratiewe vlak was die belangrikste probleem wat ondervind was, maar ten spyte daarvan kon die ondersoek suksesvol verloop. Die rol van die veearts as deel van die primêre gesondheidspan is ook hierdeur beklemtoon. Binne die kleuterskool is gevind dat daar 'n gebrek aan kennis is oor diere-etologie en dierebestuur. Kostes, praktiese versorgingsmetodes en die stimuluswaarde van diersoorte, was belangrike aspekte in die keuse van diere wat by skole aangehou is. Daarom was knaagdiere, voëls en vissies meer gewild as honde en katte. Die behuising van die diere is geëvalueer volgens voorgestelde kriteria wat tot voordeel van beide diere en kinders kan strek. Die dood en genadedood van diere by twee kleuterskole is ondersoek en voorstelle is gemaak uit 'n opvoedingkundige oogpunt, om die kinders konsepte betreffende lewe, dood en rou te laat begryp en ook om dit te kan verwerk. 'n Metode is ook ontwerp vir die analise van boeke en speelgoed en daar is bewys dat diere 'n hoofrol gespeel het in die meerderheid boeke en speelgoed by voorskole. Kinders het boeke verkies waar die hoofkarakters antropomorfiese diere was en die omgewing vergelykbaar was met die lewenswêreld van kinders. 'n Voorstel is dus gemaak dat sulke karakters gebruik word om veeartsenykunde voorligtingsboodskappe oor soönotiese siektes of dierwelsyn oor te dra aan jong kinders.Stedelike plasies, die dieretuin, landboumuseums en die Dierebeskermingsvereniging in Pretoria is besoek en daar is bevind dat dit nie veilig genoeg vir jong kinders is nie. Daar word dus aanbeveei dat veeartse in diens van plaaslike owerhede se gesondheidsdienste sulke plekke besoek, om voorstelle oor verbeterde veiligheid en higiëne te maak.Ten slote is 'n skematiese voorstelling van die veelsydige rol van veeartsenykundiges in die holistiese ontwikkeling van die voorskoolse kind saamgestel. Die verskillende rolle vir verskillende spesialiteite is ook voorgelê om die belangrike bydrae van veeartsenykunde tot die gesondheid en opvoeding van voorskoolse kinders aan te dui.
Thesis (DPhil)--University of Pretoria, 1995.
Production Animal Studies
unrestricted

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Ribeiro, Elisete Maria. "Análise da Atenção Primaria à Saúde em Curitiba: enfoque nos atributos das equipes Saúde da Família." Pontifícia Universidade Católica de São Paulo, 2009. https://tede2.pucsp.br/handle/handle/18022.

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Made available in DSpace on 2016-04-29T14:17:58Z (GMT). No. of bitstreams: 1 Elisete Maria Ribeiro.pdf: 7853414 bytes, checksum: ca9d4beb14aec1e3814dc40e05452d22 (MD5) Previous issue date: 2009-11-27
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
The field of health policy has incorporated new concepts that guide the qualification and practice of health professionals, following a trend of ensuring universal health care rights. Health services have required health professionals to adopt distinguished conducts in which they play a central role in delivering technical, operational and political excellence in their practices. This is because they are jointly responsible for ensuring an accessible, humanized, egalitarian and comprehensive health care, among other principles respected by the Brazilian Health System (SUS). This research sought to analyze, from a historic and institutional perspective, the service infrastructure quality, as well as Primary Health Care workers concepts and practices underpinning the implementation and the development of the Family Health Strategy in the Health Office of Curitiba. In order to meet such demand, a new professional profile emerges with a humanized approach, as well as generalist and resolute characteristics within the Family Health Strategy practice. Based on the theories raised by the attributes described by Starfield (2002) as critical or unique in Primary Health Care (first contact, comprehensiveness, longitudinality and coordination), the secondary attributes (family-centeredness, cultural competence and community orientation) and an attribute not only assigned to Primary Health Care (proper recording), the concepts and practices adopted by the Family Health Strategy in Curitiba are analyzed. Family Health was wholly taken and implemented within a specific technical and political timeframe and in a restricted fashion. It is defended only by a portion of significant professionals aligned to understand and embrace values, principles and attributes of Primary Health Care. Significant individuals demonstrate the progresses made in the qualification of working concepts and processes and the contradictions arising from an insufficient appropriation of ideologies by new stakeholders, which impair the delivery of a qualified Family Health Care work. This study presents how the Primary Health Care in Curitiba is organized and operates, in connection with the hegemony and qualified development of a city policy
O campo da política de saúde tem agregado novas concepções que orientam a formação e a prática dos trabalhadores de saúde, em uma tendência de garantia da universalidade do direito à saúde. O trabalho em saúde tem exigido condutas diferenciadas de seus trabalhadores, na condição de protagonistas da excelência técnica, operativa e política de sua prática profissional, por se constituírem como sujeitos corresponsáveis na garantia de acesso, humanização, equidade e integralidade da atenção em saúde, entre outros princípios do SUS. A pesquisa buscou analisar, no processo histórico-institucional, a qualificação da infraestrutura de serviços, bem como as concepções e práticas dos trabalhadores em APS que fundamentam a implantação e o desenvolvimento da estratégia Saúde da Família- SF, na SMS Curitiba. Para responder a tal demanda, demonstra-se a constituição de um novo perfil profissional, de abordagem humanizada, com características mais generalistas e resolutivas da pratica profissional em ESF. Com a base teórica no campo dos atributos descritos por Starfield (2002) como essenciais ou únicos em APS (primeiro contato, integralidade, longitudinalidade e coordenação), os atributos derivados (enfoque na família, valorização dos aspectos culturais e orientação na comunidade) e um atributo não exclusivo da APS (registro adequado), fundamenta-se a análise das concepções e práticas das ESF em Curitiba. Em sua integralidade, a Saúde da Família foi apreendida e implementada em tempo técnico e político especifico, de forma restrita, defendida por apenas um segmento de profissionais significativos, alinhados em compreensão e defesa de uma base de valores, princípios e atributos da APS. Assim, os sujeitos significativos demonstram os avanços na qualificação das concepções e processo de trabalho, e da mesma forma as contradições evidenciadas por uma insuficiente apropriação de bases ideológicas e adesão por parte de novos protagonistas que comprometem a qualificação do trabalho em Saúde da Família. Demonstra-se a capacidade de organização e funcionamento da APS em Curitiba, relacionada à hegemonia e desenvolvimento qualificado de uma política municipal

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Bumgarner, D., K. Owens, J. Correll, W. T. Dalton, and Jodi Polaha. "Primary Behavioral Health Care in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/6597.

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Polaha, Jodi. "Primary Care Behavioral Health." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6676.

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Florini, Marita A. "Primary care providers' perception of care coordination needs and strategies in adult primary care practice." Thesis, State University of New York at Binghamton, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3630859.

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Problem: Medical and nursing literature poorly identify primary care providers' (PCP) relationship to care coordination (CC). Primary care providers' education, experience, and perspective, contribute to: (a) assessments of patient's care coordination needs, and (b) variability in behavior to address needs. Dissimilar approaches to CC by PCPs affect work relationships and office flow.

Purpose: To pre-pilot a new tool describing PCPs' knowledge, perception, and behavior regarding CC. Methods: Primary care physicians, nurse practitioners, and physician assistants were surveyed.

Analysis: Frequencies and percentages provided sample characteristics. Descriptive statistics analyzed provider responses within and between groups. Narratives were analyzed for themes. Tool refinement is suggested however, the tool does describe PCPs and CC activities.

Significance: A tool was developed to evaluate areas of CC activity performed by PCPs. Information from surveys of PCPs can illuminate behaviors that lead to improved work flow, efficiency, and patient outcomes. Doctors of Nursing Practice who are PCPs contribute to primary care CC through leadership, experience, and descriptive evidence.

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Foskett-Tharby, Rachel Christine. "Coordination of primary health care." Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/coordination-of-primary-health-care(987d5002-cf2f-4ece-8f53-f89ea2127e1e).html.

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Background: Improving coordination of care is a major challenge for health systems internationally. Tools are required to evaluate alternative approaches to improve coordination from the patient perspective. This study aimed to develop and validate a new measure of coordination for use in a primary care setting. Methods: Four methods were used. Firstly, a concept analysis was undertaken to identify the essential attributes of coordination drawing upon literature from health and organisational studies and to establish its boundaries with related concepts such as continuity of care, integration and patient centred care. Secondly, existing measures of coordination were reviewed to assess the extent to which item content reflected the definition arising from the concept analysis and to appraise psychometric properties. Thirdly, a new instrument, the Care Coordination Questionnaire (CCQ), was developed utilising items from existing questionnaires and others developed following focus groups with 30 patients. Ten cognitive interviews were used to evaluate the items generated. Finally, the CCQ was administered in a cross sectional survey to 980 patients. Item and model analyses were performed. Test-retest reliability was evaluated through a second administration of the CCQ after two weeks. Concurrent validity was evaluated through correlation with the Client Perceptions of Coordination Questionnaire (CPCQ). Construct validity was evaluated through correlation with responses to a global coordination item and a satisfaction scale and the testing of two a prior hypotheses: i) coordination scores would decrease with increasing numbers of providers and ii) coordination scores would decrease with increasing numbers of long-term conditions. Results: The concept analysis suggested that coordination should be considered as a process for the organisation of patient care characterised by: purposeful activity, information exchange, knowledge of roles and responsibilities, and responsiveness to change. The systematic review identified 5 existing measures of coordination and a further 10 measures which incorporated a coordination subscale. Only one demonstrated conceptual coverage but had poor psychometric properties. A new instrument was therefore developed and tested as described above. 299 completed surveys were returned. Respondents were predominantly elderly and of white ethnicity; approximately half were female. Five items were deleted following item analyses. Model analysis suggested a four factor two-level model of coordination comprising of 18 items. This correlated well with the CPCQ, the global coordination item and satisfaction scale. The a priori hypotheses were upheld. Retest reliability was acceptable at the patient group level. Conclusions: The CCQ has demonstrated good psychometric characteristics in terms of item responses, reliability and construct validity. Further exploration of these properties is required in a larger, more diverse sample before it can be recommended for widespread use, but it shows potential utility in the evaluation of different approaches to coordinating care.

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Adindu, Anthonia U. "The effect of incongruity on quality of health information systems : Bama, Nigeria PHC case study." Thesis, University of Hull, 1995. http://hydra.hull.ac.uk/resources/hull:3692.

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Generally, organisations mobilise information from varying sources on which policies, plans, objectives and organisational management are predicated. indeed, everyone within organisation needs information to perform tasks, it is thus indispensable and its use so pervasive that a methodical approach for collection and processing is imperative. In health care organisations, involved with people and life, this is even of greater significance, in many instances allowable margin of error is narrow and can be devastating.Accurate and reliable information in clinical care for example cannot be compromised.On the other hand, adequate assessment of health services quality,effectiveness and efficiency depends on quality of information generated by the system, that is, accurate, relevant, timely, understandable and complete information. To achieve this, appropriate system design and operation is essential. Adoption of primary health care (PHC), in many developing countries in response to the Global 2000, necessitated establishment of chanisms for monitoring and evaluating effectiveness of services and programmes.Accordingly, in 1986 PHC was adopted in Nigeria, concomitantly, system monitoring and evaluation or the PHC Management Information System was effexted.The information system was envisaged to ameliorate the lack of reliable health information that has persisted since nception of modern health services in Nigeria. Findings in this and other studies indicate that existing health information systems have failed to provide accurate and reliable information, systems of data generation and processing are ineffective.The aim of this was to identify and understand factors that have contributed to the seemingly intractable and insalubrious information problem within the Nigerian health care system. It would be a herculean task for a lone researcher to undertake study of the entire health system, within resource and time limitations, data collection was therefore narrowed to the PHC level. Quality of the PHC management information system was assessed, with Bama Local Government as a case study. Focus was on understanding the information system's structure from a broad perspective to include, policies, objectives,established procedures; physical, material and human resources, in terms of their quality and quantity.Data collection was carried out using both qualitative and quantitative techniques. The structure, process and outcome models provided a framework for in-depth data collection, through observation, interview, review of records and administration of questionnaire, as well as for organisation and analysis of research data. The PHC MIS was followed through, from the village, health facility, local government, state and national levels.Study results suggest general ineffectiveness due to pervasive incongruity in the information system. In the first instance design of the MIS did not reflect information needs of community health workers and the community in general,who to the most part limited appreciation of the MIS structure, objectives to be achieved. Local and regional information need was not delineated, data collected had little relevance to local information needs, resource for systems operation was abysmal, skilled personnel and training provided severely inadequate.Consequently, data collection and processing was hampered, information produced often inaccurate, untimely, immense, irrelevant and unreliable. Data collected were neither analysed nor utilised. The information system was short of being integrated since 60% of functional units within the PHC department as well as related health organisations in the community ran parallel information systems.Research data point to serious incongruity in the organisation and management of the information system. Incongruity that resulted from factors within the organisation as well derived from events within the wider social environment, which however culminated in an effective and dysfunctional information system.Chapters one to three of the thesis deal with conceptual issues related to management information systems, organisational design and quality respectively. In chapter four methodological issues surrounding data collection were discussed. Empirical data and analysis are presented are presented in chapters five to seven. In chapter eight, an attempt was made to develop a model of organisational incongruity, applied to explicate research findings.Chapter nine focuses on measures toward establishment of an effective PHC information system in Nigeria, contributions of this study and suggestions for future research.

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Polaha, Jodi. "Integrating Behavioral Health Into Primary Care." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/6648.

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Onwuliri, Michael O. "Primary health care management in Nigeria." Thesis, Aston University, 1987. http://publications.aston.ac.uk/12207/.

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This research sets out to assess if the PHC system in rural Nigeria is effective by testing the research hypothesis: 'PHC can be effective if and only if the Health Care Delivery System matches the attitudes and expectations of the Community'. The field surveys to accomplish this task were carried out in IBO, YORUBA, and HAUSA rural communities. A variety of techniques have been used as Research Methodology and these include questionnaires, interviews and personal observations of events in the rural community. This thesis embraces three main parts. Part I traces the socio-cultural aspects of PHC in rural Nigeria, describes PHC management activities in Nigeria and the practical problems inherent in the system. Part II describes various theoretical and practical research techniques used for the study and concentrates on the field work programme, data analysis and the research hypothesis-testing. Part III focusses on general strategies to improve PHC system in Nigeria to make it more effective. The research contributions to knowledge and the summary of main conclusions of the study are highlighted in this part also. Based on testing and exploring the research hypothesis as stated above, some conclusions have been arrived at, which suggested that PHC in rural Nigeria is ineffective as revealed in people's low opinions of the system and dissatisfaction with PHC services. Many people had expressed the view that they could not obtain health care services in time, at a cost they could afford and in a manner acceptable to them. Following the conclusions, some alternative ways to implement PHC programmes in rural Nigeria have been put forward to improve and make the Nigerian PHC system more effective.

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Baker, Timothy Alan. "Oregon Primary Care Physicians' Support for Health Care Reform." PDXScholar, 1994. https://pdxscholar.library.pdx.edu/open_access_etds/4755.

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This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI). This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan. Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive. Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI). While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program. This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.

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Dunkley-Hickin, Catherine. "Effects of primary care reform in Quebec on access to primary health care services." Thesis, McGill University, 2014. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=123121.

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Primary health care reform has become an area of priority in health policy with a strong importance placed on interdisciplinary teams of health care professionals. Quebec's model, the groupes de médicine de famille (GMFs), were introduced late in 2002 emphasizing team-centered approaches to service delivery and aiming to improve access to primary health care, especially to improve after-hours access and to increase the number of Quebecers with a family doctor.A decade after their implementation, I investigated the impact of GMFs on various measures of access to primary health care and perceived remaining barriers. I emphasize potential access – i.e. measures that capture whether an individual has the ability to access needed health care including having a regular medical doctor.I used data from seven waves of the Canadian Community Health Survey to capture reported access to primary care and barriers to access. GMFs emerged at different rates in different health regions across Quebec allowing the construction of a GMF 'participation' measure using the share of primary care physicians practicing in GMFs in each health region and year. I employed a modified difference-in-difference analysis design that uses multivariate regression analysis to control for time trends in the outcomes, time-invariant differences between regions and individual-level covariates in an attempt to estimate the causal impact of GMF implementation on access to primary health care.I verified that pre-policy differences in terms of population and socioeconomic characteristics between regions with ultimately high vs. low rates of GMF participation are reasonable and remain fixed over time, making comparisons of these regions appropriate. Results suggest that rates of reported access have increased over time in most Quebec health regions. However, these measures of access vary across regions and some always report lower rates of access. Controlling for time trends, fixed differences between regions, and individual characteristics, reported access does not change significantly as GMF participation increases. Improved access to primary health care was one of the principal objectives of Quebec's primary care reform a decade ago. My findings suggest that increased GMF participation has not improved several important measures of access, and that additional policy measures may be necessary to increase potential access to primary health care.
La réforme des soins de santé de première ligne occupe une place prioritaire parmi les réformes de santé, notamment avec une grande importance accordée à des équipes interdisciplinaires de professionnels de santé. Le modèle choisi par Québec, les groupes de médecine de famille (GMFs), a été mis en place à la fin de 2002. Ce modèle met l'emphase sur des équipes interprofessionnelles et vise à augmenter le nombre de Québécois avec un médecin de famille, ainsi qu'à offrir une plus grande accessibilité des services de la première ligne, notamment hors les heures normales de travail. Une décennie après leur implantation, j'ai étudié l'impact des GMFs sur diverses mesures d'accès aux soins de santé de première ligne. Je mets l'emphase sur l'accès potentiel – c'est-à-dire les mesures permettant de déterminer si un individu a la possibilité d'accéder aux soins de santé nécessaires, y compris d'avoir un médecin régulier.J'ai utilisé des données de sept cycles de l'Étude sur la santé dans les collectivités canadiennes pour capturer l'accès déclaré aux soins de première ligne et obstacles à cet accès. Il existe une variation régionale dans l'implantation des GMFs à travers les différentes régions sociosanitaires du Québec, ce qui me permet de construire une mesure de participation aux GMFs constituée de la proportion des médecins de première ligne pratiquant en GMF par région sociosanitaire et par année. J'ai employé une analyse qui consiste de modèles de différence-dans-les-différences modifiées qui utilise une analyse de régression multivariée pour contrôler les tendances temporelles, les différences constantes entre les régions, et les covariables au niveau individuel, le but étant d'estimer l'effet causal de la mise en œuvre des GMFs sur l'accès aux soins de santé de première ligne.J'ai vérifié que les différences de caractéristiques populationnelles et socio-économiques dans la période pré-politique entre les régions ayant un taux élevé par rapport à celles ayant un faible taux de participation aux GMFs sont raisonnables et fixes au cours des années de mon étude, rendant ainsi toute comparaison de ces régions appropriées. Les résultats suggèrent que les taux d'accès déclarés ont augmenté au fil du temps dans la plupart des régions sociosanitaires du Québec. Toutefois, ces mesures d'accès varient selon les régions et certains signalent toujours des taux inférieurs d'accès. Contrôlant pour les tendances temporelles, les différences fixes entre les régions, et les caractéristiques individuelles, l'accès déclaré ne change pas de manière significative avec l'augmentation de la participation aux GMFs.Un meilleur accès aux soins de santé de première ligne constituait l'un des principaux objectifs explicites de la réforme des soins de santé de première ligne de 2002. Mes résultats suggèrent que l'augmentation de la participation aux GMFs n'a pas amélioré plusieurs mesures importantes d'accès. En conséquence, des politiques supplémentaires pourraient être nécessaires pour accroître l'accès potentiel aux soins de santé de première ligne.

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Jones, Roger Hugh. "Self care and primary care of dyspepsia." Thesis, University of Southampton, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.241615.

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Mukiapini, Shapi. "Baseline measures of Primary Health Care Team functioning and overall Primary Health Care performance at Du Noon Community Health Centre." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24504.

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Background: The importance of effective team work for improving quality of care has been demonstrated consistently in research. We conducted a baseline measure of team effectiveness and a baseline measure of primary health care performance. Aim: To improve Primary health care team effectiveness and ultimately the quality and user experience of primary care at Du Noon Community Health Centre. (CHC) Setting: Du Noon CHC in the southern/western substructure of the Cape Town Metro district services. Methods: A cross sectional study using a combination of Nominal Group Technique (NGT) method and a questionnaire survey to assess PHC team effectiveness and to obtain baseline measure for Primary Health Care (PHC) organization and performance. Results: Data from 20 providers from the primary health care team, showed that the PHC team members perceived their team as a well functioning team (70% agreement on the 7 items of the PHC team assessment tool, incorporated in the ZA PCAT. The NGT method reveals that communication and leadership are the main challenges to effective team functioning, The NGT also provides ideas on how to deal with these challenges. Data from 110 users and 12 providers using the ZA PCAT: 18.2% of users rated first contact-access as acceptable to good; 47,3% rated ongoing care as acceptable to good. The remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 65% of the users. 33% of the providers (doctors and clinical nurse practitioners) rated first contact-access as acceptable to good; 25% rated ongoing care as acceptable to good, the remaining subdomains of the ZA PCAT were rated as acceptable to good by at least 50% of providers. First contact-access received the lowest acceptable to good score (18.2%) and comprehensiveness (service available) received the highest score (88.2%) from the users. For the providers the lowest acceptable to good score was for ongoing care (25%) and the highest acceptable to good score was for primary health care team (100%). The total primary scores are good (above 60%) for both users and providers but moderately higher for the providers. Conclusions: How teams perceive their effectiveness can motivate them to generate ideas for improvement. There were discrepancies between ZA PCAT (PHC team functioning) results and the NGT method results. The ZA PCAT (8 pre-existing domains) baseline results show a contrast between providers' and users' perceptions of the PHC system at Du Noon consistent with the finding of the Western Cape ZA PCAT study. We encourage Du Noon CHC to use these results to improve the user experience of primary health care services there.

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Marshall, Emily Gard. "Universal health care? : access to primary care and missed health care of young adult Canadians." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/30948.

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Prevalence of missed health care by life course stage is examined with a critique of the measure of missed care. Canadians reporting missed care has increased from 4.2% in 1995 to 12.5% in 2001. Research questions: 1. Who reports missed care in Canada? 2. What are the relationships among life course stages, social support, predisposing, enabling and need factors to the reporting of missed care? 3. What is the role that life course stages play in the relationships among social support, predisposing, enabling, and need factors? 4. What kinds of health care are Canadians reporting they missed? 5. What reasons are provide for missing care?; and 6. Who accesses primary care and what is the relationship to reporting missed care? Methods: Analysis was done using the Canadian Community Health Survey Cycle 2.1. Nested multiple logistic regression models explore the relationships among variables of interest predicting missed care. Results: Young adults (18-30) are more likely to report missed care compared to other age groups and are least likely to have a regular doctor. Social support is most significantly protective against missed care for young adults. Weak sense of belonging to a local community and lower income are stronger predictors of missed care for young adults. Young adults differ from others in the reasons they report for missed care (i.e., more likely to report cost as a barrier). Discussion: It's not clear if the difference between young adults and other life course stages is in actual missed care or expectations of primary care. Yet, the literature on emerging adulthood invites curiosity about how delayed adulthood leaves them in less stable, financially insecure, socially and institutionally isolated situations that have subsequent consequences for primary care access. Changes in models of primary care have led to a decline in comprehensive care and more drop-in clinics; while, not having a regular doctor is associated with missed care. If patterns of inadequate primary care access established in young adulthood are perpetuated in later life, this may foretell undesirable consequences for the health of Canadians. A new model for measuring unmet health care needs is proposed.
Graduate and Postdoctoral Studies
Graduate

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Skånér, Ylva. "Diagnosing heart failure in primary health care /." Stockholm, 2004. http://diss.kib.ki.se/2004/91-7349-784-3/.

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Riley, Marie Danielle Melinda Mylo. "Building collaborative partnerships in primary health care." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/44214.

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Collaboration is an increasingly adopted strategy for addressing many of society's most complex and pressing public challenges. The General Practice Services Committee’s Divisions of Family Practice initiative offers a rich example of collaborative partnerships in action within the context of the primary health care system of British Columbia. Divisions of Family Practice are community-based nonprofit organizations consisting of family physician members. Division members work in partnership with health authority administrators and other community organization representatives with the goal of working at local and regional levels, through collaborative processes, to co-design locally feasible solutions for better delivery of primary health care services leading to improved provider and patient satisfaction. The research focuses on the question, “How can Divisions create and sustain effective collaborative practices”? This question is explored through a practitioner inquiry. The inquiry includes: a description of the General Practice Services Committee and the Divisions of Family Practice initiative; a review of the relevant literature; observations and reflections on the experience of collaborative process within the Divisions initiative from my perspective as an administrator supporting the initiative; and concludes by suggesting that further study in the areas of initiative sustainability, inclusive patient involvement, and a more culturally diverse leadership would be beneficial. The findings of the inquiry support the notion that educating about the processes of collaboration, the inherent obstacles and challenges, and the role of the behaviours of the participants, are instrumental in supporting effective collaborative partnerships. The inquiry has informed the second part of thesis, a participation guide and process handbook designed to share a model, processes and tools to foster the collaborative work of the Divisions and their partners.

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Iveson, Claire. "From primary care to mental health services:." Thesis, University of Liverpool, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.490634.

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Purves, Andrew Geoffrey. "The design of primary health care buildings." Thesis, University of Newcastle Upon Tyne, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.501068.

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A study to consider the influence of architectural design on the relationship between doctor and patient and how this has changed over the ages: an examination of how political, financial and social factors have modified this relationship and the importance of understanding the design ethos expected in a building. The study is illustrated with examples of modern medical buildings.

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Poulton, Brenda Christine. "Effective multidisciplinary teamwork in primary health care." Thesis, University of Sheffield, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.339905.

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Filipe, Luís Alexandre Coelho. "Estimating demand for primary health care services." Master's thesis, NSBE - UNL, 2012. http://hdl.handle.net/10362/9543.

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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and Economics
Primary health services exist with the purpose of providing basic health care to every person at a cost they can afford. But is it fully available to everyone? The objective of this work project is to estimate the demand for primary health care services having into account that in some regions the citizens are not using as much health care as they would like due to supply side constraints. Using the number of consultations as proxy for demand, and applying an econometric tool called switching regression, the demand for primary health care services will be estimated.

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Dyer, Halie, Byron Brooks, Karen Schetzina, and Jodi Polaha. "Behavioral Health Referrals in Pediatric Primary Care." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6624.

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Integrated care is rapidly becoming the new paradigm of healthcare and with the transition into integrated practice, many providers from various disciplines must determine how best to work as a team to improve patient outcomes. One particular setting where the logistics of integrated practice must be scrutinized is pediatric primary care, specifically in rural areas, as many psychological problems are presented in pediatric primary care, and rural children are at greater risk for engaging in unhealthy behaviors, such as sedentary lifestyle, poorer nutrition, and greater substance use. All of these concerns can be ameliorated with successful referral to behavioral health consultants (BHC) who can assist in treating these various psychosocial issues. In order for the BHC to assist with patients with psychosocial concerns, other medical providers must be able to recognize and refer these patients to the BHC. The purpose of this study was to determine the prevalence of psychosocial concerns in pediatric primary care and how often the attending medical provider noticed these concerns and referred the patient for behavioral health services. The study also examined what types of psychosocial concerns were raised, and if the referral was not addressed during the same visit, the latency between the initial referral and the behavioral health service. Retrospective electronic health record data (N=300) was collected from the well visits of all 4 and 5 year old patients in 2014 from a rural Appalachian pediatric primary care clinic. Results indicated that when a psychosocial issue was raised, the majority of medical providers appropriately referred the patient to the BHC. Psychosocial concerns were raised in 21.3% (n=64) of visits. When psychosocial concerns were raised, 62.5% (n=40) were referred for behavioral health services with 87.5% (n=35) to the in house BHC. When patients were referred to the in-house BHC, 83.3% (n =30) received services immediately, while patients who were not seen immediately, 16.7% (n=5), waited for an average 21 days to be seen by the BHC. The most common psychosocial concerns raised were related to toilet training, temper tantrums, sleep hygiene, and hyperactivity. These findings highlight the high prevalence of psychosocial issues presented in rural pediatric primary care and the continued education of providers about recognizing these concerns so the appropriate referral can be made. These findings also highlight the need for more integrated practice as primary care is the often the primary source of healthcare in rural areas and by addressing all concerns about patient well-being in this setting via integrated care, patient physical and mental health outcomes can be greatly improved.

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Temmers, Lynette. "Factors influencing the collaboration between community health workers and the public primary health care facilities in delivering primary health care services." University of Western Cape, 2019. http://hdl.handle.net/11394/7655.

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Master of Public Health - MPH
Community health workers (CHWs) are integral to improve Primary health care (PHC) coverage, utilising their unique skills within the community to make services accessible and equitable. PHC is the cornerstone of the National Health Insurance (NHI) Bill for the provision of Universal Health Care (UHC). The Department of Health (DOH) in the Western Cape, South Africa, has set priorities and requirements for the provision of funding to Non-profit organisations (NPOs) for forming coalitions with the Health Department to deliver various aspects of health care. The post-2015 agenda of the Sustainable Development Goals (SDGs) are underscored by a strong sense of intersectoral collaboration to work together to attain sufficient and sustainable progress. Collaboration between CHWs and PHC facilities is important in aligning goals and activities to ensure a comprehensive and sustainable approach to ensuring UHC

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Beynon, Teresa Anne. "Developing education in palliative care for primary health care professionals." Thesis, King's College London (University of London), 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.408772.

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Baker, Robin Lynn. "Primary Care and Mental Health Integration in Coordinated Care Organizations." PDXScholar, 2017. https://pdxscholar.library.pdx.edu/open_access_etds/3616.

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The prevalence of untreated and undertreated mental health concerns and the comorbidity of chronic conditions and mental illness has led to greater calls for the integration of primary care and mental health. In 2012, the Oregon Health Authority authorized 16 Coordinated Care Organizations (CCO) to partner with their local communities to better coordinate physical, behavioral, and dental health care for Medicaid recipients. One part of this larger effort to increase coordination is the integration of primary care and mental health services in both primary care and community mental health settings. The underlying assumption of CCOs is that organizations have the capacity to fundamentally change how health care is organized, delivered, and financed in ways that lead to improved access, quality of care, and health outcomes. Using the Rainbow Model of Integrated Care (RMIC), this study examined the factors that impact organizational efforts to facilitate the integration of primary care and mental health through interviews with executive and senior staff from three CCOs. The RMIC focuses attention on the different levels at which integration processes may occur as well as acknowledges the role that both functional and normative enablers of integration can play in facilitating integration processes within as well as across levels. The following research question was explored: What key factors in Oregon's health care system impede or facilitate the ability of Coordinated Care Organizations to encourage the integration of primary care and mental health? Using a case study approach, this study drew upon qualitative methods to examine and identify the factors throughout the system, organizational, professional, and clinic levels that support CCO efforts to facilitate the integration of primary care and mental health. Fourteen primary interviews were conducted with executive and senior staff. In addition, eleven secondary interviews from a NIDA funded project as well as twenty-four key CCO documents from three CCOs were also included in this study. The RMIC was successful in differentiating extent of CCO integration of primary care and mental health. Findings demonstrate that normative and functional enablers of integration were most prevalent at the system and organization level for integrating mental health into primary care for these three CCOs. However, there was variation in CCO involvement in the development of functional and normative enablers of integration at the professional and clinic levels. Normative and functional enablers of integration were limited at all of the RMIC levels for integrating primary care into community mental health settings across all three CCOs. The Patient-Centered Primary Care Home model provided CCOs with an opportunity to develop functional and normative enablers of integration for integrating mental health in primary care settings. The lack of a fully developed model for integrating primary care services in community mental health settings serves as a barrier for reverse integration. An additional barrier is the instability of community mental health as compared to primary care; contributing factors include historically low wages and increased administrative burden. System wide conversations about where people are best served (i.e., primary care or community mental health) has yet to occur; yet these conversations may be critical for facilitating cross-collaboration and referral processes. Finally, work is needed to create and validate measures of integration for both primary care and community mental health settings. Overall findings confirm that integrating primary care and mental health is complex but that organizations can play an important role by ensuring the development of normative and functional enablers of integration at all levels of the system.

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Dissertations / Theses on the topic 'Primary health care (PHC)'

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