ABSTRACT
Background: The current situation of Comprehensive Primary Healthcare (CPHC) in India with reference to its characteristics is lesser known. Objectives: 1. To explore various characteristics of research based on CPHC in India. 2. To identify gaps in research on CPHC. Materials and Methods: A broad search strategy was developed to obtain articles on CPHC from PubMed and Google scholar. Out of 218 articles, 17 were explored for objectives, key findings. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) was used. Results: Most were on reproductive and child health, non-communicable diseases, and utilization & gaps in services. Only 1 study was Randomized controlled trial, followed by mixed method (n=2). Fourteen studies focussed on current situation of CPHC and none on service delivery of CPHC. Conclusion: Limited studies have been conducted on CPHC in India. Significant number of research are needed for strengthening primary health care.
ABSTRACT
An ambitious attempt to achieve the goal of universal ‘comprehensive’ primary care through health and wellness centres under the Ayushmann Bharat Scheme (ABS) has been made by the Ministry of Health and Family Welfare, Government of India. The scheme has widened the package of services available to beneficiaries and it also envisages continuum of care. However, there are pre-existing weaknesses in the three tired public health system in India which may threaten the success of this scheme. In this article we describe and analyze the newer services or initiatives at the health and wellness centres under the ABS. We also attempt to identify the Strengths, weaknesses, threats and opportunities associated with this initiative.
ABSTRACT
Se analiza el desempeño de la red del Hospital de Suba II Nivel ESE en el cumplimiento de los atributos de la APS. Se realizó una evaluación rápida que adapta la metodología propuesta por Starfield y validada por Macinko en Brasil, la cual comprende encuestas a los usuarios, profesionales, coordinadores y decisores de los servicios. Los atributos estudiados son comparados con las percepciones de los actores de instituciones ambulatorias similares del sector privado. Se encontró diferencia significativa del principio de integralidad a favor del sector público y, además, que la percepción de salud de los usuarios adultos está asociada significativamente con la evaluación positiva de la prestadora de servicios de salud y el carácter público de la misma. No obstante, existe una baja calificación del enfoque familiar y orientación comunitaria, aspectos entre otros que requieren correctivos que permitan al Hospital contribuir a mejorar la salud y la equidad en salud en esta localidad.
This study evaluated the performance of a primary health care (PHC) strategy implemented by a public health care network lead by Suba Hospital. The study was based on a rapid assessment approach that adapted Starfields methodology and was validated by Macinko in Brazil. It included surveys for patients, professionals, coordinators and decision-makers. Their perceptions are compared with those of actors in private outpatient settings. This study demonstrated significant perceived gains in comprehensiveness in the public sector, and also found that usersperceptions of health are significantly associated with the positive assessment of the institution providing primary health care services and with the public nature of the institution. However, findings also indicated poor performance with regards to family and community orientation and particular elements of other important attributes of CPHC. Strategies must be oriented to address these problems in order to allow Suba Hospital to improve its contribution to population health and equity in health.
O estudo analisa o desempenho da rede do hospital de Suba II Nível ESE no cumprimento dos atributos da APS. Realizou-se uma avaliação rápida que adapta a metodologia proposta por Starfield e validada por Mocinko no Brasil, a qual compreende pesquisas dos usuários, profissionais, coordenadores e decisórios do serviço. Os atributos estudados são comparados com as percepções dos atores de instituições ambulatórias similares do setor privado. Encontrou-se uma diferença significativa do principio da integralidade a favor do setor público, como também, que a percepção da saúde dos usuários adultos está associada significativamente com a avaliação positiva da prestadora de serviços de saúde e o caráter público da mesma. Não obstante, existe uma baixa qualificação do enfoque familiar e orientação comunitária, aspectos entre outros que requerem corretivos que permitam ao hospital contribuir para melhorar a saúde e a igualdade na saúde nesta localidade.
Subject(s)
Health Evaluation , Primary Health Care , Health PolicyABSTRACT
Describir la tendencia de un conjunto de indicadores de estado de salud y analizar el comportamiento de las disparidades en salud en las localidades de Bogotá con mayor y menor desarrollo de la estrategia de Atención Primaria Integral de Salud. Metodología: El diseño corresponde al de un estudio Observacional Ecológico que describe tendencias de los indicadores de mortalidad en menores de 5 años utilizando la información oficial de las bases de datos de mortalidad, estadísticas vitales y caracterización de Salud a su Hogar. Resultados: Los hallazgos sugieren que la estrategia de Atención Primaria Integral de Salud ha podido contribuir al mejoramiento en los resultados en salud y a la reducción de las disparidades por mortalidad en menores de cinco años en la población en desventaja social de las localidades con mayor grado de cobertura de la estrategia, en el marco de una tendencia general de disminución de la mortalidad en este grupo etáreo en la ciudad.
To describe the tendency of a set of health indicators and analyze the behavior of the disparities in health in the localities of Bogota with most and least development in the strategyof Comprehensive Primary Health Care. Methodology: The design of the study is Ecological Observation. It describes the tendencies of the mortality indicators for children below five years of age utilizing official information from the mortality database, vital statistics, and home health characterization. Results: the findings illustrate that the strategy of Comprehensive Primary Health Care has been able to contribute to the improvement of health results an the reduction of mortality disparities among children under 5 years of age within the socially disadvantaged population in the localities with a higher degree of coverage of the strategy, as part of a general tendency in decreasing the child mortality rate in the city.
Subject(s)
Primary Health Care , Health Care Levels , Health Equity , Infant MortalityABSTRACT
Se presenta el análisis situacional de los avances y vacíos estratégicos en la implementación de la estrategia de atención primaria integral en salud (APIS) en Suba, realizado con enfoque de estudio de caso y técnicas multimétodo. La investigación evidencia que los logros se deben a una estructura de gobernanza con apoyo político, gubernamental, comunitario y liderazgo del sector salud, que han permitido desarrollar un modelo de gestión fundamentado en eficiencia social y calidad. Dentro de los frutos se destaca una territorialización exitosa con una amplia cobertura, caracterización y atención de grupos prioritarios. Sin embargo, existen retos como el impacto en la sostenibilidad financiera de los servicios especializados del Hospital, y el desarrollo adecuado del enfoque familiar y comunitario, entre otros.
The study presents the situational analysis of the strategic advances and gaps of the implementation of the strategy of comprehensive primary health care (APIS) in Suba. The study follows a case study methodology and mixed-method techniques. The investigation illustrates that the achievements are due to a government structure with political, governmental, and community support, and leadership from the health sector. This has allowed the development of a management model founded in social efficiency and quality. The highlighted results includea successful territorialization with a wide coverage, characterization, and attention of priority groups. However, there are challenges such as the impact in the financial sustainability of thespecialized services of the hospital, and the adequate development of the family and community focus, among others.
Subject(s)
Primary Health Care , Case Reports , Health Equity , Health ManagementABSTRACT
Este artículo muestra los desafíos y oportunidades experimentados por los formuladores de la política de la Secretaría Distrital de Salud de Bogotá (SDS), en el proceso de diseño y puesta en práctica de un enfoque de atención primaria integral de salud (APIS), inicialmente llamada Salud a Su Hogar (Alcaldía Mayor de Bogotá, Secretaría Salud, 2004), entre finales de los años 2004-2005. En el marco de un sistema de atención de salud orientado por reglas de mercado regulado, y sin ningún apoyo de las autoridades nacionales de salud, la estrategia busca contribuir al mejoramiento de la calidad de vida y reducción de las disparidades de salud de las comunidades marginadas y excluidas de la ciudad. Los resultados iniciales son favorables a la APIS porque indican mejoramiento del acceso a los servicios sociales y de salud, potenciación de la integralidad de la atención, fortalecimiento de las actividades de prevención y promociónde la salud, y estímulo a la acción intersectorial por la salud y a la participación comunitaria.
This article shows the challenges and opportunities experienced by the Bogotá Secretary of Healths policymakers when designing and implementing a Comprehensive approach to Primary Health Care (CPHC) called Health To Your Home during the years 2004 and 2005. CPHC was used as a strategy for developing communities health through strengthening their access to health care and other social services, the development of a comprehensive approach to health care, and the improvement of their quality of life. CPHC implementation has taken place under the restrictive conditions of a market driven health care system and without any support from national health authorities. Initial results indicate that CPHC might be a usefulapproach for improving the access to and the comprehensiveness of health services provision, and may be useful as well for developing the health of excluded and marginalized communitiesby enabling the improvement of their quality of life through intersectorial action and community participation.