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@#Inequity and inequality in accessing primary healthcare services can be created by systemic and structural barriers in a health system. A recent review of Papua New Guinea’s (PNG) health system revealed that there are inequities and inequalities in primary healthcare service access. This disparity is magnified in the rural and remote regions of the country. One of the main reasons for this has been the chronic shortage in government funding. This paper presents an overview of inequities and inequalities in health and suggests some public health approaches that may improve primary healthcare service access in PNG
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Objetivo: Analisar a relevância das dimensões da Escala Brasileira de Insegurança Alimentar (EBIA). Método: Conduziu-se estudo a partir da linha de base com amostra representativa de usuários do Programa Academia da Saúde de Belo Horizonte-MG. A mensuração da insegurança alimentar foi obtida pela EBIA. Utilizou-se análise fatorial para identificar as dimensões da EBIA relevantes para os usuários do Programa.Resultado: Verificou-se elevada prevalência de insegurança alimentar (31,1%), sobretudo entre as famílias com menores de 18 anos (41,0%). Foi identificada redução do percentual de respostas afirmativas segundo a gravidade de insegurança alimentar implicada na questão, sendo queitens relacionados à insegurança alimentar leve (preocupação e acesso à alimentação saudável) apresentaram maior percentual de respostas afirmativas, enquanto aqueles correlatos à insegurança alimentar severa (fome e perda de peso), menores percentuais. Foram identificados três fatores relevantes da EBIA para famílias com menores de 18 anos: preocupação, privação e crianças/adolescentes; e para as demais famílias: preocupação, privação e fome. Conclusão: Sugere-se, assim, o uso da EBIA na Atenção Primária, visando avaliar o risco de insegurança alimentar e o delineamento de ações de promoção da saúde mais abrangentes.
Objective:The aim of the current study is to analyze the relevance of dimensions of the Brazilian Food Insecurity Scale (EBIA). Methods:Baseline study conducted with sample representative of Health Academy Program (HAP) users in Belo Horizonte MG. Food insecurity was measured based on EBIA. Factor analysis was used to identify EBIA dimensions relevant to HAP users.Results: There was high prevalence of food insecurity (31.1%), mainly among families with members younger than 18 years (41.0%). Affirmative response rates have decreaseddepending on the food insecurity severity level involved in the question.Items associated with mild food insecurity (concernedwith and access to healthy food) recorded higher affirmative response rates, whereasitems associated withsevere food insecurity (hunger and weight loss) recorded lower rates. Three relevant EBIA factors were identified for family members younger than 18 years, namely: concern, deprivation and children / adolescents, whereas relevant EBIA factors identified for other family members comprised concern, deprivation and hunger. Conclusion:EBIA should be used in Primary Care in order to assess the risk of food insecurity and the design of more comprehensive health promotion actions.
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Humans , Male , Female , Primary Health Care , Diet, Healthy , Food Insecurity , Health Promotion , Brazil , Cross-Sectional StudiesABSTRACT
Based on an analysis of the capacity bottleneck and boundaries of the valid delivery of primary healthcare service, the author proposed the capacity enhancement pathways for valid delivery of primary healthcare service. Such pathways refer to enhancing primary healthcare service by means of pairing assistance,medical consortiums and telemedicine;and motivating primary practitioners for higher capacity by means of performance appraisal and position management.
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RESUMEN Objetivo Establecer los factores asociados al uso de los servicios de salud por los adultos mayores de Cartagena-Colombia. Métodos Estudio transversal. Con una población de 66 795 adultos mayores, se estimó una muestra de 656. Muestreo estratificado. Se aplicó el cuestionario "uso de los servicios de salud". Se utilizó estadística descriptiva y regresión logística para modelar la probabilidad de ser usuario del servicio. Resultados Participaron del estudio 656 adultos mayores, con un promedio de edad de 67,9 años. Consultaron por enfermedad, en el último mes, 407 participantes (62,0 %) de los cuales 376 (92,4 %) consultó 1 o 2 veces. Residir en estrato socio-económico 4, 5 y 6) (chi² 4,14 p=0,043), tener una enfermedad diagnosticada (chi² 3,82 p=0,051), enfermedad crónica (chi² 7,0 p=0,008) o esperar 30 minutos o menos para ser atendidos (chi² 3,17 p=0,075), son factores asociados al uso de los servicios de atención primaria en salud por parte de los adultos mayores en Cartagena. En el modelo de regresión las variables tener enfermedad diagnosticada (chi²3, 59 p=0,0581) y esperar 30 minutos o menos para ser atendido (chi² 3,02 p=0,0818), fueron variables explicativas del uso de los servicios. Conclusión El uso de los servicios de atención primaria por parte de los adultos mayores en Cartagena está influido por múltiples dimensiones como residir en estrato socio-económico medio, tener enfermedad diagnosticada, padecer enfermedad crónica y esperar 30 minutos o menos para ser atendidos.
Objective Establishing the factors associated with using healthcare services for the aged in Cartagena, Colombia. Methods This was a cross-sectional study. A 656 sample-size was estimated for a population of 66,795 senior citizens; stratified sampling was used. A questionnaire entitled "Using healthcare services" (Uso de los servicios de salud) was used; descriptive statistics and logistical regression were then used for modeling the probability of being a healthcare service user. Results 656 senior citizens participated in the study; average age was 67.9 years old. 407 of the participants had consulted for disease during the last month (62.0 %); 376 of them (92.4 %) had consulted once or twice. Living in socio-economicstrata4, 5 and/or 6 (Chi² 4.14; p=0.043), having a diagnosed disease (Chi² 3.82 p=0,051), suffering from a chronic disease (Chi² 7.0; p=0.008) or waiting for 30 minutes or less to be seen (Chi² 3.17; p=0.075) were factors associated with using primary healthcare services by senior citizens in Cartagena. Having a diagnosed disease (Chi² 3.59; p=0.0581) and waiting for 30 minutes or less to be seen (Chi² 3.02; p=0.0818) were the regression model variables explaining healthcare service use. Conclusion A senior citizen using primary healthcare services in Cartagena was influenced by variables such as residing in mid-level socio-economic strata, having a diagnosed disease, suffering from a chronic disease and waiting for 30 minutes or less to be seen.
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Aged, 80 and over , Female , Humans , Male , Aged/psychology , Patient Acceptance of Health Care/statistics & numerical data , Primary Health Care , Chronic Disease , Colombia , Cross-Sectional Studies , Diagnosis-Related Groups , Housing , Income , Motivation , Patient Acceptance of Health Care/psychology , Surveys and Questionnaires , Socioeconomic Factors , Time Factors , Urban Population/statistics & numerical dataABSTRACT
A análise de instituições é assunto amplamente pesquisado na área da saúde. A cultura das organizações é entendida como uma possibilidade simbólica contida em uma dimensão maior, denominada "cultura nacional". Essa premissa justifica a incorporação da abordagem sócio antropológica aos estudos de cultura organizacional. O presente estudo propôs-se a conhecer as percepções de funcionários de dois serviços de atenção básica do município de Niterói/RJ sobre estratégias de navegação social comumente utilizadas a partir da teoria desenvolvida por Roberto DaMatta. Os resultados evidenciaram o caráter relacional associado ao estereótipo do brasileiro que se manifesta mediante conflitos decorrentes da coexistência de valores baseados no `indivíduo' e na `pessoa'. Entre eles destacam-se as distorções observadas entre discurso e prática e a mobilização de estratégias de navegação social como o "jeitinho" visando estabelecer uma mediação entre a lei impessoal e a pessoa. A forma de organização dos serviços do Programa Médico de Família de Niterói aparentemente impõe a seus funcionários o desafio concreto de equacionar o princípio igualitário que fundamenta o SUS com o conjunto de valores nos quais se baseiam as relações pessoais na sociedade brasileira.
The analysis of institutions is a widely researched area of health. The culture of organizations is understood as a symbolic possibility contained in a larger dimension, called "national culture". This premise justifies the incorporation of the social anthropological approach to the study of organizational culture. This study sought to establish the perceptions of employees of two primary healthcare services in Niterói, State of Rio de Janeiro, regarding commonly used social navigation strategies from the theory developed by Roberto DaMatta. The results showed the relational character associated with the stereotype of the Brazilian people manifested by conflicts arising from the existence of values based on the `individual' and the `person'. Among them are the distortions observed between discourse and practice, and the mobilization strategies of social navigation like "making do" - to establish a mediation between the person and the impersonal law. The organization of the services of the Niterói Family Medical Program apparently sets its employees the concrete challenge of balancing the egalitarian principle that underpins the Unified Health System (SSU) with the set of values upon which personal relations are based in Brazilian society.
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Humans , Cultural Characteristics , Primary Health Care/standards , BrazilABSTRACT
Objective Probing into the primary healthcare capabilities of healthcare clinics in the four provinces in China's west,in order to recommend the government in making relevant policies.Results It is found that among those village doctOrs under 45 years of age,76.0%have senior high school diploma/secondary technical school education,89.6%have rural doctor certificates;those above 45 years old,59.5%have middle school education,96.9%have rural doctor certificates,and 1.6%have licensed assistant doctor certificates.x2check is statistically significant,as the village doctors born in different eras have different composition of education and different percentage of qualification certificates.44.44% of the village clinics have less than three rooms,and 41.11%occupy less than 40 square meters.Only 19.44%of the clinics receive funding for their medieal facilities from higher authorities.Conclusion It is imperative to enhance resources input tO the staff and facilities of village clinics in the west,to cater to the primary healthcare needs of the local people.