Training primary health care workers in Upper Volta

In collaboration with aid agencies and government health workers, Save the Children Fund medical staff have been involved in the training of primary health care workers in the Sahel region of Upper Volta. This report deals specifically with the problems involved in training illiterate health workers.     

Mobility of primary health care workers in China

Background  

Rural township health centres and urban community health centres play a crucial role in the delivery of primary health care in China. Over the past two-and-a-half decades, these health institutions have not been as well developed as high-level hospitals. The limited availability and low qualifications of human resources in health are among the main challenges facing lower-level health facilities. This paper aims to analyse the mobility of health workers in township and community health centres.     

Training health workers for primary care in a developing health service

To provide primary health care in a thinly populated mountainous country with few doctors presents great difficulties. The Royal Government of Bhutan decided to base their primary medical care service on appropriately trained medical auxilliaries. The training programme is described, and the problems of assessing the field activities discussed.     

Nurses bring primary health care to industrial workers

Progress in bringing health care to the workplace lags considerably behind progress in bringing health care to where people live. Experience in Botswana shows that the family nurse practitioner--a registered nurse midwife with one year of post-basic training--can provide useful preventive and curative services to people in their places of work.     

Hepatitis B vaccination among primary health care workers

Health care workers' immunization against hepatitis B is an essential measure to avoid occupational transmission of hepatitis B virus at primary health care centers. The aims of this study were to investigate the prevalence of complete-series vaccination against hepatitis B, estimate the prevalence of confirmed immunity, and verify the factors associated with complete-series vaccination among primary health care workers in Florianópolis, Santa Catarina State, Southern Brazil. A total of 1,249 primary health care workers participated in this study. The prevalence of complete hepatitis B vaccination was 64.61%, and 29.82% of workers indicated knowing they were immunized after taking a serological test to confirm immunity. In the adjusted analysis, complete-series vaccination was positively associated with higher level of schooling and contact with potentially infectious materials or sharps, and negatively associated with precarious employment status and current smoking. Educational measures are recommended to achieve vaccination of health workers who have not been vaccinated or have not completed the series and to inform on the need for vaccine response monitoring.     

Management of needed health care workers in primary care. Automating the calculation

The Santa Coloma de Gramenet Primary Care Service has designed a new tool to standardize and automate the process of planning the number of needed health care workers. The tool is divided in two parts: a calculator, which gives guidance on the foreseeable risk depending on the activity and the health care workers' workload, and sentinel indicators; the main is the "welfare basic level", that is the percentage structure of visited patients and their delay at 2, 3 and 7 calendar days, assessing the impact on the care of the population. The results of its use in the summer of 2010 have demonstrated its efficiency by lowering the needed workers with respect to 2009, achieving a better distribution according to the workload and improving the economic management. Given that the necessary data are accessible through computerized databases and its simple use, we believe it to be exportable to other fields.     

Can computers improve patient care by primary health care workers in India?

OBJECTIVE: The objective was to test whether a decision support technology for non-physicians can increase health care utilization and quality. DESIGN: Before and after measurements were taken from a systematic random sample of patients and staff at randomly assigned intervention and control facilities. SETTING: The study took place at primary health facilities in rural Tamil Nadu, India. PARTICIPANTS: One thousand two hundred and eighty-six patients and 82 staff were interviewed. INTERVENTION: A computer-assisted decision support technology was introduced to assist with patient screening. MAIN OUTCOME MEASURES: Outcome measures included new patient visits per month, a Global Patient Assessment of Care Index, and health worker attitude variables. RESULTS: There was a difference of difference of 430 new patient visits per month at the intervention sites (P = 0.005), an increase from baseline of 18% at intervention sites compared with a decline of 5% at control sites. The intervention was associated with significant improvements in a Global Patient Assessment of Care Index (mean difference of difference 7.9, P < 0.001). The largest gains were made in patient communication, technical quality, and general satisfaction with care. The attitudes of public health workers toward the new technology and their jobs did not change. CONCLUSIONS: Decision support technologies have considerable potential to improve coverage and quality of health care for the poor and where there is no doctor, but the unreceptive attitude of public health workers would need to be overcome. Application of these technologies should take advantage of their popularity with patients and the opportunity to work through the private sector.     

Mass produced village health workers and the promise of primary health care

The most evident aspect of primary health care (PHC) development in many countries is the mass recruitment and training of village health workers (VHWs). These VHW schemes are often merely an extension of the organized government health services. This paper takes the view that over emphasis of VHWs is a fatal limitation and narrowing of the original idea of PHC. In the spirit of PHC, communities should be allowed to go through the process of identifying their problems, sorting out their priorities, means of solving identified problems through the material and human resources they have at their disposal. Before communities have been allowed to go through such a process, the selection of VHWs is at best, an imposition from above. PHC is thus robbed of its most fundamental components, of community participation, self-determination and self-reliance.     

Occupational health in health care workers

Since the second half of the 20th century occupational health in health care workers is a well-established part of occupational medicine. Identification of environmental, biological, chemical, physical, and psychosocial hazards has lead to a number of preventive measures: Technical (e.g. use of safe instruments and double gloving as protection) and immunological (vaccinations) measures against biological hazards), and technical (lifting aides) and personal (back-schools) intervention to prevent musculoskeletal disorders are well-designed examples.     

Training primary health care workers to foster community participation.

A low level of community participation was identified as one of the weaknesses of the health sector in the United Republic of Tanzania. In order to remedy this situation, a systematic process of training trainers and students was established with full involvement of village people. Twenty-five themes were put forward as starting points for discussions between students and villagers. The students were encouraged to learn from the villagers by listening to them and asking them questions. They also participated in community activities and lived with villagers so as to obtain a good understanding of rural living conditions. In this way, problems were identified and solutions were jointly formulated. A workbook was developed during a series of workshops with students, trainers, village communities, and planners. At least two teachers were trained from each health training school; all schools were supplied with workbooks. The approach has been adopted by most health training schools in Tanzania, and the Ministry of Health is now committed to it. Both students and trainers find this to be a valuable learning experience.     

Community health workers and integrated primary health care teams in the 21st century

Community health workers are an integral part of many healthcare systems. Their roles vary and include both the socially oriented tasks of natural helpers and specific constrained tasks of health extenders. As natural helpers, community health workers play an important role in connecting public and primary care to the communities that they serve. As primary health care becomes more patient-centered and community-oriented, the natural helper roles that include trust, rapport, understanding, and the ability to communicate with the community take on an increased significance. Community health workers are effective and make the health care system more efficient. In some states, the community health worker has become a more formal member of the integrated primary health care team, and it is in this role that she or he provides structured linkages between the community, the patient, and the health care system. The effective community health workers are strongly embedded in the communities that they serve; they have clear supervision within the health care system; they have clearly defined roles in the health care system; and they are well trained and have a defined system of advancing their education and roles within the health care system.     

Community health workers "101" for primary care providers and other stakeholders in health care systems

Today's ambulatory care providers face numerous challenges as they try to practice efficient, patient-centered medicine. This article explains how community health workers (CHWs) can be engaged to address many patient- and system-related barriers currently experienced in ambulatory care practices. Community health workers are frontline public health workers who serve as a trusted bridge between community members and health care providers. Among their varied roles, CHWs can educate and support patients in managing their risk factors and diseases and link these patients to needed resources. As shown in this overview (CHW 101), including CHWs as members of multidisciplinary care teams has the potential to strengthen both current and emerging models of health care delivery.     

Improving motivation among primary health care workers in Tanzania: a health worker perspective

In Tanzania access to urban and rural primary health care is relatively widespread, yet there is evidence of considerable bypassing of services; questions have been raised about how to improve functionality.     

Contributing to the wellbeing of primary health care workers in PNG.

PURPOSE: The purpose of this paper is to investigate how organisational frames of reference, which are neither not appropriately communicated nor supported, affect the wellbeing of workers. DESIGN/METHODOLOGY/APPROACH: A review of the literature is used to develop a new model linking ambiguous frames of reference with reduced levels of workers' wellbeing. This is then tested using data collected in a study involving primary health care workers in Papua New Guinea (PNG). FINDINGS: This paper finds that, for these particular workers, the model linking ambiguous frames of reference and reduced worker wellbeing is valid. RESEARCH LIMITATIONS/IMPLICATIONS: The paper shows that there is a need for further research into a variety of areas including the importance of frames of reference to worker wellbeing, the significance of reference groups to organisational frames of reference and the consequences of reduced worker wellbeing in developing countries. PRACTICAL IMPLICATIONS: In this paper, recommendations for changes to current PNG primary health care management practices, including ensuring the support for as well as communicating the organisational frame of reference, are discussed. ORIGINALITY/VALUE: The paper shows that the experiences of these particular primary health care workers not only demonstrates the validity of the new model but also brings a unique perspective to the field of worker wellbeing, which up until now has been dominated by research conducted in western countries.     

深圳市某区社康中心医务人员麻风病知识调查

深圳市曾经是麻风病的中度流行区,1962年麻风病患病率高达0.6322‰[1],经过麻风病防治工作人员艰辛的工作和努力,1996年达到卫生部基本消灭麻风病的标准,患病率下降至1/10万以下,近几年一直维持在0.001 9%左右,处于麻风病低流行阶段,麻风病防治工作重点转移到以早期发现及宣传教育方面为主.