Rural Health Care in Bolivia*

ABSTRACT: Eighty percent of Bolivians live in rural areas. However, because of a lack of resources and an urban / curative health sector orientation, rural primary health care services are woefully inadequate. Consequently, Bolivia has the worst health conditions of any of the Latin American countries. The broader factors which underlie Bolivia's poor health conditions, such as the low standard of living and impediments to socioeconomic development, are reviewed. Rural primary health programs are hampered by a lack of local support, overdependence on central and distant Ministry of Health supervisory staff, a lack of strong national political support for rural primary health care programs, the absence of public sector support for social programs, and a lack of appropriately trained health providers who are comfortable in the rural sociocultural mileu of community-oriented primary health care. The experience of Andean Rural Health Care is briefly described, and the potential contribution of private organizations working with local communities and with the Ministry of Health is addressed. The most viable option for improving rural primary health care in Bolivia is the census-based community-oriented approach.     

Managing Mental Health Problems Among Immigrant Women Attending Primary Health Care Services

Researchers in Norway explore treatment options in primary care for immigrant women with mental health problems compared with nonimmigrant women. Three national registers were linked together for 2008. Immigrant women from Sweden, Poland, the Philippines, Thailand, Pakistan, and Russia were selected for analysis and compared with Norwegian women. Using logistic regression, we investigated whether treatment type varied by country of origin. Rates of sickness leave and psychiatric referrals were similar across all groups. Conversational therapy and use of antidepressants and anxiolytics were lower among Filipina, Thai, Pakistani, and Russian women than among Norwegians. Using the broad term “immigrants” masks important differences in treatment and health service use. By closely examining mental health treatment differences by country of origin, gaps in service provision and treatment uptake may be identified and addressed with more success.     

Managing Influenza in Primary Care

Influenza remains a significant cause of worldwide morbidity and mortality. With the availability of new effective antivirals for the treatment of influenza, early diagnosis of the disease will become increasingly important for effective disease management.Although investigators are generally in broad agreement about the symptoms of influenza, there are currently no agreed guidelines for the clinical diagnosis of influenza during annual outbreaks. This paper outlines the recommendations of a Working Party (comprising virologists and family practitioners) who met to construct criteria that could be used by primary healthcare professionals to aid early clinical diagnosis of influenza, i.e. before the development of any complications.A virologically confirmable diagnosis of influenza is likely when an otherwise healthy adult presents, during a known local influenza outbreak, with rapid onset of the symptom complex of fever, feverishness or chills plus myalgia, cough or malaise. Guidelines for the diagnosis of influenza in children, in patients with chronic diseases and in the elderly require further refinement.     

Integrated Behavioral Health for Preschool Children in Pediatric Primary Care

Behavioral problems in preschool children have led to increased rates of expulsion and suspension from preschool. This case report describes the management of children aged 0–5 with behavioral concerns in a pediatric practice. Identified children were referred to an integrated behavioral health provider who provided accessible evaluation and treatment to parents and children, as well as consultation to childcare providers. The report describes case examples of how these services prevented adverse outcomes at the preschool age for three children.

     

Managing the 'seamless service': Primary Care Groups in the new NHS.

This paper reports on empirical work examining the consequences for the development of the role of Primary Care Groups of the shift from competition (in the internal market) to relationships based on collaboration and partnership. Previous work (Conway and Willcocks, 1998; Willcocks and Conway, 1999) firstly developed a conceptual framework emphasizing the development of relationships between Primary Care Groups and their key stakeholders (for example, Health Authorities, Local Authorities and Trusts) and, secondly, sought to test this framework empirically through case study analysis of two Primary Care Groups in the north of England. This paper takes the research further and focuses on one of these Primary Care Groups, providing an in-depth analysis of particular issues such as the rationale for the particular configuration of this organization and the chosen working arrangements, the role and function of the Board and individual members, and the problems encountered in the first year of operation.     

Correction to: Integrated Behavioral Health for Preschool Children in Pediatric Primary Care

The Journal of Behavioral Health Services & Research -     

Integrated Care: Enhancing the Role of the Primary Health Care Professional in Preventing Functional Decline: A Systematic Review

Background

Although the older population is increasing worldwide, there is a marked deficit in the number of persons trained in geriatrics. It is now recognized that early detection and treatment of geriatric syndromes (frailty, sarcopenia, anorexia of aging, and cognitive decline) will delay or avert the development of disability.

Practice Facilitation in Integrated Behavioral Health and Primary Care Settings: a Scoping Review

The Journal of Behavioral Health Services & Research - Little is known about the contributions of practice facilitators in settings aiming to deliver integrated behavioral health and primary...     

Developing Tomorrow's Integrated Community Health Systems: A Leadership Challenge for Public Health and Primary Care

As the nation's health system moves away from earlier models to one grounded in population health and market-based systems of care, new challenges arise for public health professionals, primary care practitioners, health plan and institutional managers, and community leaders. Among the challenges are the need to develop creative concepts of organization and accountability and to assure that dynamic, system-oriented structures support the new kind of leadership that is required. Developing tomorrow's integrated community health systems will challenge the leadership skills and integrative abilities of public health professionals, primary care practitioners, and managers. These leaders and their new organizations must, in turn, assume increased accountability for improving community health.     

初级卫生保健体系研究

世界各国卫生体制改革的共同目标是改进初级保健的可及性、持续性、连续性和质量,实现人群卫生需求的公平性和成本效果,从而提高居民的健康水平、疾病风险分担能力和满意度.文章总结了部分国家初级卫生保健体系构成、改革动力及发展趋势,并重点介绍了国际公认发展模式较为成熟的荚国、澳大利亚初级卫生保健体系的组织形式、筹资机制与发展进程,以期获得对我国卫生体制改革的启示.     

Managing Costs, Managing Benefits: Employer Decisions in Local Health Care Markets

Objectives.  To better understand employer health benefit decision making, how employer health benefits strategies evolve over time, and the impact of employer decisions on local health care systems.
Data Sources/Study Setting.  Data were collected as part of the Community Tracking Study (CTS), a longitudinal analysis of health system change in 12 randomly selected communities.
Study Design.  This is an observational study with data collection over a six-year period.
Data Collection/Extraction Methods.  The study used semistructured interviews with local respondents, combined with monitoring of local media, to track changes in health care systems over time and their impact on community residents. Interviewing began in 1996 and was carried out at two-year intervals, with a total of approximately 2,200 interviews. The interviews provided a variety of perspectives on employer decision making concerning health benefits; these perspectives were triangulated to reach conclusions.
Principal Findings.  The tight labor market during the study period was the dominant consideration in employer decision making regarding health benefits. Employers, in managing employee compensation, made independent decisions in pursuit of individual goals, but these decisions were shaped by similar labor market conditions. As a result, within and across our study sites, employer decisions in aggregate had an important impact on local health care systems, although employers' more highly visible public efforts to bring about health system change often met with disappointing results.
Conclusions.  General economic conditions in the 1990s had an important impact on the configuration of local health systems through their effect on employer decision making regarding health benefits offered to employees, and the responses of health plans and providers to those decisions.     

The Primary Health Care Project in Belgium: a survey on the utilization of health services

The article consists of two major parts. In the Introduction a general overview is given of the Primary Health Care Project, carried out in Belgium from 1975 to 1978 in the broader framework of a large National Project in the Social Sciences. An explanation is given of the scope of the study, its method and sampling. Since the very broad study design, it was decided to make a selection of interesting results. An overview is given of the most relevant data with respect to the utilization of health care services and of medicines. After a short clarification of the concept of utilization behaviour, some data are presented in order to describe the use of medical services and the consumption of medicines. Secondly an attempt is made to explain utilization behaviour. For the explanatory model used in this project, the WHO-model functioned as an important source of inspiration. In this way it surmounted the limitations of much previous research. This model included variables on the level of the individual-perceived morbidity, predisposing factors and enabling factors-as well as system variables--such as degree of urbanization, proximity and the way of functioning of the medical supply. The research results have successfully shown that: there is a strong relationship between perceived presence and perceived seriousness of morbidity on the one hand, utilization behaviour on the other hand; the health perspective (including medical knowledge, values and attitudes) seems to have a differential influence on utilization behaviour, depending on age and social background of the respondent; the inclusion of socio-structural variables is an innovation in the Belgian health care research. The hypothetical character of the relationships found here is largely supported by the research simultaneously conducted in the French-speaking region of Belgium; accessibility and socialization are factors having a clear influence on the use of general practice services. The importance of the presence and the organization of the supply in the explanation of utilization behaviour is partly confirmed.     

Managing Conscientious Objection in Health Care Institutions

It is argued that the primary aim of institutional management is to protect the moral integrity of health professionals without significantly compromising other important values and interests. Institutional policies are recommended as a means to promote fair, consistent, and transparent management of conscience-based refusals. It is further recommended that those policies include the following four requirements: (1) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s/surrogate’s timely access to information, counseling, and referral. (2) Conscience-based refusals will be accommodated only if a requested accommodation will not impede a patient’s timely access to health care services offered within the institution. (3) Conscience-based refusals will be accommodated only if the accommodation will not impose excessive burdens on colleagues, supervisors, department heads, other administrators, or the institution. (4) Whenever feasible, health professionals should provide advance notification to department heads or supervisors. Formal review may not be required in all cases, but when it is appropriate, several recommendations are offered about standards and the review process. A key recommendation is that when reviewing an objector’s reasons, contrary to what some have proposed, it is not appropriate to adopt an adversarial approach modelled on military review boards’ assessments of requests for conscientious objector status. According to the approach recommended, the primary function of reviews of objectors’ reasons is to engage them in a process of reflecting on the nature and depth of their objections, with the objective of facilitating moral clarity on the part of objectors rather than enabling department heads, supervisors, or ethics committees to determine whether conscientious objections are sufficiently genuine.