Role of Primary Health Care in Ensuring Access to Medicines

To examine ways of ensuring access to health services within the framework of primary health care (PHC), since the goal of PHC to make universal health care available to all people has become increasingly neglected amid emerging themes of globalization, trade, and foreign policy. From a public health point of view, we argue that the premise of PHC can unlock barriers to health care services and contribute greatly to determining collective health through the promotion of universal basic health services. PHC has the most sophisticated and organized infrastructure, theories, and political principles, with which it can deal adequately with the issues of inequity, inequality, and social injustice which emerge from negative economic externalities and neo-liberal economic policies. Addressing these issues, especially the complex social and political influences that restrict access to medicines, may require the integration of different health initiatives into PHC. Based on current systems, PHC remains the only conventional health delivery service that can deal with resilient public health problems adequately. However, to strengthen its ability to do so, we propose the revitalization of PHC to incorporate scholarship that promotes human rights, partnerships, research and development, advocacy, and national drug policies. The concept of PHC can improve access; however, this will require the urgent interplay among theoretical, practical, political, and sociological influences arising from the economic, social, and political determinants of ill health in an era of globalization.In her inaugural address to the World Health Assembly, Dr Margaret Chan, Director- General of the World Health Organization, outlined the objective of the primary health care (PHC) system in improving access to health services (1). In her speech in November 2006, Dr Chan advocated “the return to primary health care as an approach for strengthening health systems in order to ensure adequate access to health services.” Clearly, Dr Chan’s commitment to strengthen the ability of PHC to provide the fundamental prerequisites for health – sufficient food, safe water, shelter, and access to essential health care and medicines – provides an impetus for national and local efforts. Nevertheless, her leadership does not provide clear directions for exact approaches to increasing such access using the concept of PHC. It is important to address PHC concerns if this enterprise is to be legitimate and exert increasing influence on access to medicines.To reassure ourselves of what PHC can do, it is useful to consider some evidence that PHC works not only to influence policies on access to medicines, but also to re-examine health and illness, which form an intrinsic part of human life. In order to show the practicality of PHC, it is vital to substantiate Dr Chan’s arguments on PHC reforms with verifiable facts, since such claims by themselves are inadequate as a justification for policy or reforms. The efficiency of PHC reforms is not just a matter of undergoing change, but achieving a reformation that maps out clear approaches, is supported by specific evidence, and finds legitimate solutions within its own context, while being supported by political and social structures.This article explains ways of increasing access to essential medicines and begins by presenting an overview of PHC strategy in improving access to health services. The roles of PHC in improving access, and the challenges that the PHC model face in this regard, are explored within emerging themes of globalization, such as global markets, diffusion of information, and new global governance of research and development. The remainder of the article provides a critical assessment of how access to medicines can be improved through existing PHC components and structures. The issue of human rights and its relationship with PHC is highlighted. We consider the relationship between PHC and human rights as the foundation on which advocacy movements for access to health services can be based. Finally, we shift attention to discussing the building blocks that constitute PHC, and how these can be used to improve access to medicines.     

Aiding Universal Health Coverage through Humanitarian Outreach Services and Global Health Diplomacy in Resource-Poor Settings

According to the Lancet Commission Report on Global Surgery, it was estimated that in 2010 about 16.9 million lives were lost due to the unavailability of Surgical services. It was further calculated that 77.2 million DALYs could simply have been averted by providing basic surgical inspection and triage. Aiding Universal Health Coverage (UHC) through Humanitarian Outreach Services in Resource-Poor Settings is both challenging and difficult to execute. However, to promote and ensure the right to health even by vulnerable groups, the role of global health diplomacy (GHD) and humanitarian diplomacy is pivotal. GHD advances the health of the poor, contribute peacekeeping and promote health security as it is also concerned with the design, and delivery of global health interventions and programs in accordance with diplomatic criteria. The synergistic Humanitarian diplomacy is more focused in persuading decision-makers and opinion leaders to act, at all times, in the interest of vulnerable people and with full respect for our fundamental principles. Since the inclusion of surgical care in the universal basic health care services play a critical role in addressing the rising epidemic of injuries, non-communicable diseases and improving quality of life, there is a great need to address the inequities in pediatric surgical services in resource-poor settings. Hence the successful practice of GHD and humanitarian diplomacy is indispensable for establishing global partnerships, securing funding and strengthening systems to promote cost-effective and essential surgical care to achieve UHC and economic development.     

Global alliance against chronic respiratory diseases

Hundreds of millions of people of all ages suffer from chronic respiratory diseases which include asthma and respiratory allergies, chronic obstructive pulmonary disease, occupational lung diseases and pulmonary hypertension. More than 500 million patients live in developing countries or in deprived populations. Chronic respiratory diseases are increasing in prevalence. Although the cost of in action is clear and unacceptable, chronic respiratory diseases and their risk factors receive in sufficient attention from the health care community, government officials, media, patients and families. The Fifty-Third World Health Assembly recognized the enormous human suffering caused by chronic diseases and requested the World Health Organization (WHO) Director General to give priority to the prevention and control of chronic diseases, with special emphasis on developing countries. This led to the formation of the WHO Global Alliance against Chronic Respiratory Diseases (GARD). GARD is a voluntary alliance of organizations, institutions and agencies working towards a common vision to improve global lung health according to local needs. GARD is developed in a stepwise approach using the following three planning steps: estimate population need and advocate action; formulate and adopt policy; and identify policy implementation steps.     

Visions and strategies to improve evaluation of health information systems. Reflections and lessons based on the HIS-EVAL workshop in Innsbruck

BACKGROUND: Health care is entering the Information Society. It is evident that the use of modern information and communication technology offers tremendous opportunities to improve health care. However, there are also hazards associated with information technology in health care. Evaluation is a means to assess the quality, value, effects and impacts of information technology and applications in the health care environment, to improve health information applications and to enable the emergence of an evidence-based health informatics profession and practice. OBJECTIVE: In order to identify and address the frequent problems of getting evaluation understood and recognised, to promote transdisciplinary exchange within evaluation research, and to promote European cooperation, the Exploratory Workshop on "New Approaches to the Systematic Evaluation of Health Information Systems" (HIS-EVAL) was organized by the University for Health Sciences, Medical Informatics and Technology (UMIT), Innsbruck, Austria, in April 2003 with sponsorship from the European Science Foundation (ESF). Methods: The overall program was structured in three main parts: (a). discussion of problems and barriers to evaluation; (b). defining our visions and strategies with regard to evaluation of health information systems; and (c). organizing short-term and long-term activities to reach those visions and strategies. RESULTS: The workshop participants agreed on the Declaration of Innsbruck (see ), comprising four observations and 12 recommendations with regard to evaluation of health information systems. Future activities comprise European networking as well as the development of guidelines and standards for evaluation studies. CONCLUSION: The HIS-EVAL workshop was intended to be the starting point for setting up a network of European scientists working on evaluation of health information systems, to obtain synergy effects by combining the research traditions from different evaluation fields, leading to a new dimension and collaboration on further research on information systems' evaluation.     

Federal Efforts to Improve Mental Health Services for Children: Breaking the Cycle of Failure

This article describes the recently implemented Child and Adolescent Service System Program (CASSP). This program, administered by the National Institute of Mental Health, is the latest federal effort to address the provision of mental health services to children and adolescents through grants to states to improve service systems at the state and local level. The article traces the history of federal initiatives for children's mental health services, a history marked by a series of failures. Drawing from the lessons of the past failures as well as the successful effort to create CASSP, implications for the survival of CASSP and future federal initiatives are presented.     

A central dilemma in the mental health sector: Structural imbalance

Mental health services provision is persistently criticised regarding resource inadequacy. Services are also subject to another dilemma, “structural imbalance”. This study demonstrates the dimensions of structural imbalance in Australia's mental health sector by recourse to the 1997 Australian Bureau of Statistics national survey of mental health and wellbeing. This study also examines the concept by reference to the Australian Government's announced COAG initiatives (April 2006), and State government responses (July 2006). The two dimensions of structural imbalance are, first, that some people with no clinical mental illness consume mental health services and, second, that other people have clinical manifestations of mental illness and (for various reasons) do not consume mental health services; the present study shows how the situations coexist. “Throwing more money” at the pre‐existing structures may do nothing to address the structural imbalance problem. Remedies are discussed by reference to the reforms undertaken in the British National Health Service in recent years.     

Collaboration--a new IT-service in the next generation of regional health care networks

During the past 10–15 years, Regional Health Care Networks (RHCN) have been established in many regions throughout the world. RHCN build on well-known techniques, methodologies and appropriate standards. Most of the European Countries today have set up IT strategic plans that focus on the establishment of RHCN. The benefits of having access to all relevant information are tremendous and contribute to cost-effective and coherent health services. By the rapid spread and use of Internet, technology has made it possible to interconnect all kinds of applications. In 2000, the most experienced regions in Europe joined PICNIC, a European project to develop the Next Generation Regional Health Care Networks and to support their new ways of providing health and social care. The previous generation of Regional Health Care Networks supported the interconnection of applications by transfer of messages. Messaging is an effective means of integration for isolated high-specialised systems that only need to exchange data. This service will continue to be one of the most important services in the future health care networks. However, tighter coupling may be desirable in some instances to avoid replicating the same functionality in several applications. In other words, certain services can be common and used by a number of applications instead of building that service inside each application. These common services are called middleware services. In PICNIC (http://www.medcom.dk/picnic), a new middleware Collaboration IT service has been identified and developed. This service allows the end users to perform real-time clinical collaboration, with exchange of text, structured data, voice and images across the limits of a single region. A clinical collaboration is associated with the shared clinical context to provide a record of relevant clinical information and facilitates synchronous as well as asynchronous collaboration. This new IT service builds on the increasing popularity of instance messaging and presence systems that facilitate smooth transition between synchronous and asynchronous interaction. The new Collaboration IT service is expected to have a strong impact on the practice of health care in the next generation of Regional Health Care Networks.     

The Role and Place of Medicinal Plants in the Strategies for Disease Prevention

Medicinal plants have been used in healthcare since time immemorial. Studies have been carried out globally to verify their efficacy and some of the findings have led to the production of plant-based medicines. The global market value of medicinal plant products exceeds $100 billion per annum. This paper discusses the role, contributions and usefulness of medicinal plants in tackling the diseases of public health importance, with particular emphasis on the current strategic approaches to disease prevention. A comparison is drawn between the ‘whole population’ and ‘high-risk’ strategies. The usefulness of the common-factor approach as a method of engaging other health promoters in propagating the ideals of medicinal plants is highlighted. The place of medicinal plants in preventing common diseases is further examined under the five core principles of the Primary Health Care (PHC) approach. Medicinal plants play vital roles in disease prevention and their promotion and use fit into all existing prevention strategies. However, conscious efforts need to be made to properly identify, recognise and position medicinal plants in the design and implementation of these strategies. These approaches present interesting and emerging perspectives in the field of medicinal plants. Recommendations are proposed for strategising the future role and place for medicinal plants in disease prevention.     

A trans-university center for global health.

Can the challenge of improving health engage university faculty and students across all disciplines to more deeply understand the world and its people in order to make it a better place? Faculty and staff at the University of Virginia's (UVa) Center for Global Health (CGH) think it can. The authors argue that by working to understand, teach, and improve the human condition, universities can engage multiple disciplines, help reverse the "brain drain," and even change perspectives.The transuniversity Center for Global Health (CGH) at UVa employs three components for addressing global health issues: (1) scholars: sending UVa students abroad to conduct international fieldwork focused on global health, (2) fellows: inviting international colleagues selected by collaborating institutions abroad to work and train at UVa and return to become leaders in their home institutions, and (3) curricula: supporting and developing global health-related curricula throughout the university.UVa's CGH is associated with sister CGHs in Fortaleza, Brazil; Hefei, China; Manila, Philippines; Accra, Ghana; and Thohoyandou, South Africa. Work with international colleagues in these centers provides opportunities for bilateral training of the next generations of leaders in global health around the world.Universities are uniquely positioned to enlist multiple disciplines to unravel the complex causes of health disparities, sustain international collaborations, and change students' outlook on the world through overseas experiences. A university that actively supports global health becomes increasingly internationalized, grounded in scientific excellence, and committed to addressing the most pressing issues humanity faces today.     

Enquiring minds want to know: topics requested by users of a children's health information website

OBJECTIVE: To investigate health information needs of users of a health information website for children and young people. METHODS: A prospective analysis was conducted of unsolicited information requests to the Children First for Health (www.childrenfirst.nhs.uk) website, an NHS-run health and hospital online information resource for children, young people and families. All specific and general enquiries were recorded prospectively and coded according to health topic, age of the enquirer and web pages accessed. RESULTS: There were 2865 (62%) general health information and 924 (21%) specific enquiries received over an 18-month period (6.3 enquiries per day). More general enquiries were received about adolescent (64%) than children's (36%) health issues. The most common topics were psychosocial issues, hospital and health services, and normal growth and development. Only 1% of requests for information related to smoking, alcohol and drugs. CONCLUSION: Children and adolescents are active users of the Internet for health information. The results of this study highlight the health topics that are of greatest interest to children and young people. PRACTICE IMPLICATIONS: The findings provide objective data on health information topics of interest to UK children and young people and can be used to guide development of health information aimed at UK youth.     

An Indicator to Estimate the Access to Imaging Services in the Costa Rican Public Health System

The aim of this work was to develop an indicator that estimates the population's access to imaging services (IS) of health care facilities in the Costa Rican Public Health System, taking into account five aspects: (a) health care facilities infrastructure, (b) capacity of the IS according to the installed technological resources, (c) epidemiological aspects, (d) demographic aspects, and (e) location of the health facility in relation to the Capital. To achieve this, 14 variables and 7 indicators were defined. These indicators were integrated into a mathematical function which resulted in a global indicator that throws quantitative data that represents the level of access of a population to the IS in their geographic region of influence. The application of the indicator was performed in eight health facility sub-networks with defined geographical regions within the territory of Costa Rica. The level of access to the imaging service of the inhabitants of the eight sub-networks results that three of them obtained a bad access, located in east and north-central of the country; other three sub-networks obtained regular access, located in the west; and the last two who obtained a good access are located in the center of the country. The results showed that the imaging services are not equitable in each sub-network. Knowing this, it is possible to work on healthcare technology management proposals in order to strengthen the regional imaging services, contributing to decentralizing the services of the general hospitals located in the Capital.     

Catastrophic Health Expenditures for Households with Disabled Members: Evidence from the Korean Health Panel

Persons with disabilities use more health care services due to ill health and face higher health care expenses and burden. This study explored the incidence of catastrophic health expenditures of households with persons with disabilities compared to that of those without such persons. We used the Korean Health Panel (KHP) dataset for the years 2010 and 2011. The final sample was 5,610 households; 800 (14.3%) of these were households with a person with a disability and 4,810 (85.7%) were households without such a person. Households with a person with a disability faced higher catastrophic health expenditures, spending about 1.2 to 1.4 times more of their annual living expenditures for out-of-pocket medical expenses, compared to households without persons with disabilities. Households having low economic status and members with chronic disease were more likely to face catastrophic health expenditures, while those receiving public assistance were less likely. Exemption or reduction of out-of-pocket payments in the National Health Insurance and additional financial support are needed so that the people with disabilities can use medical services without suffering financial crisis.     

Health literacy in the eHealth era: A systematic review of the literature

ObjectivesThis study aimed to identify studies on online health service use by people with limited health literacy, as the findings could provide insights into how health literacy has been, and should be, addressed in the eHealth era.MethodsTo identify the relevant literature published since 2010, we performed four rounds of selection—database selection, keyword search, screening of the titles and abstracts, and screening of full texts. This process produced a final of 74 publications.ResultsThe themes addressed in the 74 publications fell into five categories: evaluation of health-related content, development and evaluation of eHealth services, development and evaluation of health literacy measurement tools, interventions to improve health literacy, and online health information seeking behavior.ConclusionBarriers to access to and use of online health information can result from the readability of content and poor usability of eHealth services. We need new health literacy screening tools to identify skills for adequate use of eHealth services. Mobile apps hold great potential for eHealth and mHealth services tailored to people with low health literacy.Practice implicationsEfforts should be made to make eHealth services easily accessible to low-literacy individuals and to enhance individual health literacy through educational programs.     

住院精神病人健康咨询问题分析

目的分析精神科住院患者所存在的心理健康问题以探讨更有效的健康咨询及健康教育对策。方法应用SPSS软件包对进行健康咨询的345例精神科住院患者所咨询的问题按照性别、年龄、住院次数、入院天数的不同进行统计分析。结果患者认为无病或病轻不愿住院为第一位，占28．8％，其次为对精神症状苦恼、康复问题、药物反应、思念亲人、人际关系、服务态度，且患者所咨询的问题与入院天数、住院次数、年龄、性别均有一定的关系。结论精神科住院患者存在有许多健康及心理问题，患者所咨询的问题反映患者的主观需要，健康咨询兼顾了患者的主观需要和客观需要，它既可以解决患者的心理和健康教育问题，又能提高患者治疗的依从性。     

Improving mental health through primary care.

The government white paper Health of the nation has highlighted mental health as a key issue for the next decade. Primary care is being encouraged to take a leading role in developing effective services for people with mental health problems. This paper reviews current research on key aspects of mental health in adults: the prevalence of mental health problems, improving detection and management of mental health problems, the role of counselling, and communication between primary and secondary care. Recommendations are made for initiatives in both research and service development.     

Keeping a Rural Psychology Presence Alive

Rural communities were brought into the national mental health picture in the 1960s in President John F. Kennedy's Community Mental Health Centers Act of 1962. The delivery of services and the human resource application of that act designated rural areas as underserved, in need of some attention. Training programs in psychology, psychiatry, social work, and nursing focused some efforts to produce professional people who could work in the rural environment. As federal initiatives in community mental health have changed, the stimuli for the continued development of rural services have lagged. A thread of concern has lingered, however, as the article by Jameson and Blank (2007) demonstrates.     

A national health program for the United States. A physicians' proposal

Our health care system is failing. Tens of millions of people are uninsured, costs are skyrocketing, and the bureaucracy is expanding. Patchwork reforms succeed only in exchanging old problems for new ones. It is time for basic change in American medicine. We propose a national health program that would (1) fully cover everyone under a single, comprehensive public insurance program; (2) pay hospitals and nursing homes a total (global) annual amount to cover all operating expenses; (3) fund capital costs through separate appropriations; (4) pay for physicians' services and ambulatory services in any of three ways: through fee-for-service payments with a simplified fee schedule and mandatory acceptance of the national health program payment as the total payment for a service or procedure (assignment), through global budgets for hospitals and clinics employing salaried physicians, or on a per capita basis (capitation); (5) be funded, at least initially, from the same sources as at present, but with all payments disbursed from a single pool; and (6) contain costs through savings on billing and bureaucracy, improved health planning, and the ability of the national health program, as the single payer for services, to establish overall spending limits. Through this proposal, we hope to provide a pragmatic framework for public debate of fundamental health-policy reform.     

Global health: the ethical responsibility of the pharmaceutical industry

Health as a global issue concerns all and clearly manifests global inequality. All stakeholders of the healthcare systems and disease treatment--including the pharmaceutical industry--have an ethical obligation to contribute to promoting global health. At Novo Nordisk we primarily focus on providing our contribution to global health through defeating diabetes. At the same time we stand by being a private company required to deliver a financial profit, which is why we must create positive results on the financial, the environmental and the social bottom lines. In this article we attempt to provide a brief overview of some of the initiatives that we think business companies can take--and therefore are also obliged to in promoting global health. Further, we have pointed out a number of dilemmas within research and development as well as business ethics that all companies face when they convert the ethical principles to daily practice globally.     

Effects of health coaching on behavioral modification among adults with cardiovascular risk factors: Systematic review and meta-analysis

ObjectivesThis meta-analysis examined effects of health coaching on physical activities, dietary behaviors, health responsibility, stress management, and smoking behaviors among populations with cardiovascular risk factors.MethodsMultiple electronic databases were searched for randomized controlled trials utilizing health coaching for people with cardiovascular risk factors to lead behavioral changes. The included studies were pooled to estimate the effect size for health coaching interventions on each of the health behaviors.ResultsThis meta-analysis included 15 randomized trials. Motivational interviewing and education sessions were common coaching interventions with telephone calls or face-to-face contacts as the main contact methods. Health coaching for health behaviors showed small but significant effect sizes on physical activities, dietary behaviors, health responsibility, and stress management except for smoking behaviors.ConclusionThe study findings support that health coaching can induce positive behavioral changes among individuals with cardiovascular risk factors. Health coaching delivered by either expert or peer coaches would be easy to apply in clinical settings.Practical implicationsHealth care professionals should be aware that health coaching could provide effective motivation strategies to improve compliance of those who need to initiate and maintain their health behaviors. Health coaching could be easily delivered via telephone calls, text messages, or short-term face-to-face coaching.