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      The knowledge, ability, and skills of primary health care providers in SEANERN countries: a multi-national cross-sectional study

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          Abstract

          Background

          Primary health care (PHC) is usually the initial point of contact for individuals seeking to access health care and providers of PHC play a crucial role in the healthcare model. However, few studies have assessed the knowledge, ability, and skills (capacity) of PHC providers in delivering care. This study aimed to identify the capacity of PHC providers in countries of the Southeast and East Asian Nursing Education and Research Network (SEANERN).

          Methods

          A multi-national cross-sectional survey was performed among SEANERN countries. A 1–5 Likert scale was used to measure eight components of knowledge, ability, and skill of PHC providers. Descriptive statistics were employed, and radar charts were used to depict the levels of the three dimensions (knowledge, skill and ability) and eight components.

          Results

          Totally, 606 valid questionnaires from PHC providers were returned from seven countries of SEANERN (China, Myanmar, Indonesia, Thailand, Vietnam, Cambodia, and Malaysia), with a responsive rate of 97.6% (606/621). For the three dimensions the ranges of total mean scores were distributed as follows: knowledge dimension: 2.78~3.11; skill dimension: 2.66~3.16; ability dimension: 2.67~3.06. Furthermore, radar charts revealed that the transition of PHC provider’s knowledge into skill and from skill into ability decreased gradually. Their competencies in four areas, including safe water and sanitation, nutritional promotion, endemic diseases prevention, and essential provision of drugs, were especially low.

          Conclusions

          The general capacity perceived by PHC providers themselves seems relatively low and imbalanced. To address the problem, SEANERN, through the collaboration of the members, can facilitate the appropriate education and training of PHC providers by developing feasible, practical and culturally appropriate training plans.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-019-4402-9) contains supplementary material, which is available to authorized users.

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          Most cited references16

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          Projecting US primary care physician workforce needs: 2010-2025.

          We sought to project the number of primary care physicians required to meet US health care utilization needs through 2025 after passage of the Affordable Care Act. In this projection of workforce needs, we used the Medical Expenditure Panel Survey to calculate the use of office-based primary care in 2008. We used US Census Bureau projections to account for demographic changes and the American Medical Association's Masterfile to calculate the number of primary care physicians and determine the number of visits per physician. The main outcomes were the projected number of primary care visits through 2025 and the number of primary care physicians needed to conduct those visits. Driven by population growth and aging, the total number of office visits to primary care physicians is projected to increase from 462 million in 2008 to 565 million in 2025. After incorporating insurance expansion, the United States will require nearly 52,000 additional primary care physicians by 2025. Population growth will be the largest driver, accounting for 33,000 additional physicians, while 10,000 additional physicians will be needed to accommodate population aging. Insurance expansion will require more than 8,000 additional physicians, a 3% increase in the current workforce. Population growth will be the greatest driver of expected increases in primary care utilization. Aging and insurance expansion will also contribute to utilization, but to a smaller extent.
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            Health for all beyond 2000: the demise of the Alma-Ata Declaration and primary health care in developing countries.

            Access to basic health services was affirmed as a fundamental human right in the Declaration of Alma-Ata in 1978. The model formally adopted for providing healthcare services was "primary health care" (PHC), which involved universal, community-based preventive and curative services, with substantial community involvement. PHC did not achieve its goals for several reasons, including the refusal of experts and politicians in developed countries to accept the principle that communities should plan and implement their own healthcare services. Changes in economic philosophy led to the replacement of PHC by "Health Sector Reform", based on market forces and the economic benefits of better health. It is time to abandon economic ideology and determine the methods that will provide access to basic healthcare services for all people.
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              Inequality trends of health workforce in different stages of medical system reform (1985-2011) in China

              Introduction The aim of this study was to identify whether policies in different stages of medical system reform had been effective in decreasing inequalities and increasing the density of health workers in rural areas in China between 1985 and 2011. Methods With data from China Health Statistics Yearbooks from 2004 to 2012, we measured the Gini coefficient and the Theil L index across the urban and rural areas from 1985 to 2011 to investigate changes in inequalities in the distributions of health workers, doctors, and nurses by states, regions, and urban-rural stratum and account for the sources of inequalities. Results We found that the overall inequalities in the distribution of health workers decreased to the lowest in 2000, then increased gently until 2011. Nurses were the most unequally distributed between urban-rural districts among health workers. Most of the overall inequalities in the distribution of health workers across regions were due to inequalities within the rural-urban stratum. Discussions and conclusions Different policies and interventions in different stages would result in important changes in inequality in the distribution of the health workforce. It was also influenced by other system reforms, like the urbanization, education, and employment reforms in China. The results are useful for the Chinese government to decide how to narrow the gap of the health workforce and meet its citizens’ health needs to the maximum extent.
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                Author and article information

                Contributors
                wipada.ku@cmu.ac.th
                huyan@fudan.edu.cn
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                27 August 2019
                27 August 2019
                2019
                : 19
                : 602
                Affiliations
                [1 ]ISNI 0000 0001 0125 2443, GRID grid.8547.e, School of Nursing, , Fudan University, ; 305 Fenglin Road, Shanghai, 200032 People’s Republic of China
                [2 ]ISNI 0000 0004 1765 1045, GRID grid.410745.3, School of Nursing, , Nanjing University of Chinese Medicine, ; Nanjing, China
                [3 ]ISNI 0000000120191471, GRID grid.9581.5, Faculty of Nursing, , Universitas Indonesia Kampus UI, ; Depok, Jawa Barat Indonesia
                [4 ]GRID grid.449992.b, University of Nursing, ; Yangon, Myanmar
                [5 ]Chief Nursing Officer/Nursing Focal Person in Cambodia for WHO-WPRO, Phnom Penh, Cambodia
                [6 ]ISNI 0000 0001 0807 5654, GRID grid.440422.4, Kulliyyah of Nursing, , International Islamic University, ; 25100 Kuantan, Pahang Malaysia
                [7 ]School of Nursing, Phenikaa University, Hanoi, Vietnam
                [8 ]ISNI 0000 0000 9039 7662, GRID grid.7132.7, Faculty of Nursing, , Chiang Mai University, ; Chiang Mai, 50200 Thailand
                Article
                4402
                10.1186/s12913-019-4402-9
                6712608
                31455377
                1fd4eb54-507f-4846-a0b0-61be742059fb
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 3 May 2019
                : 5 August 2019
                Funding
                Funded by: China-UK Global Health Support Programme (GHSP)
                Award ID: 202708
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Health & Social care
                primary health care,knowledge, ability, and skills,perceived capability,cross-sectional survey,multi-national study

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