Re-engineering primary healthcare in Kerala.

IF 1.3 Q4 RESPIRATORY SYSTEM Public Health Action Pub Date : 2023-03-21 DOI:10.5588/pha.22.0033
A Krishnan, R P Varma, R Kamala, R Anju, K Vijayakumar, R Sadanandan, P K Jameela, K S Shinu, B Soman, R M Ravindran
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引用次数: 2

Abstract

Introduction: In the backdrop of the Sustainable Development Goals (SDGs), the state of Kerala, India, revamped its existing primary health centres (PHCs) into people-friendly family health centres (FHCs) in order to provide comprehensive primary care as part of a mission-based ('Aardram') initiative. It was envisioned that the mission's implementation and operation would make use of decentralised governance. The present study explored how the decentralised governance influenced reorganisation of primary care.

Methods: The study adopted an exploratory approach using qualitative methods: key informant interviews (n = 8), in-depth interviews (n = 20) and document reviews. Thematic analysis was done following deductive coding and the themes that emerged were organised under a schema.

Results: The results could be summarised under five overarching themes. Strong political commitment, combined with bureaucratic competence, facilitated implementation and functioning of 'Aardram' primary care. The insights developed through multi-sectoral training helped local governments (LGs) get involve and engage with the health system as a team in order to plan and implement interventions. The decentralised governance structures enabled re-engineering of PHCs by mobilisation of financial resources, provision of human resources, infrastructure modification, and enhanced community participation at various levels. Non-uniformity of commitment, sub-optimal engagement of urban LGs and issues of sustainability and monitoring were the shortcomings observed.

Conclusion: Decentralised governance played a positive role in the re-engineering of PHCs, which was utilised as a platform to demonstrate best practices in health governance through a participatory approach. The importance of empowering LGs through capacity building to address challenges in achieving primary care SDGs is highlighted in this study.

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重新设计喀拉拉邦的初级保健。
导言:在可持续发展目标(SDGs)的背景下,印度喀拉拉邦将现有的初级保健中心(phc)改造为以人为本的家庭保健中心(FHCs),以提供全面的初级保健,这是一项以使命为基础的倡议(“Aardram”)的一部分。按照设想,特派团的执行和业务将利用权力下放的管理。本研究探讨分散式管理如何影响初级保健的重组。方法:本研究采用探索性研究方法,采用定性方法:关键举报人访谈(n = 8)、深度访谈(n = 20)和文献综述。主题分析是按照演绎编码进行的,出现的主题是在一个图式下组织起来的。结果:结果可以概括为五个主要主题。强有力的政治承诺,加上官僚能力,促进了“Aardram”初级保健的实施和运作。通过多部门培训形成的见解帮助地方政府作为一个团队参与和参与卫生系统,以便规划和实施干预措施。分散的管治架构使初级保健得以重新设计,调动财政资源、提供人力资源、改善基础设施,以及加强社区在各个层面的参与。所观察到的不足之处包括承诺的不一致、城市地方政府的次优参与以及可持续性和监测问题。结论:分散管理在初级保健中心的重新设计中发挥了积极作用,它被用作一个平台,通过参与式方法展示卫生治理的最佳做法。本研究强调了通过能力建设赋予地方政府权力的重要性,以应对实现初级保健可持续发展目标的挑战。
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来源期刊
Public Health Action
Public Health Action RESPIRATORY SYSTEM-
自引率
0.00%
发文量
29
期刊介绍: Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.
期刊最新文献
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