Search results

Given that the workforce constitutes a principal resource of primary care, appraisal of models of care requires thorough investigation of the health workforce in all Models of Child Health Appraised (MOCHA) countries. This chapter explores this in terms of workforce composition, remuneration, qualifications and training in relation to the needs of children and young people. We have focused on two principal disciplines of primary care; medicine and nursing, with a specific focus on training and skills to care for children in primary care, particularly those with complex care needs, adolescents and vulnerable groups. We found significant disparities in workforce provision and remuneration, in training curricula and in resultant skills of physicians and nurses in European Union and European Economic Area Countries. A lack of overarching standards and recognition of some of the specific needs of children reflected in training of physicians and nurses may lead to suboptimal care for children. There are, of course, many other professions that also contribute to primary care services for children, some of which are discussed in Chapter 15, but we have not had resources to study these to the same detail.

Based on an extensive literature review, this chapter outlines key developments in global health and research during the last century with focus on the emergence of violence and child maltreatment as international public health priorities. Violence has been known to humans for millennia, but only in the late 1990s was it recognised as a global public health issue. Every year, an estimated 1 billion children are exposed to trauma, loss, abuse and neglect. Child maltreatment takes a social and economic toll on countries. Research initiated in 1985 found child maltreatment to be associated with increased disease, disability and premature death in adult survivors. The global availability of data on child maltreatment is, however, sporadic with low validity and reliability. Few global experts have consulted and involved the survivors of child maltreatment, as the experts by experience, in their attempts to provide a more comprehensive picture of reality. Youth and adult survivors of child maltreatment are often traumatised by the experience, and it is important to use trauma-informed approaches to prevent re-traumatisation. Participatory and inclusive research on child maltreatment is only in its infancy. There is a need for more inclusive research, designed by survivors for survivors, hereby strengthening local capacity building and informing policymakers from the bottom up. This chapter reviews lessons learnt and provides recommendations for how to enhance the participation and inclusion of the experts by experience in research on child maltreatment.

Equity is an issue that pervades all aspects of primary care provision for children and as such is a recurring theme in the Models of Child Health Appraised project. All European Union member states agree to address inequalities in health outcomes and include policies to address the gradient of health across society and target particularly vulnerable population groups. The project sought to understand the contribution of primary care services to reducing inequity in health outcomes for children. We focused on some key features of inequity as they affect children, such as the importance of good health services in early childhood, and the effects of inequity on children, such as the higher health needs of underprivileged groups, but their generally lower access to health services. This indicates that health services have an important role in buffering the effects of social determinants of health by providing effective treatment that can improve the health and quality of life for children with chronic disorders. We identified common risk factors for inequity, such as gender, family situation, socio-economic status (SES), migrant or minority status and regional differences in healthcare provision, and attempted to measure inequity of service provision. We did this by analysing routine data of universal primary care procedures, such as vaccination, age at diagnosis of autism or emergency hospital admission for conditions that can be generally treated in primary care, against variables of inequity, such as indicators of SES, migrant/ethnicity or urban/rural residency. In addition, we focused on the experiences of child population groups particularly at risk of inequity of primary care provision: migrant children and children in the state care system.