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To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States.

Data were derived from 13 semistructured focus groups, plus three semistructured interviews, and were analyzed inductively consistent with a grounded theory approach.

Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, nonphysician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers.

Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power.

This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach.

Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information.

While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations.

Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

The purpose of this paper is to explore how conflict-affected communities in Ukraine (the Lugansk region) can develop sustainable mental health services in decentralised settings. The main interest focuses on community stakeholders’ perception of their problems and solutions that communities can create to achieve better mental health coverage.

A series of roundtables (RTs) (4 RTs, 62 participants overall), accompanied by interactive brainstorming techniques, were conducted with communities’ representatives/stakeholders from the East of Ukraine (Lugansk region, a government-controlled area) during the year 2021. Participants (health, mental health, social care workers and administration representatives) were provided with the opportunity to discuss mental health services’ development challenges and create affordable solutions for their communities. Results of discussions were submitted to qualitative analysis and offered for review by participants.

Decentralisation in Ukraine led to allocating funds alongside responsibilities for developing the services to communities. Most of the communities appear not to be ready to acknowledge the role of mental health services, entirely relying on the existing weak psychiatric hospital-based system. Awareness-raising interactive capacity-building activities for the community leaders and decision-makers effectively promote community-based mental health services development. Five clusters of challenges were identified: leadership, coordination and collaboration problems; infrastructure, physical accessibility and financial problems; mental health and primary health-care workforce shortage and lack of competencies; low awareness of mental health and available services and high stigma; war, crises and pandemic-related problems. Communities stakeholders foresaw seven domains of action: increasing the role of communities and service users in the initiatives of governmental bodies; establishing in the communities local coordination/working groups dedicated to mental health service development; developing the community-based spaces (hubs) for integrated services provision; embedding the mental health services in the existing services (social, administrative and health care); mental health advocacy and lobbying led by local leaders and service users; increasing capacity of communities in financial management, fundraising; developing services by combining efforts and budgets of neighbouring communities.

The study has potential limitations. Participants of the roundtables were mostly appointed by local authorities, so some of them didn`t have a motivation for mental health services development. Service users were involved only from the facilitators` side, not from the side of communities; therefore, it was impossible to include their view of problems and solutions. Obtained data were limited to the opinion of local professionals, administration workers and other local stakeholders. The human rights aspect was not clearly articulated in the tasks of the roundtables.

To the best of the authors’ knowledge, the paper is original in terms of its topic (connecting decentralisation and local stakeholders’ engagement for understanding the challenges of mental health services development) and research strategy (engagement of Ukrainian communities, qualitative analysis of the discussion results and applying the best practices and international recommendations to the local context).

THIS ARTICLE APPRAISES the Government's White Paper, The New NHS: Modern, Dependable, from the perspective of a health authority chief executive, outlining the context for developing health care, the joint challenges of the White Paper and the Green Paper, Our Healthier Nation, the role and potential of primary care groups (in detail), the developing role of the health authority, and the agenda for shaping and improving the delivery of health and health services. It ends with an appraisal of particular implications for community care.

The purpose of this paper is to use a descriptive case study to establish how collaboration, innovation and knowledge‐management strategies have scaled‐up learning and development in rural, remote and other resource‐constrained Canadian delivery settings.

Intervention design was realized through a one‐time, collaborative, national capacity‐building project. A project portfolio of 72 sub‐projects, initiatives and strategic activities was used to improve access, enhance quality and create capacity for palliative and end‐of‐life care services. Evaluation was multifaceted, including participatory action research, variance analysis and impact analysis. This has been supplemented by post‐intervention critical reflection and integration of relevant literature.

The purposeful use of collaboration, innovation and knowledge‐management strategies have been successfully used to support a rapid scaling‐up of learning and development interventions. This has enabled enhanced and new pan‐Canadian health delivery capacity implemented at the local service delivery catchment‐level.

The intervention is bounded by a Canada‐specific socio‐cultural/political context. Design variables and antecedent conditions may not be present and/or readily replicated in other nation‐state contexts. The findings suggest opportunities for future integrative and applied health services and policy research, including collaborative inquiry that weaves together concepts from adult learning, social science and industrial engineering.

Scaling‐up for new capacity is ideally approached as a holistic, multi‐faceted process which considers the total assets within delivery systems, service catchments and communities as potentially being engaged and deployed.

The Pallium Integrated Capacity‐building Initiative offers model elements useful to others seeking theory‐informed practices to rapidly and effectively scale‐up learning and development efforts.

The role of the primary mental health worker (PMHW) is relatively new within child and adolescent mental health services (CAMHS). Different organisational structures have emerged and it is important to study the advantages and disadvantages associated with different PMHW practice models. The current study uses a large, representative sample of PMHWs and operationalises practice models according to the PMHWs' self‐reported location and team alignment thus identifying three models (namely CAMHS outreach, primary care based, and dedicated PMHW team). Comparisons between the models are made in relation to organisation and management, inter‐agency links, and job satisfaction with the aim of exploring the strengths and weaknesses of each model. The results suggest that each model meets the aims of the role and there is greater similarity than dissimilarity between models. However, it also indicates that attention should be paid to improving the working environments and training and development opportunities for all PMHWs irrespective of model, but with particular consideration given to improving the support available to PMHWs working in primary care based models.

Over the past two decades, Community-Based Health Planning and Services (CHPS) has been a pragmatic strategy towards universal Primary Health Care (PHC) in Ghana. However, the ability and capacity of these facilities to deliver quality primary health care remain an illusion as they are still crumbling in myriad challenges. These challenges are translated to the poor-quality services provision and low community utilization of CHPS facilities. The study presents a comparative analysis of three communities in the Kassena-Nankana East Municipality, Ghana.

Using a mixed-method research design, the study gathered and analysed data from 110 households, three community health officers (CHOs) and three community leaders using semi-structured questionnaires and interview guides.

The findings indicated that the facilities do not have the requisite inputs such as drugs and supplies, logistics, appropriate health personnel, good infrastructure, funding support necessary to deliver quality and appropriate healthcare services that meet the health needs of the communities. For the CHPS to realize their full potentials as PHC facilities, it is required that the needed inputs such as logistics, drugs and appropriate staff are in place to facilitate the activities of CHOs.

Due to the limited number of participants and selection of the study communities, the results may generalization. Also, the researchers acknowledged the inability to interview the district level health officials and the Kassena-Nankana Municipal Assembly during the field visits. This could have provided in-depth knowledge on the findings of this research as well as the validation of the results from the communities' perspective. Several attempts were made to contact and interview district-level authorities which proven futile due to the unavailability of targeted respondents. This resulted in limiting the studies at the community level. However, this limitation does not disprove the findings of this study.

The article implications for planning primary health care strategies include a keen assessment of community health needs and institutional management of primary health care facilities, equip PHC facilities with adequate resources such as drugs and appropriate staffing to provide the health needs of the communities.

The paper fulfils the gap in the literature by providing empirical data on how the challenges of primary health care facilities affected the provision of high quality service and how this can affect community’s use of the facilities.

Clinical governance is a new policy introduced by the UK government to improve quality of care in the National Health Service; it imposes a “duty of quality” on all NHS organisations, and aims to bring together managerial, organisational and clinical approaches to improving quality of care. Infrastructures have been established to support quality improvement in NHS organisations and priorities for quality improvement have been established. Initial approaches are largely educational. However, information on quality of care is starting to be shared, and experiments are being conducted with a range of financial and contractual incentives for quality improvement. For widespread cultural change to occur, a “no blame” approach to quality improvement will be necessary; this may be incompatible with the need to identify and eliminate bad practice. Other tensions include the rapid pace of change being centrally driven and uneven development of the infrastructure to support clinical governance. What has not yet been shown is that quality of care has improved. It is too early to say this yet. Given the magnitude both of the vision and the work required, it is unlikely that change will be rapid, or seen on a widespread scale.

Compiled by K.G.B. Bakewell covering the following journals published by MCB University Press: Facilities Volumes 8‐18; Journal of Property Investment & Finance Volumes 8‐18; Property Management Volumes 8‐18; Structural Survey Volumes 8‐18.