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At the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health care had a great deal of responsibility for COVID-19-related care. The pandemic demanded effective leadership to manage the new difficulties. This paper aims to explore experiences and perceptions of managers in primary health care in relation to their efforts to manage the COVID-19 crisis in their everyday work.

The authors used a qualitative approach based on 14 semi-structured interviews with managers in primary health care from four regions in Sweden. The interviews were conducted during September to December 2020. Data were analysed using conventional qualitative content analysis.

Data analysis yielded three categories: lonely in decision-making; stretched to the limit; and proud to have coped. The participants felt lonely in their decision-making, and they were stretched to the limit of their own and the organization’s capacity. The psychosocial working conditions in primary care worsened considerably during the pandemic because demands on leaders increased while their ability to control the work situation decreased. However, they also expressed pride that they and their employees had managed the situation by being flexible and having a common focus.

Looking ahead and using lessons learnt, and apart from making wise decisions under pressure, an important implication for primary health-care leaders is to not underestimate the power of acknowledging the virtues of humanity and justice during a crisis. Continuing professional education for leaders focusing on crisis leadership could help prepare leaders for future crises.

Sexual and reproductive health (SRH) interventions demand diverse services, encompassing medical, social and psychological care to ensure the overall wellbeing of service users. In the absence of multidisciplinary response to SRH interventions, service users could be deprived of crucial SRH services, which could undermine their safety and wellbeing. Based on this knowledge, our study was designed to map the interprofessional space in primary healthcare (PHC) facilities in Ebonyi State, Nigeria that deliver SRH services.

Interviews with 20 health workers and group discussions with 72 young people aged 15–24 years provided the data for the study. We analyzed data deductively, focusing on the assessments of the presence or absence of specific professionals that are typically expected to provide different aspects of SRH services.

We found conspicuous absence of laboratory diagnostic, social care, psycho-cognitive and some medical services expected of primary care. These absences necessitated unnecessary referrals, encouraged breaches in confidentiality, undermined social care and justice, increased cost of care and discouraged young clients from utilizing SRH services provided in PHCs. Our study, therefore, emphasizes the need for integrated care in the delivery of SRH services, which would involve relevant diverse professionals contributing their expertise toward comprehensive care for SRH service users.

The study provides human resource insights toward strengthening primary healthcare in Nigeria vis-à-vis efficient delivery of SRH services to guarantee the health security of service users.

The purpose of this review paper was identifying barriers to the use of telemedicine systems in primary health-care individual level among professionals.

This study used Scopus and PubMed databases for scientific records identification. A systematic review of the literature structured by PRISMA guidelines was conducted on 37 included papers published between 2009 and 2019. A qualitative approach was used to synthesize insights into using telemedicine by primary care professionals.

Three barriers were identified and classified: system quality, data quality and service quality barriers. System complexity in terms of usability, system unreliability, security and privacy concerns, lack of integration and inflexibility of systems-in-use are related to system quality. Data quality barriers are data inaccuracy, data timeliness issues, data conciseness concerns and lack of data uniqueness. Finally, service reliability concerns, lack of technical support and lack of user training have been categorized as service quality barriers.

This review identified and mapped emerging themes of barriers to the use of telemedicine systems. This paper also through a new conceptualization of telemedicine use from perspectives of the primary care professionals contributes to informatics literature and system usage practices.

Contextual to the recognition of the complex interplay between health and behavioral aspects, integrated behavioral health (IBH) has emerged. Although this model is becoming popular in the Western world, its presence in the global context is not promising. This paper aims to explore the need for IBH in India and address its barriers to implementation and possible solutions.

We analyzed the case of IBH and its potential implications for India using the current evidence base, authors' reflections and experience of implementing similar programs.

This paper identifies contextual factors, including increased instances of non-communicable diseases and psychosocial and cultural determinants of health, that necessitate the implementation of IBH programs in India. The key features of different IBH models and their applicability are outlined. The current status of IBH and potential challenges in implementation in India in terms of human resources and other factors are delineated. We also discuss the potential models for implementing IBH in India.

Integrating behavioral health in primary care is considered an effective and sustainable model to promote health and well-being across various target populations. Towards this end, this paper is the first to discuss the contextual factors of IBH in India. It is a significant addition to the knowledge base on IBH and its possible implementation barriers and strategies in low- and middle-income countries.

Advancing behavioral health and primary care integration is a priority for helping clients overcome the complex health challenges impacting healthcare deserts like those in Arizona, United States of America (USA). This study aimed to explore the perspectives of people with a substance use disorder (SUD) on accessing integrated primary care (IPC) services in a rural-serving behavioral healthcare organization in Arizona.

Clients from a behavioral health facility in Arizona (n = 10) diagnosed with SUDs who also accessed IPC participated in a 45-min semi-structured interview.

The authors identified six overarching themes: (1) importance of IPC for clients being treated for SUDs, (2) client low level of awareness of IPC availability at the facility, (3) strategies to increase awareness of IPC availability at the behavioral health facility, (4) cultural practices providers should consider in care integration, (5) attitudes and perceptions about the experience of accessing IPC and (6) challenges to attending IPC appointments. The authors also identified subthemes for most of the main themes.

This is the first study in rural Arizona to identify valuable insights into the experiences of people with SUDs accessing IPC, providing a foundation for future research in the region on care integration.

Continuity of care and access to primary care have been identified as important contributors to improved health outcomes and reduced reincarceration among people who are justice-involved. While the disproportionate burden of health concerns among incarcerated populations is well documented, less is known about their health service utilization, limiting the potential for effective improvements to current policy and practice. This study aims to examine health status and health care utilization among men recently released from a superjail in a large metropolitan area to better understand patterns of use, risk factors and facilitators.

Participants included adult men (n = 106) matched to a general population group (n = 530) in Ontario, Canada, linked to medical records (88.5% linkage) to examine baseline health status and health utilization three-months post-release. The authors compared differences between the groups in baseline health conditions and estimated the risk of emergency department, primary care, inpatient hospitalization and specialist ambulatory care visits.

Superjail participants had a significantly higher prevalence of respiratory conditions, mental illness, substance use and injuries. Substance use was a significant risk factor for all types of visits and emergency department visits were over three times higher among superjail participants.

This empirical case is illustrative of an emerging phenomenon in some regions of the world where emergency departments serve as de facto “walk-in clinics” for those with criminal justice involvement. Strategic approaches to health services are required to meet the complex social and health needs and disparities in access to care experienced by men released from custody.

This chapter seeks to quantify the effects of geographic access to community health centers on the likelihood of an individual having a regular source of health care.

Utilizing survey and center location data, the analysis employs bivariate cross-tabulation with chi-square and multinominal logistic regression to quantify the relationship between variables.

While individuals living in close spatial proximity to community health centers were more likely to identify a community health center as a regular source of care as compared with those without proximal access, the effect of community health center access on the identification of any source of regular health care was generally insignificant or negative, except for populations with a chronic medical condition.

While these findings support current literature suggesting that spatial proximity to care is insufficient to transform at-risk populations into regular primary care users, it is important to note that it is possible that individuals prefer to access primary care services outside of their immediate neighborhoods, potentially mediating the observed effect of proximity to care on the likelihood of having a regular source of care. Also, because this analysis is based on cross-sectional survey data, it is impossible to make a causal argument about the relationship between variables. Only the observed association can be asserted and used to inform future studies.

Existing research supports a positive association between community health center utilization and measures of health for social groups traditionally facing barriers to care, but few studies isolate the effect of center availability and health, particularly when considering those living in the catchment area but are not regular users. Due to the complexity and prevalence of barriers to health care for vulnerable and at-risk populations, these findings suggest that improving geographic access to primary health care does not guarantee positive outcomes for target groups. The magnitude of social disadvantage on vulnerable and at-risk populations can have a devastating effect on health care outcomes that is not easily overcome by social programs.

The purpose of this paper is to investigate how and why some service ecosystems are more resilient and, consequently, more sustainable than others during turbulent times, and how resilience can be cultivated to enable pathways to service ecosystem sustainability.

This work integrates disparate literature from multiple service and sustainability literature streams, iterating through constant comparison with findings from 44 semistructured interviews conducted in the context of primary health care clinic service ecosystems.

The authors offer a novel conceptual framework comprising pillars (shared worldview, individual actor well-being and multiactor interactions), changing practices to cultivate resilience through resilience levers (orchestrators, individual actor effort, actor inclusivity and digitaltech–humanness approach), and pathways to service ecosystem sustainability (volume vs value, volume to value, volume and value). The authors demonstrate that service ecosystems need to change practices, integrating resources differently in response to the turbulent environment, emphasizing the importance of a shared worldview across the ecosystem and assessing different pathways to sustainability.

This paper offers new insights into the important intersection of service marketing, sustainability and health care. The authors provide guidance to practitioners aiming to cultivate resilience in service ecosystems to achieve pathways to sustainability in primary health care clinics. Finally, implications for theory are discussed, and directions to guide future service research offered.

The locational disadvantage of a health-care centre often restricts adequate delivery of health-care services in an area. The purpose of this study is to examine the status of primary health-care services in such a geographically disadvantageous area which is confined by forests, tea gardens and undulating topography.

Necessary secondary data of 13 primary health centres and 236 sub-centres has been collected from the Office of the Chief Medical Officer of Health. Based on obtained data, Health-care Infrastructure Index has been prepared which has been validated by an expert panel, and subsequently, the Thiessen Polygon method has been applied through Arc GIS software to show spatial variation of health-care services delivered by different health-care centres.

In the study area, there is wide variation found in the case of physical facilities, caregivers and connectivity of road networks, which altogether affect the overall status of health-care services. Among all the indicators, some health-care centres experience staff shortages for prolonged non-recruitment, inaccessibility and inconsistent patient load in different health centres.

In spite of the unfavourable geographical landscape, health-care centres have to be set up wherever possible. There is a need to make new roads and simultaneously the existing road connectivity should be improved so that patients and caregivers can move quickly whenever required. Existing physical facilities need to be renewed or redeveloped along with increasing the number of doctors and other health-care providers as per the need of people with an adequate and optimum level of services.

The COVID-19 pandemic has had a disruptive effect on the health system. Health facility leaders were at the forefront of maintaining service delivery and were exposed to varied stressors in the early phase of the pandemic. This study aims to explore the leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in Nigeria’s epicentre.

This study conducted an exploratory descriptive qualitative study. To achieve this, 33 health facility leaders of different cadres across primary, secondary, and tertiary levels of the public health care system in Lagos, Nigeria, were remotely interviewed. The key informant interviews were transcribed verbatim and were analysed by using thematic analysis.

The health facility leaders experienced heightened levels of fear, anxiety and stressors during the early phase of the pandemic. They also had genuine concerns about exposing their family members to the virus and had to manage some health-care workers who were afraid for their lives and reluctant. Coping mechanisms included psychological and social support, innovative hygiene measures at health facility and at home, training and staff welfare in more ways than usual. They were motivated to continue rendering services during the crisis because of their passion, their calling, the Hippocratic oath and support from the State government.

The experiences of health facility leaders from different parts of the world have been documented. However, to the best of the authors’ knowledge, this is one of the first studies that specifically report multi-layer leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in sub-Saharan Africa.