Assessment of the Knowledge of Primary Health Care Staff about Primary Health Care.

The orientation about Primary Health Care among staff working in the PHC centers was assessed. Staff members numbering 909 were studied. The main criteria for judging orientation were a working knowledge of the definition and elements of PHC in addition to knowledge of the meaning of the word Alma Ata. Differences of this knowledge depending on sex, age, spoken language, type of job, postgraduate experience, previous experience in PHC and previous training in PHC were assessed. The main findings of the study were that the correct definition of PHC was known by only 51.4%, functions of PHC by 62.6%, and what Alma Ata, means in terms of PHC was known by 76.2% of the staff. This knowledge was significantly better in females than males, non-Arabic speaking staff than those who spoke Arabic, General practitioners and nurses than other staff; it was better in those staff who had long postgraduate experience, previous experience or previous training in PHC.In conclusion, the study reveals the current status of awareness of PHC staff of the implications of simple concepts of PHC and points to the importance of the orientation of staff towards these concepts in order to help them practice PHC effectively.

INTRODUCTION

The “Health For All” (HFA) declaration launched in 1977 urged the World Health Organization (WHO) and governments of the world to offer to the people of the world a level of health care that will enable them to lead a socially and economically productive life.1 In 1978, another declaration that HFA would be mainly achieved through the practice of Primary Health Care (PHC) was echoed from Alma Ata.2

In a prompt response to that issue, the King-dom of Saudi Arabia (KSA) established its PHC program in 1983.3 This resulted in a nationwide establishment of PHC centers and due the employment of staff of different nationalities pending the training of Saudi national PHC staff. The staff employed were categorized into PHC oriented general practitioners and health inspectors, PHC reoriented dentists as well as laboratory and X-ray technicians, administrators, nurses and midwives. These groups, collectively, formed the PHC teams whose task is to run the PHC service.4

Orientation on PHC is essential for these teams to be effective in their provision of PHC service. The authors of this study believe that it is useful to assess the magnitude and quality of this orientation, hence this study. By conducting the study, the authors hope to:

Appraise the PHC team's orientation on PHC. Three specific areas were to be looked into; namely: the definition of PHC, the elements of PHC and what Alma Ata means.

Assess the possible factors related to orientation on PHC among team members.

MATERIAL AND METHODS

The study was carried out in PHC centers in 3 areas; Albaha, Algassim, and AlKhobar. All health centers in these areas were included and all health personnel in these centers were studied. They consisted of general practitioners, dentists, health inspectors, pharmacists, laboratory and x-ray technicians, administrators, nurses, and midwives.

Data was collected through a self-administered questionnaire. The main items being:

Open-ended questions about the definition of PHC, the elements of PHC, and the meaning of Alma Ata.

Other variables were age, sex, spoken language, type of job, years of experience after graduation, previous experience and training in PHC.

The responses for the definition and elements of PHC were considered correct if they corresponded to those quoted by WHO in 1978.2

The meaning of Alma Ata was considered correct if it was quoted as “An international conference regarding Health For All by the year 2000, held in the city of Alma Ata in the former Soviet Union in 1978”5.

Answers were accepted in either Arabic or English. The completed questionnaires were collected only after every member of the PHC team had responded to the questionnaire.

The data were edited and processed with EPI-INFO version 5 statistical package.6

Age was grouped into “under 40 years” and “40 years or more”. Language was grouped as “Arabic” and “non Arabic”. Experience after graduation was grouped as “under 10 years” and “10 or more years”. Previous experience, and training in PHC were each grouped as “present” or “not present”. Answers were expressed as rates of correct answers against the number participating and the percentage calculated accordingly.

Frequency distributions and cross--tabulations were generated and Chi-squared test was used when comparisons of correct answers between different groups were made. A P-value of 0.05 or less was considered as significant.

RESULTS

Sample characteristics:

The total number of PHC staff participating in the study was 937. Of this number, 909 (97.0%) were included in the study. The remainder were excluded because of incomplete information given.

The majority (778, 85.6%) were below the age of 40 years and the remaining (131, 14.4%) were aged 40 years or more.

Gender distribution showed almost equal numbers of males (462, 50.8%) and females (447,49.2%).

Those who could speak Arabic were 562 (61.8%).

General practitioners were 178 (19.6%), dentists 30 (3.3%), health inspectors 47 (5.2%), nurses and midwives 472 (51.9%). Laboratory and X-ray technicians, and administrators collectively formed a fifth (182) of the respondents. Those whose experience was equal to or more than 10 years were 596 (65.6%), and 313 (34.4%) had post-qualification experience of less than 10 years.

While only 276 (30.4%) had previous PHC experience, 564 (62.0%) had previous training in PHC.

Orientation about PHC:

Correct answers on the definition of PHC were given by about half the staff Table 1. More than 60% of the respondents (569) gave correct answers about the elements of PHC, and a majority of respondents 693 (76.2%) knew what Alma Ata meant.

Table 1

Orientatlon about Primary Health Care

Effect of demographic characteristics on orientation rates:

More females than males stated the correct answers regarding the definition, and functions of PHC (40% P<0.01 for each) and the meaning of Alma Ata (P< 0.05). There were no significant variations according to age (Table 2).

Table 2

Knowledge of Deffnition and Functions of PHC, and Meaning of Alma Ata: Effects of Demographic Characteristics

On the other hand, more of the non-Arabic speaking staff (253, 72.5%) gave correct answers regarding the definition of PHC than did their Arabic speaking colleagues (214,38.1%) (P<0.01).

Similar results were found regarding the functions of PHC (Non Arabic speaking 69.2%, Arabic speaking 58.5%, P<0.001) and also for the meaning of Alma Ata, where the corresponding figures were 85.6% vs 70.5% (P< 0.001).

Effects of professional characteristics on orientation rates: table 3:

Among the different employees, nurses and midwives had significantly better answers on definition, functions of PHC, and the meaning of Alma Ata than the rest. On the other hand, the group comprising laboratory and X-ray technicians and administrators exhibited the lowest rates of correct answers.

Long postgraduates experience (10 years or more) among team members was significantly associated with higher rates of correct answers on the three aspects of PHC studied.

Staff who had previous PHC experience had higher rates of correct answers on definition, functions of PHC and meaning of Alma Ata than those who had not (P<0.001, P< 0.001, and P< 0.05, respectively).

Similarly, staff who had previous training in PHC also showed higher rates of correct answers compared to those who had none (P< 0.001, P< 0.001, and P< 0.001, respectively).

DISCUSSION

Knowledge about the essentials of PHC is vital for all PHC workers if they are to provide quality service to the public. The findings of this study, show that almost half of the workers in PHC were ignorant of its meaning, about one third were ignorant of its elements and one quarter did not know what Alma Ata meant. One major problem of PHC and its practice, is the misconceptions of the meaning of the concept. A PHC team member cannot function properly if he or she lacks insight into what its aims are. These results imply that either the workers lacked the proper orientation on PHC or reverted to old practices. In either case, refresher courses were required. The orientation was better among female than male staff. This could be accounted for by the high numbers of trained nurses and midwives who were also non-Arabic speaking. The Ministry of Health's (MOH) plan of PHC and maternal and child health (MCH) training has been accomplished in most parts of the Kingdom. In the three study areas, at least one doctor and one nurse or midwife had been exposed to training in MCH and PHC by the end of 1992.7 This has undoubtedly contributed somewhat to the orientation of the staff on PHC.

The level of knowledge was good among the general practitioners, nurses, and midwives, which is gratifying as much of the work in PHC, particularly the technical part, is carried out by these groups. This is consistent with the fact that the MOH concentrates its training on these groups. What is disturbing, however, is that the group that includes administrators, showed the least orientation on PHC. The smooth functioning of health centers is dependent on a good insight about PHC. Considering the fact that more young Saudis are being appointed as directors and administrators, it is mandatory that they be well oriented in PHC. It is without doubt that users of PHC will have confidence in the system when its providers have complete understanding of it, are committed to it and know how it can be implemented.

Long experience after graduation, previous experience and previous training in PHC have contributed towards the acquisition of good orientation in PHC. This implies that these should be taken into consideration when staff are being selected to run the PHC service in the future.7

CONCLUSIONS

The study underscored the current state of knowledge and orientation about simple PHC concepts among PHC staff working in the KSA. The results show only a fair degree of orientation which therefore demands a greater efforts towards the improvement of knowledge and orientation about PHC among its staff. This is vital for effective communication with the public and for the efficient delivery of PHC to the population. The authors strongly recommend that the staff of PHC be given short refresher courses to improve their knowledge and orientation about concepts and practices of PHC.7

Table 3

Knowledge of Definition and Functions of PHC, and Meaning of Alma Ata: Effects of Demogfaphic Characteristlcs