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Strengthening Primary Care Provider Competence: A Step towards Increasing Resilience for Future Infectious Disease Outbreaks

Author: Sanjeev Kumar works with the Health Systems Transformation Platform (HSTP) in Research Specialist Capacity. He has worked with multiple State Health Systems in India.

Provider Competence is one of the critical determinants to improve Primary Care performance. Competence is an overarching capability built on specific competencies, which attributes to improved quality of service. Global Pharmacy Framework defines competency as the knowledge, skills, attitudes, and behaviors individuals develop through education, training, and work experience. Primary Care is the pillar of the health system that meets 80%  of health care needs and acts as the link between the communities and the health service delivery system. Performance of Primary Care Providers (PCP) becomes more requisite during Outbreaks to meet the elevated demand for services due to the addition of outbreak led new cases.

Evidence from Ebola Outbreak in Western Africa in 2013 reaffirms the importance of Primary Care towards preparing, responding, and recovering from disease outbreaks. Similarly, in India, the resilient primary health care system enabled Kerala to respond quickly to the Nipah Outbreak in 2018-19. In Surveillance, Diagnosis, Treatment, Prevention, and Control, the Primary Care strategies were foundational.

In India, Study reports that only 4% of public PCPs and 6% of private PCPs diagnose the common ailments appropriately. Regarding treatment, only 21% of public and 27% of private PCPs treat the patients correctly for the common ailments.  

 Learnings from the infectious disease outbreak, Nipah (2018-19) in Kerala suggests enhancing the providers’ awareness about disease case definition, strengthening infection control, standard operating procedures, and incident management protocol could better arm the PCPs to respond the infectious disease outbreak. The study conducted in Bihar reports that the rural PCPs have poor compliance with recommended case management protocol for COVID – 19.

Based on lessons learned from infectious disease outbreaks worldwide, WHO issued interim guidance on the role of Primary Care in the COVID – 19 response. It outlined six critical principles for Primary Care: Maintain Essential Health Services, Identify and Manage Potential Cases, Avert the risk of transmission of infection to Contacts and Healthcare Workers, Enhance Surveillance, Risk Communication, Community Engagement, Provision of COVID – 19 Vaccination Services.

Maintaining essential health services is one of the utmost priorities during the outbreak. Segregation of the outbreak-related patients and the patients who need essential health services is vital. Triaging, therefore, becomes acritical skill for PCPs in such scenarios. Interpersonal Communication (IPCs) skills assume importance for effective delivery of these services, including during triaging.

Identification of Cases is one of the key strategies under Primary Care response. Contact tracing is an all-important skill that is required during an infectious disease outbreak. It includes the understanding of both the Case-definition and Case-identification. Case-identification techniques vary in different settings (household and community contacts, closed settings, healthcare settings,  public /shared transport, schools, worship places, and private social events). Case identification may be made through direct interviews with patients – either through telephone or at times by reviewing the list of patients hospitalized in the same ward or sharing the same bathroom.

In infectious disease outbreak response strategy, preventing transmission of infection to contacts and healthcare workers is one of the critical steps. Infection can spread through the direct or indirect spread of droplets. Practices such as hand hygiene, respiratory hygiene, masks, social distancing, quarantine of contacts need to be ensured by PCPs to restrict the spread of infection.  Under Institutional Quarantine, standard operating procedures (SOPs), including referral SOPs, infection control measures, and use of Personal Protective Equipment, are essential. For laboratory services, competencies on good practices for sample collection and packaging are also vital.

The Primary Care system plays a significant role in active surveillance through community health workers (CHWs). Based on the case definition, CHWs visits house to house to trace the cases. Interpersonal Communication and Use of Personal Protective Equipment are the competencies that matter most during this process.

Establishing a trust for outbreak intervention measures among the population, building public awareness and knowledge, and increasing public motivation to participate in Outbreak response are the objectives for risk communication during an outbreak. Identification of key messages and strategies to deliver culturally acceptable messages to the citizen are the key competencies.

Vaccine hesitancy is one of the bolsters that affect Vaccine coverage. Tailored communications through local health providers are solutions to all forms of hesitancies, i.e., Complacency, convenience, and confidence. Primary Care providers’ interpersonal communication skills are the key to delivering tailored messages to reduce vaccine hesitancy.

Conclusion: Primary Care system plays a fundamental role in infectious disease outbreak management. Competency is one of the most significant determinants to drive Primary Care Provider performance. More precisely, for infectious disease outbreak response, Primary Care Providers need to have competencies in Triaging, Interpersonal Communication, Contact Tracing, Infection Control Measures including PPEs, Active Surveillance, Risk Communication, and Provisioning Vaccine Services. Telemedicine and other digital interventions further enhance the effectiveness and reach of Primary Care services. Such competencies in the Primary Care Providers boost the Primary Care resilience to respond to future infectious disease outbreaks globally.

Acknowledgment:  The author acknowledges Rajeev Sadanandan, Dr. Garima Pathak for their valuable feedback.

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