Background and purpose: Due to the important role of emergencies and accidents as mainspring of mortality and morbidity, providing emergency services must be taken into account at all levels of health system. The aim of this study was to investigate the perspectives of Healthcare providers on providing prehospital emergency services and its challenges in Primary Healthcare levels in Golestan Province, northern Iran. Materials and Methods: The researchers conducted 31 interviews totally (n=21 community health workers and n=10 family physicians) using semi-structured and in-depth interviews in Golestan Province, north of Iran in the year 2014. All interviews were digitally recorded and transcribed. The collected data was then analyzed through qualitative content analysis. Results: In total, three categories were identified related to emergency services in the Primary Healthcare system, including 1) Different status of providing Primary preventive and emergency care in Primary Healthcare levels, 2) Need to develop the emergency services in health houses, and 3) Challenges of providing appropriate emergency services in the Primary levels of Healthcare system, such as lack of physical and human resources, weakness in monitoring and education system, inadequate skills, motivation in health team, heavy workload, and insufficient cooperation with other related organizations. Conclusion: The Primary levels of Healthcare system were not properly serviced in emergencies. They were also faced with numerous challenges that necessitate health policy makers to plan for promoting and providing required services at this level of Healthcare system.

Background: In planning for universal health coverage, many countries have been examining their fiscal decentralization policies with the goal of increasing efficiency and equity via “ additionalities. ” The concept of “ additionality, ” when the government of a lower administrative level increases the funding allocated to a particular issue when extra funds are present, is often used in these contexts. Although the definition of “ additionality” can be used more broadly, for the purposes of this paper we focus narrowly on the additional allocation of Primary Healthcare expenditures. This paper explores this idea by examining the impact of central level Primary Healthcare expenditure, on individual state level contributions to Primary Healthcare expenditure within 16 Indian states between 2005 and 2013. Methods: In examining 5 main variables, we compared differences between government expenditures, contributions, and revenues for Empowered Action Group (EAG) states, and non-EAG states. EAG states are normally larger states that have weaker public health infrastructure and hence qualify for additional funding. Finally, using a model that captured the quantity of central level Primary Healthcare expenditure distributions to these states, we measured its impact on each state’ s own contributions to Primary Healthcare spending. Results: Our results show that, at the state level, growth in per capita central level Primary Healthcare expenditure has increased by 110% from 2005-2013, while state’ s own contributions to Primary Healthcare expenditure per capita increased by 32%. Further analyses show that a 1% change disbursement from the central level leads to a-0. 132%, although not significant, change by states in their own expenditure. The effect for wealthier states is-0. 151% and significant and for poorer states the effect is smaller at-0. 096% and not significant. Conclusion: This analysis suggests that increases in central level Primary Healthcare expenditure to states have an inverse relationship with Primary Healthcare expenditures by the state level. Furthermore, this effect is more pronounced in wealthier Indian states. This finding has policy implications on India’ s decision to increase block grants to states in place of targeted program expenditures.

The integration of emergency psychiatric care into basic Healthcare services must be given top priority due to the continued prevalence of mental health disorders as a major public health concern. Improving the effectiveness and accessibility of mental health interventions is crucial, especially in Primary care settings. Mental illnesses continue to rank among the top ten global causes of burden; they cause 16% of Disability-Adjusted Life Years (DALYs) worldwide, and their economic costs are projected to be around USD 5 trillion. 1 The National health survey by the Indonesian government presented in 2018 in Indonesia revealed that the cases of Severe Mental Disorders (SMD) were 7 per 1000 population or a total of 1.6 million individuals. 2 Among the individuals with SMD, 15.1% have not sought treatment, and 48.9% of those who are taking medication do not adhere to their medication regimen. The high number of SMD cases is not matched by easy access to Healthcare services. 2 This is evident from the high treatment gap in mental health issues, which exceeds 90%, indicating that fewer than 10% of mental disorder cases receive standard management. Primary Healthcare providers play a key role in the early detection and crisis management of mental health issues, but the lack of resources and specialized training poses a significant challenge. 3 There is an urgent need to establish protocols and training programs that enable Primary Healthcare practitioners to identify and address mental health crises effectively. This involves the development of standardized assessment tools, enhancing collaboration with mental health specialists, and ensuring access to crisis intervention resources. By incorporating emergency psychiatric care into the Primary Healthcare setting, 4 we can reduce the stigma associated with mental health issues and facilitate a more holistic approach to Healthcare. Furthermore, addressing emergency psychiatric care in the Primary Healthcare setting can contribute to early intervention, preventing the escalation of mental health crises, and reducing the burden on emergency departments. 5 , 6 This shift towards a more comprehensive and integrated approach is in the same line with the overarching goal of achieving equality between mental and physical Healthcare. In conclusion, addressing the integration of emergency psychiatric care into basic Healthcare services is necessary to tackle the growing burden of mental health disorders in Indonesia. To effectively address this issue, policymakers, Healthcare organizations, and professionals should prioritize several key recommendations. Firstly, Indonesian policymakers need to prioritize mental health in national Healthcare agendas by allocating adequate resources and developing policies that promote the integration of emergency psychiatric care into Primary Healthcare services. This proactive approach will ensure that mental health receives encompass the attention and resources it deserves within the Healthcare system. Secondly, there is a crucial need to invest in training programs for Primary Healthcare practitioners. These programs should focus on enhancing their capacity to identify, assess, and manage mental health crises effectively. Specialized training in mental health assessment and crisis intervention techniques will better equip Healthcare providers to respond to the needs of individuals experiencing mental health emergencies. Moreover, collaboration between Primary Healthcare providers and mental health specialists should be strengthened. This collaboration will ensure timely access to specialized care and resources for individuals in crisis. Adequate funding should be allocated to support the integration of emergency psychiatric care services into existing Healthcare systems. By implementing these recommendations, Indonesia can take significant strides toward improving access to emergency psychiatric care and addressing the mental health needs of its population.

Background and Objective: Safety is one of the principles of patient care and is a vital component of quality management. The first goal of a health care organization is preventing injuries during treatment, and thus preventing endangering patient safety. Thus, the objective of this study was to investigate the safety culture among the Primary health centers in Karaj. Materials and Methods: This descriptive cross-sectional study was performed with participation of 164 health care providers, who worked in 20 Karaj health centers that were selected via simple random selection from 41 Primary health centers in 2017-2018. A modified version of the Hospital Survey on Patient Safety Culture and a demographic questionnaire were used. Central and dispersion statistics were used for data description via SPSS software version 21. Results: The mean (SD) total score of positive patient safety culture was 64. 7 (9. 9), minimum score was 36. 4 and maximum score was 89. 2. Among the dimensions of patient safety culture, the highest scores were related to the within-unit teamwork dimension with mean (SD) of 80. 3 (17. 1) and head of center support for patient safety with mean (SD) of 76. 1 (16. 6) and the lowest score was for the non-punitive response to error dimension with mean (SD) of 33. 3 (18. 8). As many as 99 (63. 1%) health care providers rated their workplace in this regard as excellent and very good, 48 (30. 6%) considered it acceptable and 10 (6. 3%) reported inadequate and poor workplace safety. Conclusion: The study indicated that the scores of patient safety culture among health care providers have increased in all its dimensions except for teamwork across units of health care, compared to the previous study. Among the dimensions of patient safety culture, the highest score was related to the within-unit teamwork and head of center support for patient safety, and the lowest score was to the non-punitive response to error.

Background and aims: The attitudes of Primary Healthcare (PHC) physicians are essential for integrating mental health services into PHC. This study aimed to assess the attitudes of PHC physicians toward depression in Oman. Methods: In 2022, a cross-sectional study was conducted on a convenient sample of 445 PHC physicians working under Oman’s Ministry of Health. The data were collected using a self-administered online form that included the revised depression attitude questionnaire. An independent t-test and multiple linear regression were used to compare mean attitude scores for binary independent variables and to adjust mean scores for different explanatory variables, respectively. Results: The percentage of physicians who showed positive attitudes exceeded 60% for most of the questionnaire statements. The overall attitude score of mean±standard deviation (SD) was 3. 56±0. 43. In addition, the mean (±SD) scores for the professional confidence, the generalist perspective, and the optimistic view subscales were 3. 32 (±0. 66), 4. 16 (±0. 55), and 3. 41 (±0. 62), respectively. The overall attitude mean score was significantly higher among physicians with previous mental health training (MHT) (P<0. 001) and work duration of less than 10 years (P<0. 001). Additionally, the scores of physicians with previous MHT were significantly higher across all subscales. Conclusion: The PHC physicians in Oman demonstrated favorable attitudes toward depression. However, there is still some room for improvement to ensure accessibility and quality of care for people with mental illnesses

Background: Primary Healthcare (PHC) is the best method to provide Primary Healthcare for the people, and is the most efficient and effective way to achieve and improve a high level of health in any society. Failure to pay attention to PHC and low-quality health services can lead to an increase in various diseases, and consequently a higher number of death toll in any society, which would cause economic damages. PHC in Iran received a lot of attention after the revolution in 1979. In PHC, a Healthcare network was established throughout the country. With the development of PHC in the Islamic Republic of Iran, the causes of death have decreased, and the death due to infectious diseases, pregnancy, and childbirth problems have also decreased. Despite the vast achievements of PHC in Iran, in recent years, enough attention has not been paid to its reconstruction and consecration. Lack of sufficient financial resources, non-implementation of family doctors in cities and executive problems in family doctors, lack of human resources, lack of attention to the education of students in the health sector, their lack of students’,interest in learning the activities of this field, and structural and administrative problems are some of the existing challenges. Results of the present study suggest that policymakers in Iran need to invest more in PHC in order to improve health indicators, reduce patient admissions to hospitals, and make more appropriate use of limited financial resources. Using the infrastructure that already exists in this sector and strengthening the network of PHC play an important role in reducing household expenses,also, the position of the family doctor and its functions can be properly implemented in the society.