2^nd Annual Congress and Medicare Expo on Primary Care and General Pediatrics September 19-20, 2016 Phoenix, USA

Camilo Bass del Campo is a specialist in Family Medicine at the University of Concepcion, Master of Public Health and Health Administration of the Catholic University of Chile. He is the past President and current Secretary General of the National Association of Primary Care Physicians of Chile and professor at the School of Public Health at the University of Chile. He also works in a Center for Primary Health Care Public Health System Chile. rnrn

Chile does not have a national policy for human resources of Primary Health Care, which causes its equitable distribution does not have parameters and therefore can not obtain the necessary impact on community health for various populations.rnrnObjectives: To analyze the spatial distribution of primary care physicians in the communes of Chile. To estimate the association between the rate of medical hours per commune and some indicators of community health.rnrnMethods: An ecological design type of comparison group was used. the distribution of the availability of medical community hours was determined. A correlation analysis was performed to estimate the association between the rate of doctors and some indicators of processes and health outcomes. Finally, the distribution of medical hours every 10,000 persons for overall adjusted mortality rate is modeled.rnrnResults: We show that the territorial distribution of physicians is uneven: an average of 3.11 days equivalent rate per 10,000 people in the large communes, and 2.23 for small communities is observed. In the correlation analysis there is a statistically significant association with most of the outcome variables. In addition, an inverse relationship, which would imply a 20% decrease in overall mortality rate adjusted for each increase in a day equivalent per 10,000 people is observed.rnrnConclusions: The uneven territorial distribution of primary care physicians in Chile, is necessary to advance the construction of a national policy to improve the quality of care that is provided to the community with high levels of resoluteness and user satisfaction.rn

Nerges Mistry is a biomedical research scientist and a community health expert with a work experience of 30 years. She is the director of Foundation for Research in Community Health and the Foundation for Medical Research and has guided several post-graduate research students. She is a member of several committees at the central level such as Task Force on Standard Treatment Guidelines and Empowered Programme Committee of the Government of India. She has more than 95 peer reviewed publications to her credit.

Community based programs deploying Community Health workers have been used globally as low-cost alternatives to serve communities. These programs are based on a task-shifting model, especially in resource poor settings and require extensive training and supervision. Implementing such programs pose its own set of challenges at various levels. A community based mental health program was implemented by the Foundation of Research in Community Health in rural parts of Western India and a thorough process documentation was used to collect data by means of informal discussions and interaction with the program staff. Programme level challenges included the onerous task of recruiting personnel experienced (in mental health) and sensitized to the topic, absorption of mental health concepts by individuals (without mental health background) and transferring the same to the community grounded in traditional beliefs, especially for mental health disorders; ensuring appropriate CHW to population ratio, establishing referral linkages, addressing rehabilitation concerns of the patients and supervising the heavy documentation. Community level challenges included working carefully around the power equations in the community, ensuring participation from the community, dispel misconceptions and suspicions regarding mental health and handling field emergencies. Systemic challenges involved the tedious process of attempting to transfer the expertise and knowledge gathered to the public health systems, attempting to include mental health care at the already over burdened primary care level, along with maintaining regular drug procurement to ensure a sustainable provision for mental health needs of the community. These experiences serve the purpose of improving implementation of community based programs.