Dubai Primary Health Care Centers Conformation to WHO Age-Friendly Primary Healthcare Recommendations

The WHO project for conforming PHC to requirements of all age groups has resulted in publishing a toolkit for age-friendly PHC in 2008. The toolkit included checklists for physical environment and signage properties. This study matched the current physical environment properties of DHA’s PHC Health Centers against WHO’s recommendations. This is a cross sectional descriptive study that included visits to all 12 Primary Health Care Centers in Dubai city during August-September 2016 with the objective to assess the degree of fulfillment of current properties of Health Centers building to the recommendations of WHO as listed in “Age-friendly Primary Health Care Centres Toolkit” [1]. The study found that 81.86% of physical environment properties are matching the recommendation of WHO, while signage matching was 44.6%. The study concluded that most PHC properties have a physical design that met WHO’s recommendations. The two major deviations were accessibility by public transportations and presence of grab bars. Factors that had a significant impact on design were compliance with multiple international and local standards, the availability of private cars, and the availability of wheel chairs. Signage in DHA’s health centers followed a central plan that differed from WHO’s recommendations.


Introduction
Elderly population in Dubai has almost doubled over the last decade from 10,797 (1.25% of total Dubai population) in 2005, to an estimated 59,977 (2.45% of total Dubai population) in 2015 [2].Primary Health Care (PHC) is the front line of health care system of Dubai, putting it at the optimal position to serve the needs of this population.A total of 9,965,632 outpatients visits were recorded during the year of 2015 in Dubai, DHA received 22.2% of them, and half of them were in the primary health care centers, while the other half were in hospitals or specialized centers [3].
According to a previous study conducted in 2015 on sources of care provided for elderly patients population in Dubai [4], primary health care centers were the primary source of health care for elderly (99% of them), followed by DHA hospitals (60.9%), then by Private hospitals (16.7%), treatment abroad (10.2%) and Ministry of Health facilities (2.3%) [4].
Besides being the major source of healthcare for its elderly attendees, 27.5% of these elderly were partially or completely dependent in 3 functions of Activities of Daily Living (ADL) [4].Thus, conformation of these HCs to accommodate the functional disabilities becomes very important.The Department of Ageing and Life Course (ALC) of WHO, has developed a toolkit to assist countries to deal with the peculiarities of elderly people in the setting of PHC [1].This toolkit is also used to assess conformation of current PHC design to the needs of elderly in other countries [5] [6].
Elderly seeking PHC in Dubai can visit clinics as adults, or they can be referred to geriatric medicine services.These geriatric medicine services are provided by elderly care unit in primary health care centers, and include specialized geriatric medical services at homes, acute hospital care and outpatient clinics (three general geriatric medicine clinics, two osteoporosis clinics, one memory clinic and one falls clinic) distributed geographically in 6 HCs to cover all catchment areas in Dubai.Some of the peculiar factors in the experience of the elderly with health centers visits are the pivotal role of escort and private cars, and pursuing multiple international standards for care in the health centers.
Private cars being the prime means of transport in Dubai, as private light vehicles are widely prevalent; with a ratio of one private light vehicle for every two residents [7].
Despite the ongoing graying of population in the Gulf States and the advancing health system, published data on primary health care services for elderly in this region is scarce, particularly if compared to amount of available articles on other population groups.One study, published in 2013, with a similar scope, was conducted in Riyadh area, in Saudi Arabia [5], and it can be used as a benchmark for comparison, due to the social, cultural and economic comparable environment.This article describes the degree of buildings designs conformation to seniors' needs (Elderly population) in primary health care centers belonging to Dubai

Objective
To assess the degree of buildings designs conformation to the recommendations of WHO as listed in "Age-Friendly Primary Health Care Centers Toolkit".

Methods
This is a cross sectional, descriptive and quantitative study based on observing, assessing and analyzing data collected from 12 primary health care centers of DHA in Dubai at a specific point in time from September 16 th 2016 until October 27 th 2017 (six weeks).The properties of primary health care centers were checked against recommendations for building design and signage checklists as recommended by WHO in "Age-Friendly Primary Health Care Centers Toolkit" [1].
Two experts, one healthcare provider and one engineer trained on the checklists visited the twelve health centers during allocated period of time to check if design of the buildings and signage are convenient and in conformity to the elderly patients.Two checklists were used in the visits, one for physical building design and the other for signage.The building and design checklist has 44 properties items, and signage checklist has 20 properties items.
All items on the checklists were addressed in all health centers, except physical design items in buildings that have more than a ground floor, as there were only four centers with services present in more than one floor.
The results were presented in tables.Every item on the tables represents a single building and design or signage property on the checklist.The tables show the percentage of centers properties matching the recommendation of the WHO.
The items (properties) on the checklist were re-organized and grouped for ease of explanation.
Data was recorded and analyzed manually using Microsoft excel 2013, and Microsoft Windows 7 platform.In the third pattern, the remaining health centers did not follow either outlays.

PHC Health centers in
Four health centers have this pattern with clinical services distributed on two levels of the building in three of them.
Table 1 and Figure 1 show spatial patterns of health centers in Dubai.

Discussion
The PHC of DHA is JCI accredited [8], in addition, recently received six ISO certificates [9].Therefore, DHA's standards in health centers design, administration and clinical services are high.
Most of the properties of the building and design met the recommendations of WHO's toolkit (81.6%).The primary health care centers were originally built taking in consideration the best practices.This is due to the fact that the design and utilities in the health centers have been continuously revised and improved with each accreditation process.While most of the physical building and design specifications met the recommendations in the WHO toolkit, the signage specifications did not (44.6%),due to a common uniform design of signs, which did Table 1.Spatial patterns of primary health care centers in Dubai.Since almost all seniors attend health centers by private transportations, parking areas around health centers become more important to patients, especially disabled ones.As part of building code in DHA regulation guide, all health centers in Dubai have at least one parking lot for disabled, except in the oldest health centers, where parking lot for disabled was allocated for ambulance.The availability of parking lots for disabled is relatively higher in Dubai health centers (92%) than in Riyadh health centers (33%).
Only two health centers in Dubai had signs on main roads pointing to their location, because they are the only health centers that satisfied municipality regulations, which restrict road signs for health facilities that work 24 hours with a number of in-patients beds only.
Inside health centers, grab bars were not available in 50% of Health centers (esp.older ones).This is may be due to the wide use of wheel chairs for assisting mobility.The sufficient availability of wheel chairs and the adaptation of the building design (entrance ramps, door and corridor width…) to their use are licensing pre-requisites [12], but grab bars installation is not a pre-requisite for licensing by DHA guide.All these factors together may have contributed to the low adoption of grab bars in Dubai's health centers.In a culturally and econom- Dubai have three patterns of outlays designs.First pattern is a new two-level health center, stellate in floor plan layout, provided with grab bars on walls, three health centers have this pattern.Second pattern has an older single-floor circular plan layout, without grab bars, five health centers have this pattern.

Figure 1 .
Figure 1.Design configurations of health centers in Dubai.

Table 2
average 81.86%) with about 43% of the building and design properties existed as recommended in all centers (19/44, 43%).The frequency of availability of examined properties is markedly skewed towards actual existence (median percentage 92%).Four health centers had two floors, while the rest had only a ground floor.The design elements of the entrances in the health centers are generally matching recommendations of WHO for age-friendly PHC design.
shows that most of primary health care centers building and design properties matched the recommendations stated in WHO's Age-Friendly PHC DOI: 10.4236/aar.2017.6600986 Advances in Aging Research toolkit (pooled

Table 2 .
Dubai primary health care centers building and design checklist results.

Table 3 .
Dubai primary health care centers signage checklist results.
[11] dependence on private cars is also evident in a society with similar culture in city of Riyadh, Kingdom of Saudi Arabia; where private cars represented 93.4% of all types of vehicles, and 58% of families own two or more private cars[11].This situation is matching that of Riyadh health centers, where none of them was served by public transportation.