Co-produced. Endowed with rights and responsibilities. Equitable. Continuous. Shared accountability. Comprehensive. Ethi
The WHO Framework on integrated people-centred health services Geneva Health Forum 19-21 April 2016, Geneva
The changing global context: challenges and opportunities
Ageing
Innovation
Climate change
Globalization
Rising costs
NCDs
Citizen voice
Urbanization
Source: WHO Global Health Observatory Data Repository, 2015
Health system challenges EMERGING DEMANDS Double-burden of disease and multimorbidity
Unhealthy behaviours & lifestyle choices
SYSTEM CONSTRAINTS Lack of community empowerment and engagement Insufficient and misaligned financing Sub-optimal health workforce
Unequal access Greater citizens expectations
PoorHEALTH quality/safety
SYSTEM Deficient participation Low satisfaction
Increased need to self-manage care Need for cost efficiency and accountability
Limited intersectoral action
Service fragmentation and inappropriate service delivery model
People-centred and integrated health services in the NUKA health system, Alaska, USA
Case management in Torbay, UK
Promoting HIV/AIDS literacy in Angola
Integrated health care networks in Brazil
Integrated health care networks in Chile
Social participation in Tupiza, Bolivia
Shared accountability contract for population health outcomes, Kinzigtal, Germany
Promoting service coordination in Lithuania
Integrated care in South Karelia, Finland
What are the experiences to date?
Integrating HIV/AIDS and TB in Mali
Mobilizing communities to reduce maternal and neonatal deaths in Malawi
Family medicine in Thailand as part of UHC
Balanced scorecard to promote accountability, Afghanistan
Integrating traditional and complementary medicine in Asia
Communityowned primary care networks in Mali
Improved access to care for marginalized groups
Reduced unplanned hospitalizations
Increased ability to selfmanage
Shared decision-making
Shift in the balance of care, allocating resources closer to needs
What outcomes have been achieved?
Increased access to care
Greater community influence & better relationships with care providers that build awareness and trust
Improved health literacy
Workforce role enhancement
Reduced perinatal and neonatal mortality
Reduced costs
Increased health coverage
Greater community engagement & participatory representation
Better coordination of care
Greater quality of care
Success
Lessons from implementation: challenges to achieve sustainability and scale
t1
t2
t3 Time (years)
Project’s duration Source: Adapted from Amelung et al. 2014, Transform Proposal
1
Project failure
2
Slow death
3
Struggling projects
4
Sustainable projects
5
Scaling up
6
System transformation
The vision “All people have equal access to quality health services that are co-produced in a way that meets their life course needs, are coordinated across the continuum of care and are comprehensive, safe, effective, timely, efficient and acceptable; and all carers are motivated, skilled and operate in a supportive environment”
Defining integrated people-centred health services delivery Shared accountability
Evidenceinformed
Led by wholesystems thinking
Ethical
Empowering
Goal oriented
Holistic
Respectful
Integrated peoplecentred services delivery
Coordinated
Collaborative
Co-produced Continuous Comprehensive Sustainable Endowed with rights and responsibilities
Source: Adapted from National Voices (2013)
Preventive
Equitable
A model for integrated people-centred health services delivery
Stategy1. Empowering & engaging people Examples of interventions
Improving health literacy
Fostering community participation
Sharing decision making between people & health professionals
Boosting community awareness
Giving people access to personal health records
Enhancing community delivered care
Supporting self-management
Harnessing patient and user groups
Promoting personal care
Addressing structural factors that marginalize at-risk communities
Parallel processes in the development and implementation of the Framework Parallel processes in the Framework consultation development and implementation Implementation support Interim report consultation of2015thePublic Framework Consultation with WHO Regional Offices Executive Board
2016 World Health Assembly
Call for action for IPCHS
Piloting and development of demonstration sites
Assessment and implementation toolkits Monitoring and evaluation Exchanging knowledge and facilitating change
Supporting the implementation of the Framework: aims and objective
CONTACT INFORMATION Services Delivery and Safety Department World Health Organization Avenue Appia 20 CH-1211, Geneva 27 Switzerland For more information on health services delivery visit http://www.who.int/servicedeliverysafety/areas/peoplecentred-care/en/
