People-centred integrated

health services

“In my country, access to treatment is a very big challenge if one is not known by a health worker or comes from a poor society. One may take too long to get the attention of a doctor for treatment. Women are sexually abused to get treatment favours. Some people use their political power, economic status or position at work to access treatment.”

Patient’s brother, WHO African Region

Challenge

Vision Strategy

Climate change Ageing

NCDs

Innovation Globalization

UrbanizationCitizen voice

The changing global context: challenges and opportunities

Rising costs

Source: WHO Global Health Observatory Data Repository, 2015

Health system challenges

Unequal access

Poor qualityLack of safety

Low participation

Low satisfaction

HEALTH SYSTEM

Need for cost- efficiency and accountability

Unhealthy lifestyleDouble-burden

of disease and multi-morbidity

Increased need to

self-manage care

Emerging demands

Greater citizens

expectations

Lack of community engagement

Limited intersectoral

action

Insufficient & misaligned financing

System constraints

Sub-optimal health

workforce

Service fragmentation & inappropriate service delivery

model

Why do people not access services?

• Geographical barriers

• Economic barriers

• Low knowledge/awareness

• Sociocultural factors (gender, ethnicity)

• Stigma, fear of social isolation

• Lack of health system responsiveness

Access barriers

Challenge Vision Strategy

© World Health Organization 2015

“Treat each patient as if they were your own family. Show compassion, caring and provide hope to patients…Spend more time with them and their families. Help patients learn about their diseases. Encourage patients to….become their own advocates. Share information about groups where they can get support. Most importantly, don’t treat a patient like a number in a factory. Treat them as an individual, like it was your own mother/father/sister/brother. Show compassion, caring and empathy.”

Patient’s son, WHO Region of the Americas

“A future in which all people have access to health services that are provided in a way that responds to their preferences, are coordinated around their life course

needs and are safe, effective, timely, efficient and of acceptable quality”

The vision

People-centred integrated health services delivery: example of Alzheimers

Source: Adapted from National Voices (2013)

Coordinated

Preventive

Goal oriented

Evidence-informed

Empowering

Respectful

Co-produced Endowed with

rights and responsibilitie

s

Equitable

Continuous

Shared accountabilit

y

Comprehensive

EthicalLed by whole-

systems thinking

Sustainable

Collaborative

Holistic

Alzheimer’s social

outreach worker

Dementia advisory nurse

Continence adviser

Consultant Out-of-hours doctors

Dietician

Community dentist

Physiotherapist

Speech & language adviser

District nurses

Occupational therapist

Equipment service

Wheelchair service

Social worker

GP

Live-in carers

Oxygen service

Person-centred

Integrated services delivery

Malcolm

& Barbara

People-centred health

services

Adopts the perspectives of individuals, families and communities. Sees them as participants as well as beneficiaries of trusted health systems that respond to their needs. Organized around the health needs and expectations of people rather than diseases.

People-centred integrated health services delivery

Services are managed and delivered in a way to ensure people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation and palliative care services, according to their needs, throughout their life.

Integrated health

services

A framework for people-centred integrated health services delivery

One size does not fit all

The way forward: five strategic directions

Strengthening governance and accountability

Empowering & engaging people

Reorienting the model of care

Coordinating services

The way forward: five strategic directions

Strategic direction 1. Empowering & engaging people

Improving health literacy

Examples of interventions

Sharing decision making between people & health professionals

Giving people access to personal health records

Supporting self-management

Promoting personal care

Fostering community participation

Boosting community awareness

Enhancing community delivered care

Harnessing patient and user groups

Addressing structural factors that marginalize at-risk communities

Strategic direction 2. Strengthening governance & accountability

Examples of interventions

Developing patients charters

Providing communities with information

Undertaking community consultations

Collecting and acting upon patient and users experiences

Decentralizing and devolving

Registering with providers

Performance-based contracting

Performance-based financing

Contracting for quality and equitable services

Strategic direction 3. Reorienting the model of care

Strengthening primary care through family & community practice models

Examples of interventions

Developing community based multidisciplinary teamsExpanding ambulatory, community & home-based careIntegrating mental and physical health care

Harnessing peer groups

Outreaching services to marginalized and remote communities

E-health

Assessing health technologies

Defining a comprehensive package of services offered to population

Strategic direction 4. Coordinating services

Care coordination

Examples of interventions

Care management

Developing care pathways

Integrating primary and specialist care

Integrating vertically oriented services into primary care servicesIntegrating health and social care

Building intersectoral partnerships

Integrating traditional and complementary medicine into modern health systems

Strategic direction 5. Creating an enabling environment

Examples of interventions

Promoting transformational and distributed leadership

Securing dedicated resources

Prioritizing health workforce education and training

Using mixed payment models based on capitation (cappuccino model)

Defining clear roles and responsibilities

Ensuring regular communication and open feedback

Strengthening and aligning regulatory framework

The way forward: five strategic directions

Strengthening governance and accountability

Empowering & engaging people

Reorienting the model of care

Coordinating services

Thank you