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Co-creating Health Systems WHO Geneva, May 2006 Dr Shaun Conway Sharon White.

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Presentation on theme: "Co-creating Health Systems WHO Geneva, May 2006 Dr Shaun Conway Sharon White."— Presentation transcript:

1 Co-creating Health Systems WHO Geneva, May 2006 Dr Shaun Conway Sharon White

2 Expectations 1.Explore the potential of Co-creation as an innovative approach to strengthening health systems 2.Advocate for Human Scale Development in pursuing development goals & poverty reduction 3.Present our PPM project (under development) as an example to apply these concepts and focus the discussion 4.Identify lessons for improving our work

3 Problems with traditional services Providers - resist centrally derived targets & performance improvement Professionals - de-motivated by poor pay; heavy workload Users - poor quality, impersonal experience Products - singular, high cost consumptive Public-private divide Little accountability for care outcomes & impact Innovation difficult to propagate Fragmented - not efficient and lacks synergy Centralized - discourages creativity and self-efficacy in decision making

4 HS challenges for Development Goals Inadequate coverage (limited supply) Variable quality (reduced effectiveness) Fragmentation (Lack of efficiency & absorptive capacity) No sustainability (consumptive vs productive) Failing prevention Systems not meeting the needs of people Treat affected populations vs develop healthy communities These challenges will not be solved by just increasing aid or achieving economic growth (i.e. traditional development approaches)

5 Human Scale Development Development is a process that happens inside people as a consequence of what happens between people and their life support systems, as they satisfy their fundamental human needs by fashioning an infinite range of diverse satisfiers. Manfred Max-Neef

6 The Chronic Care Model (Adapted from: Wagner EH. Effective Clinical Practice, 1998)

7 Components of Health Systems 1.Rules 2.People 3.Money 4.Supplies 5.Information 6.Management 7.Community Traditionally health systems are closed and operate within parallel public and private domains

8 Drivers of Public Health Benefit Most health benefit accrues from changes outside the health system Family and individuals (through self-care) provide majority of healthcare, +traditional healers Cumulative changes result from health trends (especially if increasing self-efficacy for health action)

9 A 7 th element of health systems Sustainable systems need cohesion =community Social cohesion Shared goals Shared values Identity Participation Creativity... Types of community User community Provider community Professional community… Social support and a sense of belonging (being part of a social network) are a vital part of good health

10 Co-creating Open Systems By enabling collaboration across sectoral, organizational and public/private boundaries this creates communities that can grow as distributive networks to make sustainable contributions that address local health needs. These communities co-create health systems through new combinations of financing, knowledge, human resources, etc.

11 Changing Paradigms Prevailing strategies rely largely on outmoded theories of control and standardisation of work. More modern, and much more effective, theories of production seek to harness the imagination and participation of the workforce [health providers] in reinventing the system Don Berwick, Quality & Safety in Health Care, December 2003

12 Desirable characteristics of Open Systems… Accessible by being distributed across communities & households Collaborative so resources, know-how, effort & expertise are shared Creative building on what is already available and more adaptive to local needs High-Impact with greater potential to generate long-term public health benefits Sustainable when participants in care are seen as producers, rather than consumers

13 Unlocking the potential to co-create health Create conditions for co-creation Help providers become organized, motivated and equipped Activate communities / networks and help them to become better organised Introduce interventions that have the greatest potential to synergistically satisfy fundamental human needs Distribute information, resources, know-how

14 Public-Private Mix A design that establishes the conditions for co-creating health systems: Purpose (shared goals) Participants Operating platform Tools & processes Resources Agency


16 Shared Public Health Goals Availability Quality Sustainability Service Integration

17 Participants in the mix Private Companies Medical practitioners Public Sector employees CBOs (Home-based care) Traditional Healers Care supporters Dispensaries Workforce (esp. Peer Educators) Church groups, School teachers… These are active communities that have the energy, people and potential to co-create health services

18 Examples of corporate contributions Health of the workforce community Advocacy & political influence Corporate Social Responsibility Leveraging Core competency Funding / donations (including co-investment) CSR is business response to sustainability

19 Operating Platform Public Health Approach Package of essential public health interventions Guidelines Training Monitoring tools … A franchise for public health care

20 Tools & processes Contracting (including MoU) Accreditation Training (eg. IMAI) Monitoring & reporting … Wherever possible, use National Programme tools, processes, standards, etc. BUT difference here is in how these are operationalized (for sustainability)

21 Resources Co-investment Drug supply Knowledge Expertise …

22 Agency Roles Create conditions Advocacy (alignment of public health goals) Tools and processes Public Health Approach (programme alignment) Resources (investment, allocation, management) Organise, motivate & equip providers Community-building (mobilise participation, establish partnerships) Developmental interventions Distribute information, resources, know-how Manage sustainable development of system Learning and knowledge management (incl reporting) etc.

23 What motivates co-creation? Interventions that satisfy fundamental Human Needs can drive sustainable participation : + Subsistence+ Understanding + Protection (health)+ Creation + Participation+ Identity + Idleness (recuperation) + Affection (care)+ Freedom (choice) Needs Theory is central to understanding Human Scale Development


25 I Know! intervention meeting Human Needs NeedHavingBeingDoing SubsistenceStipendEmployedPeer Support ProtectionTreatmentSupportedAdhering Understanding TrainingTx LiterateLearning ParticipationRoleIn TeamTrain others CreationOpportunityResourcefulCommunicating Identity Expert Patient DisclosedAdvocacy FreedomChoiceAbleDeciding

26 Early experiences Opportunities: Risks: CSR (linked to workplace responses) GBC, WEF, GCSD Co-investment PEPFAR, GFATM PLHA Advocacy for participation Political declarations about Private Sector More organised providers Developing markets Local action (building on workplace programme) Establishing legitimacy Aligning corporate partner Defining governance Feasibility? Political processes ROLES & INFLUENCES OF LOCAL/PROVINCIAL GOVERNMENT…

27 Government Roles How to exercise stewardship over open systems? PPP policy Levels of decision-making Resource allocation Regulation Relationship with Agency

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