PAHO/WHO STRATEGY INTEGRATED HEALTH SYSTEM DELIVERY NETWORK Dr Malhi Cho Health Systems and Services PAHO

Health Systems Reforms XX and XXI Centuries Up to the 1920s: Sanitary Campaigns 1920-1940: Social Security systems (Bismarck model) 1950-1970s” “Welfare State systems” (Beveridge model) 1970-80s: Primary Health Care (Health for All – Alma Ata) 1980 to 90s: Cost-containment and efficiency driven (International Financial Institutions) 2000 to date: Renewal of PHC People centered care Integrated Healthcare delivery Social Protection in Health Universal Access to Health and Universal Health Coverage (Universal Health)

The progress…….. 2005 WHR 2008 1978 Renewed PHC Reforms based on PHC Alma Ata 1978

Integrated Health Services Delivery Networks

Integrated Management Systems Attribute 10 Integrated management of clinical, administrative and logistical support systems

Integrated Management Systems Administrative Depends on size and complexity of network Multi-disciplinary management team responsible for the continuum of care Economies of scale in centralized management and support systems

Integrated Management Systems Clinical Depends on size and complexity of network Centralized and integrated clinical support systems Laboratory Radiology Other diagnostic systems Medical technology assessment and rationalization

Integrated Management Systems Logistical support Depends on complexity of network Organized and centralized for the whole network Appointment system Medical transport Other transport Maintenance Centralized purchase, storage and delivery of drugs and medical supplies

Integrated Management Systems Attribute 11 Sufficient, competent and committed human resources for health that are valued by the network

Integrated Management Systems Human Resources for Health Quantity, distribution and competencies for appropriate services to cover population needs Defining composition of basic health teams Defining requirements for specialized care based on population health needs New positions and new competencies Development plan Organizational culture National Human Resources for Health policies

Integrated Management Systems Attribute 12 An integrated information system that links all network members with data disaggregated by age, sex, place of residence, ethnic origin, and other pertinent variables.

Integrated Management Systems Information System Links all network members Not only Electronic Medical Record Nor only an Epidemiological Information system

Integrated Management Systems Information System Should include: Unique personal identifier Health status of population (including social determinants) Demand and utilization One Health Record Personal, Family and Community Health Information Clinical Information (personal medical record) Information on population satisfaction Other clinical support information: Call Centers PDR/Vademecum Universal definitions of terms and standards Clinical Guidelines & Treatment Protocols Operational information: Admissions, discharges, visits/consultations, referrals, etc. Appointment System Visits and consultations Procedure Planning (Surgeries, labs, imaging) Management & Financial Information (Balanced Score Card, Daily Management Dashboards, PERC, etc.) The question of Confidentiality

Integrated Management Systems Attribute 13 Results-Based Management

Integrated Management Systems Results-Based Management (RBM) A strategy or approach through which an organization ensures that its processes, products and services contribute to achievement of clearly defined results.

Integrated Management Systems Results-Based Management (RBM) Strategic planning and management framework; Strategy to achieve change in the way institutions operate; Improve performance and achievement of results; Accountability

Integrated Management Systems Results-Based Management (RBM)

Lessons Learned Integration process: Are complex and take a long time. Require wide systemic changes Require the commitment of health workers, managers and policy makers Integration is not a one-fit-all. There can be different modalities and levels of integration in one system. Evidence suggest that clinical integration, integrating information systems and staff buy-in are the most challenging changes to achieve. Integration is not a cure for lack of resources. Important lessons are extracted.

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