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

2. Health Systems Reforms XX and XXI Centuries
Up to the 1920s: Sanitary Campaigns
: Social Security systems (Bismarck model)
s” “Welfare State systems” (Beveridge model)
s: 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)

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

5. Integrated Health Services Delivery Networks

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

7. 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

8. 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

9. 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

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

11. 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

12. 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.

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

14. 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

15. Integrated Management Systems
Attribute 13
Results-Based Management

16. 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.

17. 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

18. Integrated Management Systems
Results-Based Management (RBM)

19. 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.

20. Thank you!