Presentation on theme: "European Forum for Primary Care: "Twinning Population Health and Primary Care" Barcelona, Spain, 1-2 September, 2014 WHO Strategy on People-Centered and."— Presentation transcript:
1 European Forum for Primary Care: "Twinning Population Health and Primary Care" Barcelona, Spain, 1-2 September, WHO Strategy on People-Centered and Integrated Health Services (PCIHS)Hernan MontenegroCoordinatorServices Organization and Clinical InterventionsService Delivery and Safety (SDS)
3 Ongoing challenges for health Access – 1/3 of people with mental health disorders in HICs receive treatment, as low as 2% in LMICsAvailability – 58% of countries have any palliative care programAcceptability – delivering women experience verbal abuse, condescension, intimidation and even physical abuseQuality of care – international survey of clinical practice for heart failure found only 59% of quality of care indicators achieve, under clinical trial conditions
4 Emerging challenges for health services Non-communicable diseases:multiple-morbiditieslong-term, continuous careService fragmentationExisting and growing inequitiesRecognition of the significant challenges to reforming health service delivery systems
5 Ongoing challenges for health Lack of coordinationCoordination Of Care, Medical Errors, And Safety Among Sicker Adults In Eleven Countries, 2011
6 Emerging challenges and opportunities Demographic and Epidemiological TransitionSocio-political factors:concerns about health care costs, and cost-efficiencyIncreasingly active and organized consumersTechnological advances:Patient self-monitoring and self- managementLinkages between health care providers (e.g. electronic medical records)Globalization:Export of unhealthy lifestylesMedical tourism
7 Building on Global Commitments Reinvigorating Primary Health Care (WHR 2008)Health systems strengthening (Everybody’s Business 2007)Universal Health Coverage (WHR 2010)Rio Declaration on social determinants (2011)Prevention and control of NCDs (UNGASS 2011)Multiple regional reportsGrowing global commitments– but can service delivery systems deliver?
8 Source: WHO, Primary Health Care- Now More than Ever, World Health Report, 2008
9 Understanding People Centered and Integrated Health Services Universal Health CoveragePeople Centered CareIntegrated Health ServicesPeople centered and integrated care to support UHC-The best case scenario-
11 Core principles guiding People-Centered and Integrated Care ComprehensiveEquitableSustainableCo-ordinatedContinuousHolisticPreventativeEmpoweringCo-producedRespectfulRights and responsibilities approachCollaborative careShared accountabilityEvidence-informedWhole-systems thinkingComprehensive - a commitment to universal health coverage to ensure care is comprehensive and tailored to the evolving needs and aspirations of peopleEquitable – care that is accessible and available to allSustainable – care that is both efficient, effective and contributes to sustainable developmentCo-ordinated – care that is integrated around people’s needs and effectively coordinated across different providers and settingsContinuous – continuity of care and services that are provided across the life courseHolistic - a focus physical, socio-economic, mental, and emotional wellnessPreventative - tackles the social determinants of ill-health through intra- and inter-sectoral action that promote public health and health promotionEmpowering – supports people to manage and take responsibility for their own health9.Co-produced – through active partnerships with people and communities at an individual, organizational and policy-level10.Respectful - to people’s dignity, social circumstances and cultural sensitivities11.Rights and responsibilities approach12.Collaborative care - that supports relationship-building, team-based working and collaborative practice across primary, secondary, tertiary care and other sectors13.Shared accountability - between care providers for quality of care and health outcomes to local people14.Evidence-informed15.Whole-systems thinking
12 Examples of interventions for each Strategic Action Empowering and engaging peopleHealth literacyAccess to personal health recordsSelf-management & carePatient/family involvement in clinical decision makingDevelopment of community organizations, etc.Strengthening governance & accountabilityDecentralization & devolutionPerformance based-contracting & financingProvider report cards, patient reported outcomes & surveysRegistration with specific provider(s)Patient charters, etc.Reorienting the model of careStrengthening primary care through family/community practice modelsExpand ambulatory, community & home-based careComprehensive benefits plansHealth technology assessmentsOutreach services for marginalized communities, etc.Coordinating servicesIntegrating vertically oriented services into primary care servicesInformation systemsInter-professional collaborationReferral systemsInter-sectoral partnerships, etc.Creating an enabling environmentLeadership and development of shared visionInclusion into national health policies, strategies & plansDedicated resourcesChanging organizational cultureReorienting the health workforce, etc.
13 Strategy implementation Country contextLow income countriesMiddle income countriesHigh income countriesSome special cases:Fragile/conflict affected statesSmall island statesLarge federal states
14 Strategy implementation Country-ledEquity-focusedEnsuring that people’s voices are heardRecognizing interdependenceSharing knowledgeLearning/action cycles
16 Strategy implementation Some key issues for health workforce (HWF)HWF planning and skills mixCapacity gaps and distributionNew roles and functions (e.g. network planning and management; clinical integration)Regulation (e.g. certification, re-certification, flexibility to relocate)Teamwork, multi-disciplinary teams and inter-professional collaborationOrganizational cultureInnovation and learning with bottom-up approachesPerformance assessment and mutual accountabilityCo-production of healthCompensation, incentives and motivationIn service training and career development pathCompetencies (e.g. systems thinking, teamwork, negotiation, conflict resolution)Inter-professional trainingInterim short training courses to compensate for lack of specialists
17 Next stepsRefine, publish and disseminate two versions of the Strategy:Shorter version for policy-makersLarger version for broader technical audienceMobilize resources in support of StrategyStart rolling out implementation of Strategy jointly with other partners during 2nd semester of 2014