BUILDING INTEGRATED HEALTH SERVICE DELIVERY NETWORKS PEOPLE CENTERED CARE (IHSDNs Attribute # 6) July 28 - 30, 2015 Belize REYNALDO HOLDER Health Services and Access Unit Department of Health Systems and Services

Overview Definitions: Differences with traditional model Person Centered People, Family and Community Centered Differences with traditional model Life Course Approach Ethnicity and Gender Self-care & Self-management Patient Bill of Rights

Definitions Person centred care is about care approaches and practices that see the person as a whole with many levels of needs and goals with these needs coming from their own personal social determinants of health. Hence, to be ‘person-centred’ means being responsive to holistic needs and to tailor care to individuals’ or group’s specific characteristics and potential.

Definitions People centred care goes beyond a model or care that confronts common epidemiological population profiles to one that considers holistic needs and aims of the community in an evolutionary movement that should strengthens individuals and communities’ competencies and action towards health and well-being. People centred care also encompasses person-centred care.

People centred care: Key principles (Montenegro et al, 2010) Promotion of health and wellbeing Focus on whole-person care Care for all people Partnership and participation Sensitivity to social/cultural diversity and context Quality of relationship and communication between the system and users Tailored and responsive care – i.e. to individual needs Comprehensive Continuous Right and responsibilities

Conventional Ambulatory Medical Care People-centered Care Focus on illness and cure Focus on health needs Relationship limited to the moment of consultation Enduring personal relationship Episodic curative care Comprehensive, continuous and person-centered care Responsibility limited to effective and safe advice to the patient at the moment of consultation Responsibility for the health of all in the community along the life course; responsibility for tracking and addressing determinants of ill health. Users are consumers of the care they purchase People are partners in managing their own health and that of the community they live in.

Innovative Clinical Practices

The Life Course Approach: Definition The Life Course Perspective: Looks at how chronological age, relationships, common life transitions, and social change shape people’s lives from birth to death. Considers how protective and risk factors, and events that occur earlier in life influence the trajectories and later outcomes across individual and population life spans. Life course theory: Helps explain health and disease patterns- including healthdisparities – across populations and over time Is population-focused Is firmly rooted in social determinants and social equity models

The Life Course Approach: Implications Goals of a life course approach: To optimize health across the lifespan for all people To eliminate health disparities across populations and communities Change in accountability: responsibilities across cohorts. Need to incorporate a whole-person, whole family and whole community approach – alliance building beyond the usual reach of public health. Need for horizontal linkages and integration between health and other services.

The Life Course Approach: Implications Assure the availability of services and support during critical or sensitive periods throughout the lifespan. Address risk and protective factors today that will influence tomorrow’s health. Focus on health equity from the perspective of the population and time: going beyond tracking disparities to identify and address root causes of disparities at the population level.

The Life Course Approach: Implications Take into account the broader social and environmental context in which people live and the connections across the lifespan, in the design of individual interventions Take into account the temporal (longitudinal) aspect of risk and protective factors in the analysis of health and disease Strong emphasis on a healthy start: pre-conception, antenatal, neonatal periods

Integrated Health Services Delivery Networks

Understanding Integrated Care Integrated care means different things to different people – there is no universally accepted definition.

Integrated care is centred around the needs of service users ‘The patient’s perspective is at the heart of any discussion about integrated care. Achieving integrated care requires those involved with planning and providing services to ‘impose the patient’s perspective as the organising principle of service delivery’ (Shaw et al, 2011, after Lloyd and Wait, 2005)

Gender issues for consideration Gender equity and gender equality interact: Equitable coverage of women and men´s differentiated health needs Going beyond the biological categories: ‘Gender differentials in exposure and vulnerability to health risk can arise for two main reasons: the interplay of biological sex with the social construction of gender, and direct impacts of structural gender inequalities’ (Sen and Ostlin, 2009)

Ethnic issues for consideration Ethnicity: Traditionally excluded group (equity): Requires a targeted approach to ensure and evaluate universal access and coverage (equal inclusion and wellbeing for all); Specific cultural barriers to health: Require an intercultural approach in order that all people can access integral, adequate, opportune quality services that respond to their needs and realities

Ethnic issues for consideration Inequities in health: Higher levels of infant mortality Inequalities in causes of mortality: physical injuries; infections and parasites TB principally affects indigenous population Intersections with gender inequalities: Higher unmet contraceptive need amongst indigenous women Less prenatal control and skilled attendance at birth for indigenous and afrodescendent women

Thank you!