BUILDING INTEGRATED HEALTH SERVICE DELIVERY NETWORKS FIRST LEVEL OF CARE MULTI-DISCIPLINARY TEAMS & SPECIALIZED CARE (IHSDNs Attribute # 3 and 4) July 28 - 30, 2015 Belize REYNALDO HOLDER Health Services and Access Unit Department of Health Systems and Services

Overview Definitions: Attribute # 3: Attribute # 4: First Level of Care Specialized Care Attribute # 3: Gateway to the health delivery services Comprehensive, integrated and continuous care Coordination of the continuum of services Integration of priority (vertical) programs Attribute # 4: Constant adjustments based on needs Non-hospital settings

Integrated Health Services Delivery Networks

Multi-Disciplinary First Level of Care Attribute 3 A multi-disciplinary first level of care that covers the entire population, serves as preferred first point of access to the system, and integrates and coordinates care throughout the continuum, in addition to meeting most of the population’s health needs.

Multi-Disciplinary First Level of Care Definitions: First Level of Care: the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Adapted from the Institute of Medicine

Multi-Disciplinary First Level of Care Definitions: Specialized Care: includes a multiplicity of services provided in both ambulatory and hospital settings, involving care and services that are specific to clinical specialties or allied disciplines. Social Care: includes social support and coordination with other non-health institutions to secure safe transition for patients return to home and to normal life.

Multi-Disciplinary First Level of Care Attribute # 3 Preferred first point of contact with health services Multi-disciplinary teams Comprehensive, integrated and continuous care Coordination of the continuum of services Integration of priority (vertical) programs

Multi-Disciplinary First Level of Care Multi-disciplinary teams Configuration of health teams based on needs of the population in specific territory Different experiences: Physician led Nurse led Dependent of available resources

Multi-Disciplinary First Level of Care Comprehensive, integrated and continuous care Should address all health needs of individuals and communities; Care should be integrated no matter were it is received; FLC must ensure continuity and coordinate person’s transit throughout the services.

Multi-Disciplinary First Level of Care Integration of Priority Programs Care based on person’s needs, not on vertical programs Care provided to each individual based on needs and age related health promotion, prevention and risk management. Care of individuals in context with care of the family and the social determinants of the community.

Multi-Disciplinary First Level of Care Remember: PUBLIC HEALTH The IHSDNs has responsibility for Public Health activities and interventions in the assigned territory; Ensures planning, implementation and evaluation of Public Health activities (Immunization, Public Health surveillance of water quality, sewage disposal, food safety, etc.)

Delivery of Specialized Services Attribute 4 Delivery of specialized services at the most appropriate location preferably in non-hospital settings.

Delivery of Specialized Services Extensive network of healthcare facilities Range of health facilities: First Level of Care Second level ambulatory services Specialist ambulatory services Acute Hospitals Diagnostic services Nursing centers, Home-based care Rehabilitation centers

Delivery of Specialized Services Definitions: Appropriate care: refers to the provision of care That meets the health needs of the entire population; That is effective and based on the best available scientific evidence; Interventions that are safe; Allocation of resources based on equity and economic efficiency.

Delivery of Specialized Services Non-hospital settings Health centers Polyclinics (specialized outpatients centers) Interface with FLC teams (Kaiser Permanente, One-Stop Care Centers) Re-thinking and re-engineering of hospitals Acute care Intensive care Major surgery

Moving Forward: The How? Define sector population size Decide on composition of FLC teams Allocate current human resources (FLC and Specialist) to sectors. Criteria for prioritizing Determine Human Resources for Health gap Prepare plan for gap resolution

Thank you!