People-centred integrated health services

“In my country, access to treatment is a very big challenge if one is not known by a health worker or comes from a poor society. One may take too long to get the attention of a doctor for treatment. Women are sexually abused to get treatment favours. Some people use their political power, economic status or position at work to access treatment.” Patient’s brother, WHO African Region ChallengeVisionStrategy

Climate change Ageing NCDs Innovation Globalization Urbanization Citizen voice The changing global context: challenges and opportunities Rising costs Source: WHO Global Health Observatory Data Repository, 2015

Health system challenges Unequal access Poor quality Lack of safety Low participation Low satisfaction HEALTH SYSTEM Need for cost- efficiency and accountability Unhealthy lifestyle Double-burden of disease and multi-morbidity Increased need to self-manage care Emerging demands Greater citizens expectations Lack of community engagement Limited intersectoral action Insufficient & misaligned financing System constraints Sub-optimal health workforce Service fragmentation & inappropriate service delivery model

Why do people not access services?

Geographical barriers Economic barriers Low knowledge/awareness Sociocultural factors (gender, ethnicity) Stigma, fear of social isolation Lack of health system responsiveness Access barriers

ChallengeVisionStrategy © World Health Organization 2015 “Treat each patient as if they were your own family. Show compassion, caring and provide hope to patients…Spend more time with them and their families. Help patients learn about their diseases. Encourage patients to….become their own advocates. Share information about groups where they can get support. Most importantly, don’t treat a patient like a number in a factory. Treat them as an individual, like it was your own mother/father/sister/brother. Show compassion, caring and empathy.” Patient’s son, WHO Region of the Americas

“A future in which all people have access to health services that are provided in a way that responds to their preferences, are coordinated around their life course needs and are safe, effective, timely, efficient and of acceptable quality” The vision

People-centred integrated health services delivery: example of Alzheimers Source: Adapted from National Voices (2013) Coordinated Preventive Goal oriented Evidence- informed Empowering Respectful Co-produced Endowed with rights and responsibilities Equitable Continuous Shared accountability Comprehensive Ethical Led by whole- systems thinking Sustainable Collaborative Holistic Alzheimer’s social outreach worker Dementia advisory nurse Continence adviser Consultant Out-of-hours doctors Dietician Community dentist Physiotherapist Speech & language adviser District nurses Occupational therapist Equipment service Wheelchair service Social worker GP Live-in carers Oxygen service Person- centred Integrated services delivery Malcolm & Barbara

People-centred health services Adopts the perspectives of individuals, families and communities. Sees them as participants as well as beneficiaries of trusted health systems that respond to their needs. Organized around the health needs and expectations of people rather than diseases. People-centred integrated health services delivery Services are managed and delivered in a way to ensure people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation and palliative care services, according to their needs, throughout their life. Integrated health services

A framework for people-centred integrated health services delivery One size does not fit all

The way forward: five strategic directions The way forward: five strategic directions Strengthening governance and accountability Empowering & engaging people Reorienting the model of care Coordinating services

The way forward: five strategic directions

Strategic direction 1. Empowering & engaging people Improving health literacy Examples of interventions Sharing decision making between people & health professionals Giving people access to personal health records Supporting self- management Promoting personal care Fostering community participation Boosting community awareness Enhancing community delivered care Harnessing patient and user groups Addressing structural factors that marginalize at-risk communities

Strategic direction 2. Strengthening governance & accountability Examples of interventions Developing patients charters Providing communities with information Undertaking community consultations Collecting and acting upon patient and users experiences Decentralizing and devolving Registering with providers Performance-based contracting Performance-based financing Contracting for quality and equitable services

Strategic direction 3. Reorienting the model of care Strengthening primary care through family & community practice models Examples of interventions Developing community based multidisciplinary teams Expanding ambulatory, community & home-based care Integrating mental and physical health care Harnessing peer groups Outreaching services to marginalized and remote communities E-health Assessing health technologies Defining a comprehensive package of services offered to population

Strategic direction 4. Coordinating services Care coordination Examples of interventions Care management Developing care pathways Integrating primary and specialist care Integrating vertically oriented services into primary care services Integrating health and social care Building intersectoral partnerships Integrating traditional and complementary medicine into modern health systems

Strategic direction 5. Creating an enabling environment Examples of interventions Promoting transformational and distributed leadership Securing dedicated resources Prioritizing health workforce education and training Using mixed payment models based on capitation (cappuccino model) Defining clear roles and responsibilities Ensuring regular communication and open feedback Strengthening and aligning regulatory framework

The way forward: five strategic directions The way forward: five strategic directions Strengthening governance and accountability Empowering & engaging people Reorienting the model of care Coordinating services

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