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

2. 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

3. 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.

4. 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.

5. 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

6. 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.

7. Innovative Clinical Practices

9. 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

10. 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.

11. 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.

12. 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

13. Integrated Health Services Delivery Networks

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

15. 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)

16. 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)

17. 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

18. 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

19. Thank you!