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

2. 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

3. Integrated Health Services Delivery Networks

4. 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.

5. 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

6. 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.

7. 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

8. 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

9. 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.

10. 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.

11. 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.)

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

13. 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

14. 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.

15. 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

16. 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

17. Thank you!