1. European Forum for Primary Care: "Twinning Population Health and Primary Care" Barcelona, Spain, 1-2 September, WHO Strategy on People-Centered and Integrated Health Services (PCIHS)
Hernan Montenegro
Coordinator
Services Organization and Clinical Interventions
Service Delivery and Safety (SDS)

2. Content Rationale Strategy analytical framework
Strategic directions on PCIHS
Strategy implementation
Next steps

3. Ongoing challenges for health
Access – 1/3 of people with mental health disorders in HICs receive treatment, as low as 2% in LMICs
Availability – 58% of countries have any palliative care program
Acceptability – delivering women experience verbal abuse, condescension, intimidation and even physical abuse
Quality of care – international survey of clinical practice for heart failure found only 59% of quality of care indicators achieve, under clinical trial conditions

4. Emerging challenges for health services
Non-communicable diseases:
multiple-morbidities
long-term, continuous care
Service fragmentation
Existing and growing inequities
Recognition of the significant challenges to reforming health service delivery systems

5. Ongoing challenges for health
Lack of coordination
Coordination Of Care, Medical Errors, And Safety Among Sicker Adults In Eleven Countries, 2011

6. Emerging challenges and opportunities
Demographic and Epidemiological Transition
Socio-political factors:
concerns about health care costs, and cost-efficiency
Increasingly active and organized consumers
Technological advances:
Patient self-monitoring and self- management
Linkages between health care providers (e.g. electronic medical records)
Globalization:
Export of unhealthy lifestyles
Medical tourism

7. Building on Global Commitments
Reinvigorating Primary Health Care (WHR 2008)
Health systems strengthening (Everybody’s Business 2007)
Universal Health Coverage (WHR 2010)
Rio Declaration on social determinants (2011)
Prevention and control of NCDs (UNGASS 2011)
Multiple regional reports
Growing global commitments– but can service delivery systems deliver?

8. Source: WHO, Primary Health Care- Now More than Ever, World Health Report, 2008

9. Understanding People Centered and Integrated Health Services
Universal Health Coverage
People Centered Care
Integrated Health Services
People centered and integrated care to support UHC
-The best case scenario-

10. Proposed analytical framework

11. Core principles guiding People-Centered and Integrated Care
Comprehensive
Equitable
Sustainable
Co-ordinated
Continuous
Holistic
Preventative
Empowering
Co-produced
Respectful
Rights and responsibilities approach
Collaborative care
Shared accountability
Evidence-informed
Whole-systems thinking
Comprehensive - a commitment to universal health coverage to ensure care is comprehensive and tailored to the evolving needs and aspirations of people
Equitable – care that is accessible and available to all
Sustainable – care that is both efficient, effective and contributes to sustainable development
Co-ordinated – care that is integrated around people’s needs and effectively coordinated across different providers and settings
Continuous – continuity of care and services that are provided across the life course
Holistic - a focus physical, socio-economic, mental, and emotional wellness
Preventative - tackles the social determinants of ill-health through intra- and inter-sectoral action that promote public health and health promotion
Empowering – supports people to manage and take responsibility for their own health
9.Co-produced – through active partnerships with people and communities at an individual, organizational and policy-level
10.Respectful - to people’s dignity, social circumstances and cultural sensitivities
11.Rights and responsibilities approach
12.Collaborative care - that supports relationship-building, team-based working and collaborative practice across primary, secondary, tertiary care and other sectors
13.Shared accountability - between care providers for quality of care and health outcomes to local people
14.Evidence-informed
15.Whole-systems thinking

12. Examples of interventions for each Strategic Action
Empowering and engaging people
Health literacy
Access to personal health records
Self-management & care
Patient/family involvement in clinical decision making
Development of community organizations, etc.
Strengthening governance & accountability
Decentralization & devolution
Performance based-contracting & financing
Provider report cards, patient reported outcomes & surveys
Registration with specific provider(s)
Patient charters, etc.
Reorienting the model of care
Strengthening primary care through family/community practice models
Expand ambulatory, community & home-based care
Comprehensive benefits plans
Health technology assessments
Outreach services for marginalized communities, etc.
Coordinating services
Integrating vertically oriented services into primary care services
Information systems
Inter-professional collaboration
Referral systems
Inter-sectoral partnerships, etc.
Creating an enabling environment
Leadership and development of shared vision
Inclusion into national health policies, strategies & plans
Dedicated resources
Changing organizational culture
Reorienting the health workforce, etc.

13. Strategy implementation
Country context
Low income countries
Middle income countries
High income countries
Some special cases:
Fragile/conflict affected states
Small island states
Large federal states

14. Strategy implementation
Country-led
Equity-focused
Ensuring that people’s voices are heard
Recognizing interdependence
Sharing knowledge
Learning/action cycles

16. Strategy implementation
Some key issues for health workforce (HWF)
HWF planning and skills mix
Capacity gaps and distribution
New roles and functions (e.g. network planning and management; clinical integration)
Regulation (e.g. certification, re-certification, flexibility to relocate)
Teamwork, multi-disciplinary teams and inter-professional collaboration
Organizational culture
Innovation and learning with bottom-up approaches
Performance assessment and mutual accountability
Co-production of health
Compensation, incentives and motivation
In service training and career development path
Competencies (e.g. systems thinking, teamwork, negotiation, conflict resolution)
Inter-professional training
Interim short training courses to compensate for lack of specialists

17. Next steps
Refine, publish and disseminate two versions of the Strategy:
Shorter version for policy-makers
Larger version for broader technical audience
Mobilize resources in support of Strategy
Start rolling out implementation of Strategy jointly with other partners during 2nd semester of 2014