European Forum for Primary Care: "Twinning Population Health and Primary Care"

Barcelona, Spain, 1-2 September, 2014

WHO Strategy on People-Centered and Integrated Health

Services (PCIHS)

Hernan MontenegroCoordinator

Services Organization and Clinical InterventionsService Delivery and Safety (SDS)

• Rationale

• Strategy analytical framework

• Strategic directions on PCIHS

• Strategy implementation

• Next steps

Content

• 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

Ongoing challenges for health

• 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

Emerging challenges for health services

Ongoing challenges for healthLack of coordination

Coordination Of Care, Medical Errors, And Safety Among Sicker Adults In Eleven Countries, 2011

Percent of respondents who: Experienced coordination gaps in past 2 years

Experienced gaps in hospital/surgery discharge planning

Reported regular doctor seemed uninformed about hospital/ surgery care

Experienced medical, medication, or lab error

Reported pharmacist or doctor did not review prescriptions in past year Country

Test results/ records not available at appointment or duplicate tests ordered

Key information not shared among providers

Specialist lacked medical history or regular doctor not informed about specialist care

Any gap AUS 19% 12% 19% 36% 55% 18% 19% 34% CAN 25 14 18 40 50 19 21 28 FRA 20 13 37 53 73 15 13 58 GER 16 23 35 56 61 17 16 29 NETH 18 15 17 37 66 9 20 41 NZ 15 12 12 30 51 19 22 31 NOR 22 19 25 43 71 18 25 62 SWE 16 18 20 39 67 35 20 55 SWI 11 10 9 23 48 15 9 25 UK 13 7 6 20 26 11 8 16 US 27 17 18 42 29 12 22 28

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

• 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?

Building on Global Commitments

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

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-

Proposed analytical framework

1. Comprehensive

2. Equitable

3. Sustainable

4. Co-ordinated

5. Continuous

6. Holistic

7. Preventative

8. Empowering

Core principles guiding People-Centered and Integrated Care

9. Co-produced

10. Respectful

11. Rights and responsibilities approach

12. Collaborative care

13. Shared accountability

14. Evidence-informed

15. Whole-systems thinking

Examples of interventions for each Strategic Action

• Low income countries

• Middle income countries

• High income countries

• Some special cases:

• Fragile/conflict affected states

• Small island states

• Large federal states

Strategy implementationCountry context

Strategy implementation

• Country-led

• Equity-focused

• Ensuring that people’s voices are heard

• Recognizing interdependence

• Sharing knowledge

• Learning/action cycles

• 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

Strategy implementationSome key issues for health workforce

(HWF)

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