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Strategy 5: Creating an enabling environment

 

In order for the four previous strategies to become an operational reality, it is necessary to create an enabling environment that brings together all stakeholders to undertake transformational change. This complex task will involve a diverse set of processes to bring about the necessary changes in leadership and management, information systems, methods to improve quality, reorientation of the workforce, legislative frameworks, financial arrangements, and incentives.

 

Strategic approach Policy options and interventions

5.1 Strengthening leadership and management for change. New forms of collaborative leadership that help to bring together multiple stakeholders are needed for successful reform of health services. All health care professionals, and especially clinicians, need to be engaged in management and leadership for change in continuous partnership with local communities.

  • Transformational and distributed leadership

  • Change management

5.2 Strengthening information systems and knowledge management. Development of information systems and an organizational culture that supports monitoring and evaluation, knowledge sharing and using data in decision-making is also a prerequisite for transformational change.

  • Development of information systems

  • Systems research

  • Knowledge management

5.3 Striving for quality improvement and safety. Institutions and providers need to strive constantly for quality improvement and safety. These efforts include both technical and perceived quality.

  • Quality assurance

  • Creating a culture of safety

  • Continuous quality improvement

5.4 Reorienting the health workforce. Special attention needs to be given to readying the health workforce with an appropriate skills mix in order equitably and sustainably to meet population health needs. Health workers must be organized around teams and supported with adequate processes of work, clear roles and expectations, guidelines, opportunities to correct competency gaps, supportive feedback, fair wage, and a suitable work environment and incentives.

  • Tackling health workforce shortages and poor distribution

  • Tealth workforce training

  • Multi-professional teams working across organizational boundaries

  • Improving working conditions and compensation mechanisms

  • Provider support groups

  • Strengthening professional associations

5.5 Aligning regulatory frameworks. Regulation plays a key role in establishing the rules within which professionals and organizations must operate within more people-centred and integrated health systems – for example, in terms of setting new quality standards and/or paying against performance targets.

  • Aligning regulatory framework

5.6 Improving funding and reforming payment systems. Changes in the way care is funded and paid for are also needed to promote adequate levels of funding and the right mix of financial incentives in a system that supports the integration of care between providers and settings and protection of patients against undue out-of-pocket expenditures on health.

  • Ensuring sufficient health system financing and aligning resource allocation with reform priorities

  • Mixed payment models based on capitation

  • Bundled payments

Extract from: WHO. Framework on integrated people-centred health services: report EB138/37. Geneva: World Health Organization; 2015, available online at: http://apps.who.int/gb/ebwha/pdf_files/EB138/B138_37-en.pdf, accessed 12 January 2016