People-centred health care

In recent years, there has been increasing interest in the patient’s perspective of health care and how health systems can better respond to the needs of all health care stakeholders and constituencies in a holistic manner. Previous recommendations of Member States through the WHO Regional Committees for the Western Pacific and South-East Asia reflect the need to pursue work in the following: equity and fairness into policies; the development of programmes firmly grounded in ethical principles; the quality of health care and patient safety; human dignity, patients’ rights and needs, and the role of families, culture and society; the broader psychosocial and cultural determinants of health; and ethics related to medical practice, research and education. These issues have widespread relevance and significance. Improving health care quality and safety and enhancing the people’s experience of care require attention not only to health system design but also to the focus ...

Evaluation of health care delivery integration: The case of the Russian Federation

This case study explores the current state of affairs within Russia's health system providing care for increasingly complex chronic conditions from the perspective of providers, namely physicians. A survey was developed by a group of experts and later distributed by the Russian center for public opinion research in August 2012. It focused on the interactions between providers at different levels of the health system often working in different organizational models such as primary care offices, polyspecialty clinics as well as hospitals. The survey focused on three areas crucial to integration, namely: teamwork, coordination and continuity of care. The results from the survey showed that the level of integration was low by nearly every measure across the different levels of the health system. The authors note that little emphasis has been placed on this issue since the 60/70's "when quite a lot of regulation was issued on district ...

Exploring perceptions of community health policy in Kenya and identifying implications for policy change

BACKGROUND:

Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change.

METHODS:

We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before ...

Strategies and incentives for enhancing the application of health impact assessment (HIA) in Nigeria: a view from those who should know

In consonance with the paradigm shift from curative to more preventive healthcare, there has been an increasing application of health impact assessment (HIA) in many developed countries. However, progress towards the integration of HIA into public policy in many developing countries has been comparatively very slow. This article is a primary research to evaluate the barriers and motivational factors; and to proffer effective strategies and incentives for enhancing the application of HIA in health and development policies in Nigeria. Semi-structured questionnaires were designed and primarily disseminated online to a random sample of health and non-health professionals, public service workers, policy-makers and business entrepreneurs in Nigeria. Additional questionnaires were also hand-delivered. Inferential statistics was used in the analysis of the 510 responses that were received. The findings show that 71% of the respondents had never heard about HIA, and 80.7% of those who were aware of HIA had not received ...

People-centred health systems, a bottom-up approach: where theory meets empery

BACKGROUND AND METHODS:

Health systems are complex and constantly adapt to changing demands. These complex-adaptive characteristics are rarely considered in the current bureaucratic top-down approaches to health system reforms aimed to constrain demand and expenditure growth. The economic focus fails to address the needs of patients, providers and communities, and ultimately results in declining effectiveness and efficiency of the health care system as well as the health of the wider community. A needs-focused complex-adaptive health system can be represented by the 'healthcare vortex' model; how to build a needs-focused complex-adaptive health system is illustrated by Eastern Deanery AIDS Relief Program approaches in the poor neighbourhoods of Nairobi, Kenya.

FINDINGS AND CONCLUSIONS:

A small group of nurses and community health workers focused on the care of terminally ill HIV/AIDS patients. This work identified additional problems: tuberculosis (TB) was underdiagnosed and undertreated, a local TB-technician was trained to run a local ...

Director-General’s Opening address to the 69th World Health Assembly

Dr. Margaret Chan’s opening address for the 69th World Health Assembly holding from the 23rd to the 28th of May 2016, in Geneva, called for celebration of the stunning health achievements to date, but warned that health challenges have grown far more numerous and complex.

The speech spanned across the various areas of focus of the WHO. As such, the global strategy on people-centred and integrated health services also featured:

“[…] Innovations help, but ambitious goals are feasible and affordable only if we cut out waste and inefficiency.

We do so through integrated, people-centred care that spans the life course, from pre-conception through ageing, and brings prevention to the fore. The target for universal health coverage moves us in that direction.

UHC is the target that underpins all others. It is the ultimate expression of fairness that leaves no one behind. It also has the best chance of meetings people ...

Health policy and integrated mental health care in the SADC region: strategic clarification using the Rainbow Model

Mental illness is a well-known challenge to global development, particularly in low-to-middle income countries. A key health systems response to mental illness is different models of integrated health care, especially popular in the South African Development Community (SADC) region. This complex construct is often not well-defined in health policy, hampering implementation efforts. A key development in this vein has been the Rainbow Model of integrated care, a comprehensive framework and taxonomy of integrated care based on the integrative functions of primary care. The purpose of this study was to explore the nature and strategic forms of integrated mental health care in selected SADC countries, specifically how integrated care is outlined in state-driven policies.

Manifesto for a healthy and health-creating society

Brexit and the troubled state of the NHS call for re-thinking the UK's approach to health. At the same time, health problems are growing; the NHS faces severe financial constraints and appears to lurch from crisis to crisis, with leaving the European Union likely to exacerbate many problems including staffing issues across the whole sector. However, new scientific developments and digital technology offer societies everywhere massive and unprecedented opportunities for improving health. It is vital for the country that the NHS is able to adopt these discoveries and see them translated into improved patient care and population health, but also that the UK benefits from its capabilities and strengths in these areas.

Integrated Care: theory to practice

"Integrated care" is pitched as the solution to current health system challenges. In the literature, what integrated care actually involves is complex and contested. Multi-disciplinary team management is frequently the primary focus of integrated care when implemented internationally. This study examine the practical application of integrated care in the NHS in England to exemplify the prevalence of the case management focus. It looks at the evidence for effectiveness of multi-disciplinary team case management, for the focus on high-risk groups and for integrated care more generally. They suggest realistic expectations of what integration of care alone can achieve and additional research questions. 

Advancing team-based primary health care: a comparative analysis of policies in western Canada

The article analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. 

The new frontier of strategic alliances in health care: New partnerships under accountable care organizations

Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful cordination will hinge in large part on the ability of health care organizations to successfully partner across organizational boundaries. This article findings suggests that the success of the ACO model will hinge in large part upon the success of new partnerships, with important implications for understanding ACO readiness and capabilities, the relatively small savings achieved to date by ACO programs, and the path to providers bearing more risk for population health management. 

Health assessments for health governance—concepts and methodologies

For better supporting the science-governance interface, the potencial of health assessments appears underrated. The aims of this study are to identify what various types of health assessment have in common, how they differ; which assessments to apply for which purpose; and what needs and options there are for future joint development. 

The new frontier of strategic alliances in health care: New partnerships under accountable care organizations

Accountable care organizations (ACOs) and similar reforms aim to improve coordination between health care providers; however, due to the fragmented nature of the US health care system, successful coordination will hinge in large part on the ability of health care organizations to successfully partner accross organizational boundaries, however, little is known about new partnerships formed under the ACO model. 

Governing Collaborative Healthcare Improvement: Lessons From an Atlantic Canadian Case

The Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease (AHC) Quality Improvement Collaborative (QIC) in Eastern Canada provided an approach to spur system-level reform across multiple health systems for patients and families living with chronic disease. Developed and led by senior executives with a unique governance approach and involving clinical front-line teams, the AHC serves as a practical example of leadership creating and driving momentum for achieving success in collaborative health system improvements 

Assessing the feasibility of community health insurance in Uganda: A mixed-methods exploratory analysis

Community health insurance (CHI) aims to provide financial protection and facilitate health care access among poor rural populations. Given common operational challenges that hamper the full development of the scheme, there is need to undertake systematic feasibility studies. These are scarce in the literature and usually they do not provide a comprehensive analysis of the local context. The present research intends to adopt a mixed-methods approach to assess ex-ante the feasibility of CHI. 

Health policy and systems research: the future of the field

Health policy and systems research (HPSR) has changed considerably over the last 20 years, but its main purpose remains to inform and influence health policies and systems. Whereas goals that underpin health systems have endured – such as a focus on health equity – contexts and priorities change, research methods progress, and health organisations continue to learn and adapt, in part by using HPSR. For HPSR to remain relevant, its practitioners need to re-think how health systems are conceptualised, to keep up with rapid changes in how we diagnose and manage disease and use information, and consider factors affecting people’s health that go well beyond healthcare systems. The Sustainable Development Goals (SDGs) represent a shifting paradigm in human development by seeking convergence across sectors. They also offer an opportunity for HPSR to play a larger role, given its pioneering work on applying systems thinking to health, its focus on health equity ...

Public involvement in health research systems: a governance framework

Growing interest in public involvement in health research has led to organisational and policy change. Additionally, an emerging body of policy-oriented scholarship has begun to identify the organisational and network arrangements that shape public involvement activity. Such developments suggest the need to clearly conceptualise and characterise public involvement in health research in terms of governance.

How Do We Evaluate Health in All Policies?; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”

It is well-established that population health is influenced by a multitude of factors, many of which lie outside the scope of the health sector. In the public health literature it is often assumed that intersectoral engagement with nonhealth sectors will be instrumental in addressing these social determinants of health. Due to the expected desirable outcomes in population health, several countries have introduced Health in All Policies (HiAP). However, whether this systematic, top-down approach to whole-of-government action (which HiAP entails) is efficient in changing government policies remains unclear. A systematic evaluation of HiAP is therefore much needed

Public–private partnerships in practice: collaborating to improve health finance policy in Ghana and Kenya

Social health insurance (SHI), one mechanism for achieving universal health coverage, has become increasingly important in low- and middle-income countries (LMICs) as they work to achieve this goal. Although small private providers supply a significant proportion of healthcare in LMICs, integrating these providers into SHI systems is often challenging. Public–private partnerships in health are one way to address these challenges, but we know little about how these collaborations work, how effectively, and why. 

Best practices in scaling digital health in low and middle income countries

Healthcare challenges in low and middle income countries (LMICs) have been the focus of many digital initiatives that have aimed to improve both access to healthcare and the quality of healthcare delivery. Moving beyond the initial phase of piloting and experimentation, these initiatives are now more clearly focused on the need for effective scaling and integration to provide sustainable benefit to healthcare systems.

Evaluating Health in All Policies; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”

Health in All Policies (HiAP) has gained attention as a potential tool to address complex health and societal challenges at global, regional, national and subnational levels. In a recent article, Lawless et al propose an evaluation framework developed in the context of the South Australia HiAP initiative. Strategies, mediators, activities and impacts identified in the framework could potentially be useful for evaluating HiAP in other settings. Creating and sustaining political will, managing conflicts of interest and achieving financially, politically and conceptually sustainable HiAP initiatives are challenges that could be further strengthened in the current framework.

Developing more participatory and accountable institutions for health: identifying health system research priorities for the Sustainable Development Goal-era

Health policy and systems research (HPSR) is vital to guiding global institutions, funders, policymakers, activists and implementers in developing and enacting strategies to achieve the Sustainable Development Goals.  The findings from this exercise identify HPSR funding priorities and future areas for evidence production and policy engagement.

Health in the 2030 Agenda for Sustainable Development: from framework to action, transforming challenges into opportunities

The clock is ticking and just a little more than 10 years remain to meet the 17 Sustainable Development Goals (SDGs). Enhanced political and public awareness, inter- and transdisciplinary engagement, new partnerships, and multisectoral collaborations are required to foster knowledge-and-action societies in order to tackle the complex issues that are inherent to sustainable development. A one-day symposium held in Basel, Switzerland, in November 2018 offered a venue for open exchange on how to stimulate dialogue for co-creating innovative ideas and scalable action to address some of the most pressing challenges of the 2030 Agenda for Sustainable Development.

Integrated care systems in the English NHS: a critical view

The intriguing evolution of health policy in recent years has implications for all parts of the health system. With the UK falling behind most high-income countries on many measures of child health and growing evidence of a worrying health gap between UK children in deprived and affluent areas, paediatricians and others working in child health will want to remain abreast of the broader policy backdrop even where child health has not been privileged in policymaking. While the 2012 Health and Social Care Act reinforced the fragmentation of the service through multiple providers in competition with one another, subsequent policy promises local collaboration and joint working. This article traces this evolution and asks what it means.

International cooperation in public health in Martinique: geostrategic utility for cancer surveillance in the Caribbean

Cooperation in public health and in oncology in particular, is currently a major issue for the island of Martinique, given its geopolitical position in the Caribbean region. The region of Martinique shares certain public health problems with other countries of the Caribbean, notably in terms of diagnostic and therapeutic management of patients with cancer. This study presents a roadmap of cooperation priorities and activities in cancer surveillance and oncology in Martinique.

Challenges in turning a great idea into great health policy: the case of integrated care

In the organization of health care and health care systems, there is an increasing trend towards integrated care. Policy-makers from different countries are creating policies intended to promote cooperation and collaboration between health care providers, while facilitating the integration of different health care services. Hopes are high, as such collaboration and integration of care are believed to save resources and improve quality. However, policy-makers are likely to encounter various challenges and limitations when attempting to turn these great ideas into effective policies. In this paper, we look into these challenges.

Rethinking workforce planning for integrated care: using scenario analysis to facilitate policy development

A goal of health workforce planning is to have the most appropriate workforce available to meet prevailing needs. However, this is a difficult task when considering integrated care, as future workforces may require different numbers, roles and skill mixes than those at present. With this uncertainty and large variations in what constitutes integrated care, current health workforce policy and planning processes are poorly placed to respond. The scenario-based workforce shows that through applying techniques that have been developed to accommodate uncertainty, health workforce planning can benefit when confronting issues associated with integrated care.

Health Networks in Action: The experiences of Argentina, Brazil, Colombia and Mexico

Dioselina is a 54-year-old divorcée who has no children and lives alone in a large city. She has been unemployed for a year and just started receiving welfare six months ago. As for her health, she has long-term obesity, chronic obstructive pulmonary disease, and diabetes. In recent months, she began to develop foot ulcers because her blood sugar was not being monitored properly, which is attributable in part to difficulty accessing healthcare services and getting medications and lab tests. If she does not receive rapid treatment and more specialized care for the ulcers, they could worsen and require hospitalization.

A growing number of people who seek health care have stories like Dioselina’s. Healthcare systems in Latin America and the Caribbean face significant health challenges affecting all age groups, which cause premature death and take a heavy social and economic toll.

Taking cues from the Declaration of Astana, nations ...

Informing the implementation and use of person-centred quality indicators: a mixed methods study on the readiness, barriers and facilitators to implementation in Canada

Person-centred care (PCC) is a key component of high-quality healthcare, which actively engages patients and their caregivers in care decisions and considers patient needs, preferences and values. A focus on ‘person-centredness’ as opposed to ‘patient-centredness’ promotes a more holistic perspective on care, which is not limited to a person’s disease or illness, but also acknowledges the factors that influence a person’s well-being.PCC is a model of care that remains aspirational for many healthcare jurisdictions and sectors of care. However, in practice it has been challenging to implement as it requires changes in healthcare structures and processes.

Fit for the Future: a new plan for GPs and their patients

General practice is the cornerstone of the NHS, helping around 50 million people in England every year, carrying out 370 million consultations last year. So, when GPs and their patients tell us that general practice is in crisis, we should all be concerned.

In 2022, the RCGP launched Fit for the Future: a new plan for GPs & their patients to put pressure on politicians and decision makers with responsibility for the NHS in England to commit to a bold new plan to provide GPs and patients with the support that they need.

This campaign follows our 2019 Fit for the Future (PDF file, 1.1 MB) vision which set out how, with the right tools and support, we can revitalise and reform general practice by 2030, so that it can continue to deliver world class patient care. Pressures on general practice have since intensified even further and have been exacerbated ...

A comparison of three organisational levels in one health care region in Sweden implementing person-centred care: coupled, decoupled or recoupled in a complex organisation

Establishing more substantial patient involvement in the health care has become fundamental to Western health care services. Person-centred care (PCC) has been developed as a way of working that involve the patients and family members. However, the implementation of PCC in clinical practice has proven to be challenging. The aim of this study was to explore the congruence of managers’ perceptions and understanding of various aspects of PCC across three organisational levels in one health care region in Sweden in terms of coupling, decoupling and recoupling.

Integrated Health and Social Care in the United States: A Decade of Policy Progress

Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes.

Global Conference on Person-Centre Care: Knowledge(s) and Innovation for Health in Changing Societies

Welcome to the first Global Conference on Person-Centred Care, that will take place in Gothenburg, Sweden, from 14-16 May, 2024.
Optional pre-conference workshops will be offered lunch to lunch from 13-14 May.

The aim of the conference is to provide an arena for various stakeholders with an interest in furthering person-centred care practice, innovations, perspectives, and knowledges. The conference will platform explorations and accounts of person-centred care as related to several interdisciplinary and interprofessional fields, including integrated care, comprehensive care, and personalised health founded on partnerships, transcending healthcare practices and organisations, as well as policy and structural levels.

The conference will be of interest to health professionals from across the globe, patient and family carer representatives, researchers and students from various disciplines, leaders and decisions-makers in healthcare and health policy, as well as the healthcare industry. The conference will operate as a hybrid event, with condensed virtual sessions offered to ...

Models, theoretical design and formal evaluation of integrated specialist community health service provision for the first 2000 days: a scoping review

This scoping review identifies evidence for design, models and evaluation of integrated care service provision for families and children in the first 2000 days, in the context of community-based specialised health, education and welfare services.