IPCHS. Integrated People-Centred Health Services

Contents

Contents tagged: health systems

Sept. 17, 2020 Global Publication

Health care for chronic neurological patients after COVID-19

Covid-19 has hit the world population hard. Its effects continue to arise at the community and individual level. However, recovered patients, who had a relatively long stay in the ICU due to the complications of the disease, present and will present very diverse sequelae: post-traumatic stress, transient cognitive alterations and neurological alterations. This article-commentary shows how the health system should reformulate certain priorities for the care of the neurological sequelae of the pandemic at the individual level.

Sept. 14, 2020 South-East Asia Publication

Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines

Community health workers (CHWs) are an important cadre of the primary health care (PHC) workforce in many low- and middle-income countries (LMICs). The Philippines was an early adopter of the CHW model for the delivery of PHC. This study aims to address this gap by examining the lived experiences and roles of BHWs in urban and rural sites in the Philippines.

Aug. 25, 2020 South-East Asia Publication

COVID-19 care in India: the course to self-reliance

Many times we think of the integration of health systems as an urgent need. However, there are cases (and realities) where it is necessary to centralize to homogenize the action in the face of a crisis such as the SARS-CoV2 pandemic. The public health response to COVID-19 in India has been highly centralised, resulting in a homogenous strategy applied across a sixth of the world’s population.

June 10, 2020 Global Publication

Rethinking Integrated Care: A Systematic Hermeneutic Review of the Literature on Integrated Care Strategies and Concepts

Integrated care is a broad concept, used to describe a connected set of clinical, organizational, and policy changes aimed at improving service efficiency, patient experience, and outcomes. Despite examples of successful integrated care systems, evidence for consistent and reproducible benefits remains elusive. This review identified four perspectives on integrated care: patients’ perspectives, organizational strategies and policies, conceptual models, and theoretical and critical analysis.

May 26, 2020 Global Event

Time to get our act together on UHC and health emergencies

UHC2030 will launch a discussion paper to consolidate our vision for resilient health systems, and priority actions for both emergency preparedness and UHC goals. With this, we aim to bring partners together around common messages on public health actions as ‘step zero’ of UHC, so health systems better support health security and UHC. This builds on the recent statement from UHC2030 co-chairs which called on world leaders to remember their UHC commitments as they respond to COVID-19.

Ilona Kickbusch, Chair of the International Advisory Board of the Global Health Centre, will moderate a panel discussion with senior leaders from WHO, World Bank, OECD and respondents from academia and civil society. This event proposes to stimulate discussion with stakeholders from across the UHC movement and beyond, immediately after the World Health Assembly, in order to leverage the momentum around the discussions among ministers of health.

The event is jointly organised by ...

May 13, 2020 Europe Publication

Integrated Care Programs for People with Multimorbidity in European Countries: eHealth Adoption in Health Systems

eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics.

April 24, 2020 Global Publication

The key role of palliative care in response to the COVID-19 tsunami of suffering

Coronavirus disease 2019 (COVID-19) has brought a tsunami of suffering that is devastating even well resourced countries. The disease has wreaked havoc on health systems and generated immense losses for families, communities, and economies, in addition to the growing death toll. In this most challenging time, health responders can take advantage of palliative care know-how to focus on compassionate care and dignity, provide rational access to essential opioid medicines, and mitigate social isolation at the end of life and caregiver distress. 

Feb. 5, 2020 Europe Publication

Horizontal and Vertical Integration of Health Care Providers: A Framework for Understanding Various Provider Organizational Structures

Current U.S. policy and payment initiatives aim to encourage health care provider accountability for population health and higher value care, resulting in efforts to integrate providers along the continuum. Providers work together through diverse organizational structures, yet evidence is limited regarding how to best organize the delivery system to achieve higher value care. 

Nov. 6, 2019 Europe Publication

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.

Oct. 7, 2019 South-East Asia Publication

The development and reform of public health in China from 1949 to 2019

Public health system plays a vital role in the development of health sector in China and protects the health of Chinese people. However, there are few comprehensive reviews and studies focusing on its evolution and reform. It is worthwhile to pay attention to the public health development in China, given that the history and structure of public health system have their own characteristics in China.

The study is a retrospective review of the development public health over seven decades in China. It presents the findings from some national or provincial survey data, interviews with key informants, reviews of relevant published papers and policy contents

Oct. 2, 2019 Global Publication

Integrated care for older people (ICOPE) implementation framework: guidance for systems and services

Alongside supporting community-level services, the Integrated Care for Older People (ICOPE) approach helps broader health and social care systems effectively respond to the diverse and complex needs of older people. The ICOPE Implementation Framework provides guidance for policy makers and programme managers to concretely assess and measure the capacity of services and systems to deliver integrated care at the community level.

The ICOPE Implementation Framework provides a score card to help assess the overall capacity of health and social care services and systems to deliver integrated care in community settings and support the development of ICOPE implementation action plans. There are 19 actions needed to implement ICOPE on the services level (meso) and systems level (macro). The scoring process provides an evidence-based means of highlighting areas for improvement as well as establishing concrete measures of future improvements.

Sept. 19, 2019 Europe Publication

Care Redesign Survey: To Improve Chronic Disease Care, Change the Payment Model

Many health care organizations are reasonably effective in treating chronic diseases, but they are limited from doing better by fee-for-service payment, which remains the predominant payment model in the United States. The latest NEJM Catalyst Insights Council report serves as a snapshot in time, showing the intent of health care providers to be proactive in treating chronic disease, but limitations in their ability to address population health

Aug. 27, 2019 Africa Publication

Strengthening national health research systems in the WHO African Region – progress towards universal health coverage

Health challenges and health systems set-ups differ, warranting contextualised healthcare interventions to move towards universal health coverage. As such, there is emphasis on generation of contextualized evidence to solve local challenges. However, weak research capacity and inadequate resources remain an impendiment to quality research in the African region. WHO African Region (WHO AFRO) facilitated the adoption of a regional strategy for strengthening national health research systems (NHRS) in 2015. This article assessed the progress in strengthening NHRS among the 47 member states of the WHO AFRO.

March 19, 2019 Global Publication

The role of patient value and patient-centred care in health systems

Patient-centred care, with its emphasis on patient value, is a widespread health system goal. To examine the progress of the evolution towards more patient-centred health care and draw lesson for the future, the Economist Intelligence Unit conducted a survey and interviews on patient representatives, a cohort in which IAPO was present. However, the findings show that despite some progress, especially in Europe and the US, in practice such care often remains more aspiration than reality.

March 7, 2019 Global Publication

Patient Engagement In Research: Early Findings From The Patient-Centered Outcomes Research Institute

Charged with ensuring that research produces useful evidence to inform health decisions, the Patient-Centered Outcomes Research Institute (PCORI) requires investigators to engage patients and other health care stakeholders, such as clinicians and payers, in the research process. Many PCORI studies result in articles published in peer-reviewed journals that detail research findings and engagement’s role in research. To inform practices for engaging patients and others as research partners, this study analyzed 126 articles that described engagement approaches and contributions to research. PCORI projects engaged patients and others as consultants and collaborators in determining the study design, selecting study outcomes, tailoring interventions to meet patients’ needs and preferences, and enrolling participants. Many articles reported that engagement provided valuable contributions to research feasibility, acceptability, rigor, and relevance, while a few noted trade-offs of engagement. The findings suggest that engagement can support more relevant research through better alignment with patients’ and clinicians’ real-world ...

Feb. 18, 2019 Global Publication

Community-Based Social Innovations

This research defined CBSIs as community initiatives that seek to: a) empower older people to improve their self-efficacy in caring for themselves and their peers; b) maintain their well-being and; c) promote social cohesion and inclusiveness. Health systems across both developed and developing regions struggle to meet the diverse and complex needs of increasing number of older persons. This study hypothesized that community based social innovations (CBSIs) can improve the health and well-being of older people through community-based care. 

 

Dec. 19, 2018 Western Pacific Publication

An evidence-based approach to understanding the competency development needs of the health service management workforce in Australia

Competent managers are essential to the productivity of organisations and the sustainability of health systems. Effective workforce development strategies sensitive to the current competency development needs of health service managers (HSMs) are required. The aim of this article was
to conduct a 360° assessment of the competence of Australian HSMs to identify managerial competence levels, and training and development needs.

Nov. 28, 2018 Africa Publication

Universal health coverage necessitates a system approach: an analysis of Community-based Health Planning and Services (CHPS) initiative in Ghana

The 9th Global conference on health promotion (Shanghai 2016) reaffirmed the role of primary health care (PHC) in achieving the 2030 Sustainable Development Agenda. Gaining much international recognition, the community-based health planning and services (CHPS) initiative is considered one of the pragmatic strategy in delivering on the promise of universal health coverage (UHC) through the PHC strategy, in Ghana. Yet, certain key factors threaten its successes – renewing the relevance of this study to present the barriers to and facilitators of the initiative. According to their findings, CHPS contribution particularly in bridging geographical access to health cannot be demeaned. Nevertheless, the full functioning of the initiative is limited by factors centered on the following themes: health governance and leadership, provision of services of quality, financial risk protection strategies targeting public health, information and care continuity, and the right mix of trained health professionals of even distribution across communities. Addressing the challenges ...

Nov. 5, 2018 Global Publication

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.

Oct. 15, 2018 Africa Publication

From Stumbling Block to Enabler: The Role of Public Financial Management in Health Service Delivery in Tanzania and Zambia

The way governments manage resources through the budget cycle has important implications for health policy and whether governments achieve societal objectives such as efficiency, equity, quality, and accountability. Studies found a positive association between health service delivery outcomes and good governance of public finance, however the mechanisms through which public financial management affects service delivery remains underexplored. This article maps the three stages of the budget cycle to common performance criteria used in health service delivery. It applies this approach to experiences in Tanzania and Zambia.

Aug. 29, 2018 Africa Publication

Data value and care value in the practice of health systems: A case study in Uganda

In anthropology, interest in how values are created, maintained and changed has been reinvigorated. This case study, draws on this literature to interrogate concerns about the relationship between data collection and the delivery of patient care within global health. They followed a pilot study conducted in Kayunga, Uganda that aimed to improve the collection of health systems data in five public health centres and it´s observed that measurement, calculation and narrative practices could be assigned care-value or data-value and that the attempt to improve data collection within health facilities transferred ‘data-value’ into health centres with little consideration among project staff for its impact on care

Aug. 29, 2018 Global Publication

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 ...

July 27, 2018 Americas Publication

Implementation and clinical effectiveness of a community-based non-communicable disease treatment programme in rural Mexico: a difference-in-differences analysis

Non-communicable diseases (NCDs) account for the five largest contributors to burden of disease in Mexico, with diabetes representing the greatest contributor. However, evidence supporting chronic disease programmes in Mexico is limited, especially in rural communities. Compañeros En Salud (CES) partnered with the Secretariat of Health of Chiapas, Mexico to implement a novel community-based NCD treatment programme. This article describe the implementation of this programme and conducted a population-based, retrospective analysis, using a difference-in-differences regression approach to estimate the impact of the programme

May 7, 2018 Global Publication

Defining the global health system and systematically mapping its network of actors

The global health system has faced significant expansion over the past few decades, including continued increase in both the number and diversity of actors operating within it. However, without a stronger understanding of what the global health system encompasses, coordination of actors and resources to addres today´s global health challenges will not be possible

Jan. 15, 2018 Europe Publication

How to assess and prepare health systems in low- and middle-income countries for integration of services—a systematic review

Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle- income countries (LMICs). This article adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for capacity to implement integrated services. 

Dec. 3, 2017 Global Publication

Integrated care: learning between high-income, and low- and middle-income country health systems

Integration is a challenging concept to define, in part because of its multiple dimensions and varied scope: from integrated clinical care for individual patients to broader systems integration- or linkage-involving wide range of interconnected services. This commentary compares integrated care in high-and lower- income countries. Although contexts may differ significantly between these settings, there are many common features of how integration has been understood and common challenges in its implementation

Nov. 6, 2017 Eastern Mediterranean Publication

Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review

The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed. This paper reviews the progress and outcomes of healht systems reform in the UAE

June 2, 2017 Global Event

European Observatory Venice Summer school 2017: "Placing the person at the centre of the health system: concepts, strategies, results"

The Observatory Venice Summer School 2017 is a one week intensive course that brings together policy makers, planners, managers, professionals and civil society representatives who will be learning, debating and sharing experiences about the conceptual, strategic and practical issues around achieving person-centred health systems.

Objectives:

To explore how ‘person-centredness’ is understood at the different levels of the system and by different stakeholders and what this means for the development of person-centred strategies

To review key approaches to achieving person-centred health systems in different contexts

To examine ways of monitoring the performance of person-centred strategies

To assess the evidence about the impacts of person-centred strategies at different system levels and understand who benefits and what the possible unintended consequences are

To discuss future trends, key challenges and policy options towards achieving person-centred health systems

 

Read more...

March 31, 2017 Europe Publication

Bringing integration home: policy on health and social care integration in the four nations of the UK

This paper outlines relevant policies on the integration of health and social care in four home nations: Scotland, Wales, Northern Ireland and England. The aim of the paper is to offer a comparison of emphasis and approaches and draw out general insights on the implementation of integrated care policy. Also in this paper reveals considerable opportunities for further research and comparative modelling of integration approaches. 

March 30, 2017 Europe Publication

Integrating safety concepts in health and social care

Keeping individuals safe from harm and exploitation is a clearly articulated goal within both the health and social care sectors. Two key concepts associated with achieving this common aim are safety and safeguarding. The purpose of this paper is to critically appraise the differences in safety terminology used in health and social care, including opportunities and challenges for greater integration of safety systems across health and social care in England. 

Dec. 2, 2016 Africa Publication

Patient-Centered Care and People-Centered Health Systems in Sub-Saharan Africa: Why So Little of Something So Badly Needed?

Patient–centered care (PCC) is increasingly recognized as a key dimension of quality healthcare, but unfortunately remains poorly implemented in practice. This paper explores the current state of PCC in sub-Saharan Africa and potential barriers to its implementation, with a focus on public first line health services. They develop an analytical framework based on expert knowledge, field experience, and a conceptual literature review. Factors contributing to the (lack of) implementation of PCC are structured in three distinct but interacting layers. The first layer encompasses factors that influence and shape the performance of providers.  The training of health workers is key in that respect. Training models remain dominated by a biomedical perspective, with little attention for psychosocial dimensions of the illness experience. The second layer of determinants relates to the structural and organizational features of the health system. The emphasis in many African health care systems on specific programmatic outputs, and ...

May 25, 2016 Europe Publication

Exploring payment schemes used to promote integrated chronic care in Europe

The rising burden of chronic conditions has led several European countries to reform healthcare payment schemes. This paper aimed to explore the adoption and success of payment schemes that promote integration of chronic care in European countries. A literature review was used to identify European countries that employed pay-for-coordination (PFC), pay-for-performance (PFP), and bundled payment schemes. Existing evidence from the literature was supplemented with fifteen interviews with chronic care experts in these countries to obtain detailed information regarding the payment schemes, facilitators and barriers to their implementation, and their perceived success.

Austria, France, England, the Netherlands, and Germany have implemented payment schemes that were specifically designed to promote the integration of chronic care. Prominent factors facilitating implementation included stakeholder cooperation, adequate financial incentives for stakeholders, and flexible task allocation among different care provider disciplines. Common barriers to implementation included misaligned incentives across stakeholders and gaming. The implemented payment schemes targeted ...

May 25, 2016 Western Pacific Publication

Consolidating the social health insurance schemes in China: towards an equitable and efficient health system

Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health insurance schemes in fund level and benefit package. Political commitments, institutional innovations, and a feasible implementation plan are the major elements needed for success in consolidation. Achievement of universal health coverage in China needs systemic strategies including consolidation of the social health insurance schemes.

March 18, 2016 Americas Publication

Primary Care and Public Health Services Integration in Brazil’s Unified Health System

Objectives: We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice.

Methods: We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience.

Results: Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidencebased practice engagement and service integration were moderately correlated.

Conclusions: Age and race ...

March 17, 2016 Americas Publication

Health-system reform and universal health coverage in Latin America

Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens—with defined and enlarged benefits packages—and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and ...

Feb. 10, 2016 Africa Publication

Counting the cost of child mortality in the World Health Organization African region

Background: Worldwide, a total of 6.282 million deaths occurred among children aged less than 5 years in 2013. About 47.4 % of those were borne by the 47 Member States of the World Health Organization (WHO) African Region. Sadly, even as we approach the end date for the 2015 Millennium Development Goals (MDGs), only eight African countries are on track to achieve the MDG 4 target 4A of reducing under-five mortality by two thirds between 1990 and 2015. The post-2015 Sustainable Development Goal (SDG) 3 target is "by 2030, end preventable deaths of new-borns and children under 5 years of age". There is urgent need for increased advocacy among governments, the private sector and development partners to provide the resources needed to build resilient national health systems to deliver an integrated package of people-centred interventions to end preventable child morbidity and mortality and other structures to address all ...

Feb. 10, 2016 South-East Asia Publication

Implementing people-centred health systems governance in 3 provinces and 11 districts of Afghanistan: a case study

BACKGROUND:

Previous studies show that health systems governance influences health system performance and health outcomes. However, there are few examples of how to implement and monitor good governing practices in fragile and conflict affected environments. Good governance has the potential to make the health system people-centered. More research is needed on implementing a people-centered governance approach in these environments.

CASE DESCRIPTION:

We piloted an intervention that placed a people-centred health systems governance approach in the hands of multi-stakeholder committees that govern provincial and district health systems. We report the results of this intervention from three provinces and eleven districts in Afghanistan over a six month period. This mixed-methods exploratory case study uses analysis of governance self-assessment scores, health management information system data on health system performance, and focus group discussions. The outcomes of interest are governance scores and health system performance indicators. We document the application of a people-centred health ...

Feb. 10, 2016 Global Publication

Community Participation in Health Systems Research: A Systematic Review Assessing the State of Research, the Nature of Interventions Involved and the Features of Engagement with Communities

BACKGROUND:

Community participation is a major principle of people centered health systems, with considerable research highlighting its intrinsic value and strategic importance. Existing reviews largely focus on the effectiveness of community participation with less attention to how community participation is supported in health systems intervention research.

OBJECTIVE:

To explore the extent, nature and quality of community participation in health systems intervention research in low- and middle-income countries.

METHODOLOGY:

We searched for peer-reviewed, English language literature published between January 2000 and May 2012 through four electronic databases. Search terms combined the concepts of community, capability/participation, health systems research and low- and middle-income countries. The initial search yielded 3,092 articles, of which 260 articles with more than nominal community participation were identified and included. We further excluded 104 articles due to lower levels of community participation across the research cycle and poor description of the process of community participation. Out ...

Jan. 9, 2016 Europe Publication

Acute hospitals and integrated care

In March 2015, the King’s Fund published a report regarding the progress made by five acute hospital providers in England towards developing more integrated models of care. According to the report, becoming more closely integrated with primary care has proved a considerable challenge for these hospitals. This is partly due to the lack of alternatives to building relationships on a practice-by-practice basis. As the report explains, GP provider groups or federations “are still at an early stage of development in many areas of the country, and where they do exist it is not always clear that they are sufficiently cohesive to represent local practices and have leverage over them”. 

However, the report identifies a number of factors which facilitate the coordination between hospitals and primary care. These include strong clinical leadership in general practice; employing people with a primary care background at a senior level within the acute provider ...