IPCHS. Integrated People-Centred Health Services

Contents

Contents tagged: primary health care

Sept. 7, 2018 Americas Publication

Designing a framework for primary health care research in Canada: a scoping literature review

Despite significant investments to improve primary health care (PHC) delivery in Canada, provincial health care systems remain fragmented and uncoordinated. Canada’s commitment to strengthening PHC should be driven by robust research and evaluation that reflects our health policy priorities and responds to the needs of the population. One challenge facing health services researchers is developing and sustaining meaningful research priorities and agendas in an overburdened, complex health care system with limited capacity for PHC research and support for clinician researchers.

July 27, 2018 Africa Publication

Strengthening decentralized primary healthcare planning in Nigeria using a quality improvement model: how contexts and actors affect implementation

Quality improvement models have been applied across various levels of health systems with varying success leading to scepticisms about effectiveness. Health systems are complex, influenced by contexts and characterized by numerous interests. Thus, a shift in focus from examining whether improvement models work, to understanding why, when and where they work most effectively is essential

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

July 23, 2018 South-East Asia Publication

Vertical integrated service model: an educational intervention for chronic disease management and its effects in rural China – a study protocol

Chronic diseases are becoming a huge threat to the Chinese health system. Although the New Round of Medical Reform aims to improve this, the chronic disease management in rural China is still worrying as it relies highly on hospital care instead of primary care. The vertical integrated care model has proven to be effective for chronic disease patients in many high-income countries, while few studies have been conducted in China. In this project, vertical integrated care will be applied to optimize the care of patients with type 2 diabetes mellitus (T2DM) and primary hypertension in rural China, and to shift the care from hospital to primary care.

June 6, 2018 Western Pacific Publication

Coordinating Mental and Physical Health Care in Rural Australia: An Integrated Model for Primary Care Settings

The "GP Clinic" providers primary health care to people using community mental health services in a small town in Australia. This article examines the factors that have driven successful integration in this rural location. Integrated physical and mental health service models that focus on building local service provider relationships and are responsive to community needs and outcomes may be more beneficial in rural settings than top down approaches that focus on policies, formal structures, and governance. 

May 18, 2018 Eastern Mediterranean Publication

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries

Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. This paper describes and analyse the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC

May 9, 2018 Africa Publication

Primary health services at district level in South Africa: a critique of the primary health care approach

The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite, South Africa´s progress and attempts at implementing primary health care, various factors still limit its success.

May 7, 2018 Americas, Global Publication

Characteristics of Indigenous primary health care service delivery models: a systematic scoping review

Indigenous populations have poorer health outcomes compared to their non-Indigenous counterparts. The experience of colonisation, and the long-term effects of being colonised, has caused inequalities in Indigenous health status, including physical, social, emotional, and mental health and wellbeing. This systematic scoping review aims to identify the characteristics of Indigenous primary health care service delivery models. 

April 30, 2018 Americas Publication

Strategy for revitalization of the primary health care in Cuba

Despite the existence of an integrated model of health systems and services, the research conducted in the areas of management, support, health services and finances show some phenomena that weaken the capacity of responding to the population's health requirements, particularly the first care level. The range of possibilities offered by the transforming process in the health sector encourages putting forward a revitalizing strategy centered on the capacity and need of innovating and further developing the Cuban primary health care strategy. The bases supporting the proposal, the objectives and the strategic areas of development were presented, with the focus on revitalizing the capacities of the health care system to articulate an effective, sustainable and integrated strategy. Such strategy may respond to the existing problems and meet the new health challenges to guarantee access, equity and sustained quality in health services.

Authors: MSc. Pedro López Puig, MSc. Alina María ...

April 2, 2018 Africa Publication

Ghana's community-based primary health care: Why women and children are ‘disadvantaged’ by its implementation

Policy analysis on why women and children in low- and middle- income settings are still disadvantaged by access to appropiate care despite Primary Health Care (PHC) programmes implementation is limited. Drawing on the street- level bureaucracy theory, this article explored how and why frontline providers (FLP) actions on their own and in interaction with health system factors shape Ghana´s community-based PHC implementation to the disadvantage of women and children accessing and using health services. 

March 25, 2018 Africa Publication

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to stregthen African health systems in order to address communicable and non-communicable diseases. The aim of this article was to assess the position of civil society-led community home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demand arise. 

March 25, 2018 Africa Publication

The perceived impact of family physicians on the district health system in South Africa: a cross-sectional survey

The 2008 World Health Report "Primary Health Care-Now More Than Ever" defines strong Primary Health Care (PHC) systems as those systems which offer first contact care that is patient-centred with an orientation to the patient´s family and community context, embedded in a service that is comprehensive, integrated, continuos, and community-orientated, and in which patient-care is well co-ordinated. This report warned against oversimplified approaches to PHC in developing countries, which only focus on priority deseases or rely on unsupported health workers who are poorly equipped for the complexity of PHC. The World Health Assembly supports the report´s recommendation that PHC should be offered by a multidisciplinary team that includes a family physician. 

Nov. 17, 2017 Americas, Western Pacific Publication

Using Information Communication Technology in Models of Integrated Community-Based Primary Health Care: Exploring ICT in the iCOACH Study

Information and communication technology (ICT) is a promising enabler to support delivery of integrated care by inter-disciplinary teams by supporting information sharing across professional and  organizational boundaries; arguably a crucial aspect of successful models of integrated care

Oct. 23, 2017 Europe Publication

Managing multimorbidity: profiles of integrated care approaches targeting people with multiple chronic conditions in Europe

In response to the growing populations of people with multiple chronic deseases, new models of care are currently being developed in European countries to better meet the needs of these people. This paper aims to describe the occurrence and characteristics of various types of ntegrated care practices in European countries that target people with multimorbidity.

July 31, 2017 Africa Publication

Social accountability in primary health care in West and Central Africa: exploring the role of health facility committees

Social accountability has been emphasised as an important strategy to increase the quality, equity, and responsiveness of health services. In many countries, health facility committees (HFCs) provide the accountability interface between health providers and citizens or users of health services. This article explores the social accountability practices facilitated by HFCs in Benin, Guinea and the Democratic Republic of Congo. 

July 25, 2017 Europe Publication

The degree of integration of non-dispensing pharmacists in primary care practice and the impact on health outcomes: A systematic review

A non-dispensing pharmacist conducts clinical pharmacy services aimed at optimizing patients individual pharmacotherapy. Embedding a non-dispensing pharmacist in primary care practice enables collaboration, probably enhancing patient care. The degree of integration of non-dispending pharmacists into multidisciplinary health care teams varies strongly between settings. The degree of integration may be a determinant for its success. This study investigates how the degree of integration of a non-dispensing pharmacist impacts medication related health outcomes in primary care. 

July 4, 2017 Africa Publication

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to strengthen African health systems in order to address communicable and non-communicable diseases. The aim of this study was to assess the position of civil society-led community unity home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demands arise. 

July 1, 2017 Europe Publication

Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care

This study analysed the clinical impact of a home-based intermediate Care model in the Catalan health system, comparing it with usual bed-based care to check if the extended CGA-based hospital-at-home programme has an association with shorter stay and favourable clinical outcomes and if is needed to do studies to test this intervention to the whole Catalan integrated care system. 

April 6, 2017 Western Pacific Publication

Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia

The terms integration and integrated care describe the complex, patient-centred strategies to improve coordination of healthcare services. Frameworks exist to conceptualise these terms, but these have been developed from a professional viewpoint. 

The objetive of this study was to explore consumers and provider´s concepts, expectations and experience of integrated care. A key focus was whether frameworks developed from a professional perspective are effective models to explore people´s experiences. 

April 6, 2017 Europe Publication

Feasibility of an implementation strategy for the integration of health promotion in routine primary care: a quantitative process evaluation

Process evaluation is recommended to improve the understanding of underlying mechanisms related to clinicians, patients, contect and intervention delivery that may impact on trial or program results, feasibility and transferability to practice. The aim of this study was to assess the feasibility of the Prescribe Healthy Life (PVS from the Spanish "Prescribe Vida Saludable") implementation strategy for enhancing the adoption and implementation of an evidence-based health promotion intervention in primary health care. 

March 30, 2017 Eastern Mediterranean Publication

Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic  diseases. International evidence suggest that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA. 

Feb. 20, 2017 Americas Publication

User-Centered Design of a Tablet Waiting Room Tool for Complex Patients to Prioritize Discussion Topics for Primary Care Visits.

Complex patients with multiple chronic conditions often face significant challenges communicating and coordinating with their primary care physicians. These challenges are exacerbated by the limited time allotted to primary care visits.

OBJECTIVE:

Our aim was to employ a user-centered design process to create a tablet tool for use by patients for visit discussion prioritization.

METHODS:

We employed user-centered design methods to create a tablet-based waiting room tool that enables complex patients to identify and set discussion topic priorities for their primary care visit. In an iterative design process, we completed one-on-one interviews with 40 patients and their 17 primary care providers, followed by three design sessions with a 12-patient group. We audiorecorded and transcribed all discussions and categorized major themes. In addition, we met with 15 key health communication, education, and technology leaders within our health system to further review the design and plan for broader implementation of the tool ...

Feb. 13, 2017 Americas Publication

Integrating primary care providers in the care of cancer survivors: gaps in evidence and future opportunities

Since the release of the Institute of Medicine report: From cancer patient to cancer survivor: lost in transition, in 2005, there has been a national call in the USA to provide coordinated, comprehensive care for cancer survivors, with an emphasis on the role of primary care. Several models of care have been described, which focus on primary care providers (PCPs) as receiving cancer survivors who are transferred after successful treatment, and who are given specific types of information from oncology-based care (eg, survivorship care plans), and not as active members of the cancer survivorship team. They provide recommendations for education, clinical practice, research, and policy initiatives that might advance the integration of PCPs in the care of cancer survivors in diverse clinical settings.

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 ...

Nov. 14, 2016 Europe Publication

Strengthening the model of primary health care in Estonia (2016)

Faced with increasing rates of chronic conditions, multi-morbidities and a growing elderly population, strengthening the primary health care model in Estonia is of critical importance. Moreover, recent health system reviews have signalled with clear consensus the importance of reviewing the organization of primary care to best respond to population and individual health needs.

In this context and backed by the available evidence, this assessment sets out to explore the organization of primary care looking to three key interrelated policy questions:

  1. How can a population approach be adopted, with consideration in particular to the existing health information system?
  2. What are the possible organizational models for primary care providers and settings that would match population needs? And further, how do these promote coordination with other services, such as services delivered in hospital and by social care? And,
  3. How do health system enabling factors support the transformation of health services delivery in terms ...

Nov. 11, 2016 Europe Publication

Self-perception of leadership styles and behaviour in primary health care

The concept of leadership has been studied in various disciplines and from different theoretical approaches. 

In the primary health care (PHC) setting, managers´leadership style is defined as a set of acttitudes, behaviours, beliefs and values. The objetives of this study were to describe and learn about the self-perception of behaviours and leadership style among PHC managers; to determine the influence of the leadership style on job satisfaction, efficiency and willingness to work in a team; and to determine the relationship between transformational and transactional styles according age, gender, profession and the type of organization. 

Sept. 19, 2016 South-East Asia Publication

Healthy China : deepening health reform in China building high-quality and value-based service delivery

As many other countries, China faces big challenges to meet the health care needs of her citizens, associated with a rapidly aging society and increasing burden of non-communicable diseases (NCDs). Also, health costs have been growing at a rate higher than GDP growth since 2008.

Since the launch of health reform in 2009, China has invested significantly in health infrastructure at the grassroots level and made progress in building the primary care doctors system. Basic public health services capacity has been significantly enhanced. China is progressing quickly to achieving universal health coverage and some of the reform achievements have attracted worldwide attention.

The reform commanded many innovative pilots in health financing and service delivery at the local level and provided a strong foundation for the next stage of reform. This report aim to support China during this reform phase by recommending 8 sets of strategic reform directions, referred to as ...

Sept. 14, 2016 Americas Publication

Break the Cycle of Violence: A Miami-Area Community Drives Change

Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was held in May 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health.

One highlight of the meeting was interviewing community collaborations funded by The BUILD Health Challenge. The BUILD Health Challenge is a national awards program designed to support community collaborations that are working to give everyone a fair chance to be healthy.

 

Overview

The Liberty City Community Collaborative for Change targets a Miami-area community that is characterized by poverty, lack of food access, low educational attainment levels, and violence, including disproportionately high rates of physical, sexual, and child abuse. These attributes lead to trauma, chronic stress, and mental and physical health outcomes, such as depression, anxiety, substance abuse, sleeping disorders, high blood pressure, and strokes. 

About the Practical Playbook National Meeting

Key stakeholders from across sectors – representing professional associations, community ...

June 30, 2016 Americas, Global Publication

CMMI’s New Comprehensive Primary Care Plus: Its Promise And Missed Opportunities

The Center for Medicare and Medicaid Innovation (CMMI) has recently announced an initiative called Comprehensive Primary Care Plus (CPC+), evolved from the previous Comprehensive Primary Care (CPP) initiative. The initiative mainly consists on paying a fee to those primary care practices willing to introduce organizational changes centered in five primary care functions:  (1) access and continuity; (2) care management; (3) comprehensiveness and coordination; (4) patient and caregiver engagement; and, (5) planned care and population health.

 

In this post, the authors outline some of the promises and downsides of the PCC+. On the bright side, the authors analyse how financial incentives can make primary care practices introduce innovations that may lead to improvements in the quality of their clinical performance. On the other side, two main downsides are mentioned: (I) the lack of incentives to achieve good results in the care that takes place beyond the primary care services -hospital admissions ...

June 21, 2016 Europe, Global Publication

Can hospital services work in primary care settings?

In this post, the author analyzes how recent changes in primary care in the National Health Services could face the purpose of moving some services from hospital to primary care settings.

The author bases her discussion on a report published by RAND corporation (“Outpatient Services and Primary Care”) that identifies five main areas to be considered when moving services from hospital to primary care:

  1. Transfer: The substitution of services delivered by specialists for services delivered by primary care clinicians.
  2. Relocation: Shifting the venue of specialist care from hospitals to primary care settings.
  3. Liaison: Joint working between specialists and primary care clinicians to provide care to individual patients.
  4. Professional behaviour change: Changing the way GPs refer patients to specialists.
  5. Patient behaviour change: Helping patients make informed decisions about their care.

There is not a unique way of moving these services; many studies suggest that patients’ satisfaction usually grows when services are ...

June 19, 2016 Americas Publication

The creative potential of health work to develop an integrated care model in Brazilian primary health care  

In November 2015, at the 3rd World Congress on Integrated Care and 8th National Congress of Integrated Medicine, “Co-producing High Quality People-Centered Integrated Care for ALL”, Debora Santos presented her PhD research on primary health care teams in Alagoas, the most unequal state in Brazil. According to Debora Santos, while Brazil's Unified Health System (SUS) is headed by principles of integrated care, in practice a biomedical conception of health typically prevails instead of one focused on integrated care. Therefore, the objective of her research was to identify potential ways to develop an integrated care model of primary health care focused on the principles of social health rights, integrated access, equity, team work and health promotion. Through focus groups and interviews with primary health care teams she identified several challenges and potentialities for integrated care. For example,  the teams faced both objective (clinical) and subjective (emotional) needs but had limited ...

May 31, 2016 Global Publication

No universal health coverage without primary health care

Correspondance

Universal health coverage is currently the aspiration of many countries worldwide. We commend Michael Reich and colleagues for analysing lessons learned from different country experiences, but we believe there is a crucial element neglected within the ongoing universal health coverage debate.

Health-care system development requires more than financing and human resource considerations. Although essential, these components must be integrated into an overall framework for organising and delivering care that best meets population needs. Primary health care provides such a framework, builds the backbone of an effective health-care system, and can improve health, reduce growth in costs, and lower inequality. Strong orientation towards primary health care and its core principles (often outlined as first contact, continuous, comprehensive, and coordinated care) is shown to be stable over time and was often incorporated in the early days of many health-care systems that have a strong primary health-care orientation today. This observed stability ...

May 26, 2016 Global Publication

Understanding pressures in general practice

“General practice is in crisis”; that is how this King’s Fund report start its analysis, pointing to funding and workforce as two of the main problems in general practice situation. Increasing needs and complexity, trends of moving patients from hospital to communities and rising expectations in population act as factors that increase pressures in general practice.

This report identifies some immediate priorities and some future challenges in order to protect general practice and to make it can face future needs.

Immediate priorities would be: (I) providing practical support to practices, (II) accelerating the uptake of technologies that can help practice deal with growing pressures more effectively, (III) encouraging reshaping of workforce in primary care, (IV) reducing bureaucratic burdens, (V) placing primary care at the heart of sustainability and transformation plans, (VI) supporting patients to use health services appropriately.
Long-term challenges pointed by this report are: (I) solving deficiencies in ...

May 26, 2016 Europe Publication

Reshaping the workforce to deliver the care patients need

Workforce structure is one of the most difficult things to modulate in health systems. Current transition to new models of care could be a good opportunity to make workforce structure match actual needs of systems and populations. In this report, published by the Nuffield Trust, it is analyzed how organizations could reshape their current workforce and what the benefits would be:

There is a need to evolve from an illness-based system to a patient-centred system.
Workforce should meet future needs by incorporating professionals with a vision aligned with future models of care.
There are opportunities to develop the current workforce at all grades: from redeploying support staff, extending the skills of registered professionals and training advanced practitioners.
There is good evidence that support workers can provide good-quality, patient-focused care as well as reduce the workload of more highly qualified staff. Investment here could provide a cost-effective and rapid solution to ...

May 26, 2016 Europe Publication

Developing care for a changing population: Learning from GP-led organisations

The way a health system is organized may influence the care this system provides. In this Nuffield Trust report some GP-led experiences are described, analyzing what are the internal characteristics and external context that have affected GP-led progress.

The intra-organizational characteristics listed are: (I) strong links between clinical leaders and GP member practices, (II) sophisticated strategic and operational management support, (III) use of multiple forms of peer-led improvement, (IV) organizations are both entrepeneurial and pragmatic, (V) linked data between the organization’s own services and other providers.

In what concerns to external context, the three characteristics listed are: (I) a receptive context for change, (II) capability to transfer some of the commissioner role to providers through capitated budgets, (III) slow pace and short-term nature of decision-making.

The slow pace and short-term nature of decision-making in clinical commissioning groups may drive emerging organisations to focus on service developments outside of their ...

May 12, 2016 Global Publication

New primary care model yielding early results

Several ways of shaping primary care are being developed all around the world. Improving the role of nurses or giving general practitioners new competences are just a couple of ways of moving primary care towards a more comprehensive way of working.

In this post in the NHS Confederation Blog, some of the initiatives performed to change primary care are explained and some of the challenges that future primary care will face are listed.


One of the main points outstanded is the need of integrating care and workforce from different levels of health care. As it is said in this post “Patients will benefit from easy access to a single integrated, multidisciplinary team drawn from a wide range of health and social care professionals”

April 19, 2016 South-East Asia Publication

A strategic approach to Reproductive, Maternal, Newborn, Child and Adolescent health (RMNCH+A) in India

India’s National Rural Health Mission (NRHM) launched its RMNCH+A approach in 2013, which essentially looks to address the major causes of mortality among women and children as well as the delays in accessing and utilizing health care and services. The RMNCH+A strategic approach has been developed to provide an understanding of ‘continuum of care’ to ensure equal focus on various life stages. Priority interventions for each thematic area have been included in this to ensure that the linkages between them are contextualized to the same and consecutive life stage. It also introduces new initiatives like the use of Score Card to track the performance, National Iron + Initiative to address the issue of anemia across all age groups and the Comprehensive Screening and Early interventions for defects at birth , diseases and deficiencies among children and adolescents. The RMNCH+A appropriately directs the States to focus their efforts on ...

April 18, 2016 Africa Publication

Primary Care guideline for adults Western Cape, South Africa

The Knowledge Translation Unit (“KTU”) is a clinical research unit within the University of Cape Town Lung Institute (“UCTLI”) which has spent 15 years developing the Practical Approach to Care Kit (“PACK programme”) to support and empower nurses, doctors and other health workers working in primary healthcare.

PACK Adult is a comprehensive clinical practice guideline that aims at equipping nurses and other clinicians to diagnose and manage common adult conditions at primary level. The starting point is any of 40 common symptoms, each of which provides the opportunity to identify one or more of 20 important chronic conditions in the second half of the guideline. These include infectious diseases, chronic respiratory diseases, cardiovascular risk, hypertension and diabetes, mental health conditions, musculoskeletal disorders, epilepsy and women’s health. See sample pages and contents pages below.

BMJ has partnered with the KTU to make the PACK programme available to assist in improving ...

April 4, 2016 Global Publication

The MDG To SDG Transition: the role of hospitals and integrated primary care.

In 2016, the world will be moving from the Millenium Development Goals (MDG) to the Sustainable Development Goals (SDG). Regarding health-related goals, most of the funding in recent years has been focusing on disease-specific programmes and strengthening primary care; nevertheless, public health, health promotion, prevention, and controlling risk factors through a broad range of policy interventions, both within and outside the health sector, must be an important focus in the era of SDGs.


In this post, integrated health services are seen as a main factor to achieve the health-related topics in the SDGs. The author defends not only strong primary care services to deliver broad quality care, but also that these services should be integrated with essential hospital services. The article emphasizes that this kind of integration would be even more important in countries with a weak health system, in order to build a strong system that could face the ...

March 28, 2016 Europe Publication

Joining Up Care Where We Live

In April 2015 the charity Access Dorset published a video titled “Joining Up Care Where We Live”, in which citizens and patients are interviewed about their experiences with care coordination. Some respondents felt that care coordination still needs to improve. For example, according to a member of the Lypoedema and Lymphoedema Support Group, "the hospitals don't talk to the GPs" . According to a passer-by interviewed on the street, the “most unnerving thing” for a patient going to the hospital is to be asked: “So why are you here?”. On the other hand, one respondent who has a heart defect recalled a good example of care coordination. After an echocardiogram, the hospital informed her GP about the results and the GP called her to explain that her medication needed to be adjusted. With her consent, the GP immediately sent the prescription to the chemist. The video also focuses on two ...

Feb. 1, 2016 Europe Publication

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 ...

June 2, 2015 Publication

Ouagadougou declaration on primary health care and health systems in Africa: achieving better health for Africa in the new millennium

The International Conference on Primary Health Care and Health Systems in Africa, meeting in Ouagadougou, Burkina Faso, from 28 to 30 April 2008, reaffirms the principles of the Declaration of Alma-Ata of September 1978, particularly in regard to health as a fundamental human right and the responsibility that governments have for the health of their people. Having analysed the experience of Primary Health Care implementation in the countries of Africa in the last 30 years, the Conference expresses the need for accelerated action by African governments, partners and communities to improve health; the Conference, also reaffirming the importance of the involvement, participation and empowerment of communities in health development in order to improve their well-being; and recognizing the importance of a concerted partnership, in particular, civil society, private sector and development partners to translate commitments into action; hereby makes the following Declaration.

June 2, 2015 Publication

Declaration of Alma-Ata

The International Conference on Primary Health Care, meeting in Alma-Ata this twelfth day of September in the year Nineteen hundred and seventy-eight, expressing the need for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world, hereby makes the following Declaration.

June 2, 2015 Publication

World health report 2008: primary health care; now more than ever

Why a renewal of primary health care (PHC), and why now, more than ever? Globalization is putting the social cohesion of many countries under stress, and health systems are clearly not performing as well as they could and should. People are increasingly impatient with the inability of health services to deliver. Few would disagree that health systems need to respond better – and faster – to the challenges of a changing world. PHC can do that.

June 1, 2015 Publication

Integrated health service delivery networks: concepts, policy options and a road map for implementation in the Americas

Health systems in the Americas are characterized by highly fragmented health services. Experience to date demonstrates that excessive fragmentation leads to difficulties in access to services, delivery of services of poor technical quality, irrational and inefficient use of available resources, unnecessary increases in production costs, and low user satisfaction with services received. (...) The region is home to several good practices in the creation of Integrated Health Service Delivery Networks (IHSDNs), especially in countries like Brazil, Canada, Chile, Costa Rica and Cuba, which have traditionally supported the development of networks. Other countries in Latin America and the Caribbean are adopting similar policies to organize their health services. Despite these efforts, addressing fragmentation and providing more equitable, comprehensive, integrated, and continuous health services remain significant challenges for the majority of countries in the Americas.

June 1, 2015 Publication

Policy relevant determinants of health: an international perspective

Background: International comparisons can provide clues to understanding some of the important policy-related determinants of health, including those related to the provision of health care services. An earlier study indicated that the strength of the primary care infrastructure of a health services system might be related to overall costs of health services. The purpose of the current research was to determine the robustness of the findings in the light of the passage of 5–10 years, the addition of two more countries, and the findings of other research on the possible importance of other determinants of country health levels. Methods: Thirteen industrialized countries, all with populations of at least 5 million, were characterized by the relative strength of their primary care infrastructure, the degree of national income inequality, and a major manifestation of a behavioral determinant of health that is amenable to policy intervention (smoking), using international data sets and ...

June 1, 2015 Publication

Primary health care: making Alma-Ata a reality

The principles agreed at Alma-Ata 30 years ago apply just as much now as they did then. “Health for all” by the year 2000 was not achieved, and the Millennium Development Goals (MDGs) for 2015 will not be met in most low-income countries without substantial acceleration of primary health care. Factors have included insufficient political prioritisation of health, structural adjustment policies, poor governance, population growth, inadequate health systems, and scarce research and assessment on primary health care. We propose the following priorities for revitalising primary health care. Health-service infrastructure, including human resources and essential drugs, needs strengthening, and user fees should be removed for primary health-care services to improve use. A continuum of care for maternal, newborn, and child health services, including family planning, is needed. Evidence-based, integrated packages of community and primary curative and preventive care should be adapted to country contexts, assessed, and scaled up. Community participation and ...

June 1, 2015 Publication

Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care.

The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is high in low-income and middle-income countries and is predicted to increase with the ageing of populations, urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is increasingly becoming a chronic disorder. An integrated approach to the management of chronic diseases, irrespective of cause, is needed in primary health care. Management of chronic diseases is fundamentally different from acute care, relying on several features: opportunistic case finding for assessment of risk factors, detection of early disease, and identification of high risk status; a combination of pharmacological and psychosocial interventions, often in a stepped-care fashion; and long-term follow-up with regular monitoring and promotion of adherence to treatment. To meet the challenge of chronic diseases, primary health care will have to be strengthened substantially. In the many countries with shortages of primary-care doctors, non-physician clinicians will have a ...