There is a need to ensure that the voices of the most vulnerable populations are included on the path to universal health coverage. This requires an integrated and people-centred approach in how health services are planned, delivered, monitored and evaluated. Strategies that focus on engaging and empowering underserved and marginalized subpopulations are essential to inform policy and decision-makers on how they can improve access to quality health services and financial protection for disadvantaged subpopulations and address broader societal goals such as equity, social justice, solidarity, and social cohesion. These were some of the key messages to come out of a session on the “WHO Framework on integrated people-centred health services: reaching out to vulnerable populations” that took place on 29 January at the Prince Mahidol Award Conference in Bangkok, Thailand.
The session was hosted by the WHO/Headquarters Service Delivery and Safety Department, in collaboration with the WHO/Headquarters Gender, Equity and Human Rights Team.
Panelists presented their experiences in implementing integrated and people-centred strategies to reach out to the most vulnerable populations within their national contexts.
Ms Orajitt Bumrungskulswat, Former Senior Director, Bureau of Community Health Service System, National Health Security Office (NHSO) shared challenges in accessing health services in Thailand, particularly for people living in remote and marginalized areas who may also have greater health needs. To address this, a coordinated approach between the Community Coordinating and Complaint Center, the Community Health Fund and Community Long Term Care Fund was initiated with the local authority and community, along with funding support from the National Health Security Office. A strategy to support integration across the health sector, along with engagement and empowerment of local communities supported the government in ensuring that even the most vulnerable people in the local community would have access to quality health services.
Another example was illustrated by Dr Fran Baum, Director, Southgate Institute for Health, Society, and Equity, Flinders University, Australia using an Aboriginal community controlled health service model of primary health care that has evolved in Australia. The services, which include medical and other curative services, group programs, community development and social action on issues of local and national importance, are managed by community boards and represent a comprehensive approach to primary health care. By reorienting the model towards primary health care, and engaging and empowering local communities, the services were found to be more comprehensive and culturally appropriate.
Ms Rina Dey, Behavior Change Communication Advisor, CORE Group-India described India’s efforts in reaching marginalized and disadvantaged populations to eradicate polio. Systems-level collaborations between government departments and development partners, combined with the coordination of local strategies such as inclusion of migrant and mobile populations in the micro-plans, health camps and engagement of community, influential people, religious institutions and leaders to overcome barriers and motivate parents to immunize their children against polio and routine immunization, has led to the eradication of polio in India and has paved the way for future programmes.
Mr Ikuo Takizawa, Deputy Director General, Human Development, Department, Japan International Cooperation Agency (JICA) presented experiences in strengthening governance and accountability in LMICs. Multiple levers were shared on how to strengthen governance and accountability using rules, organizations and structures, empowerment, resources and incentives, and specific examples on community involvement and participatory management were shared from Bangladesh and Tanzania respectively.
The presentations were followed by comments from panelists: Dr Jim Campbell, Director, Health Workforce, WHO/Headquarters; Dr Suneeta Sharma, Director, USAID Health Policy Plus Project, Vice President, Health Practice, Palladium; and Dr Rafael Gonzalez, Coordinator, ALAMES (Latin American Association of Social Medicine).
The session brought together health systems leaders to reinforce that UHC requires concerted action within and outside the health sector, and engagement with all segments of society, in order to address inequities in accessing health services, as well as other determinants of health inequities. It also allowed the opportunity to highlight WHO’s leadership in “leaving no one behind “ in the context of the SDGs, including work on health inequality monitoring and incorporating equity, gender, and human rights in national plans, policies and programmes.
WHO Gender, Equity and Human Rights
WHO Framework on integrated people-centred health services