Comprehensive Primary Health Care Reform in Costa Rica

In the past, Costa Rica was characterized by a duplicative and fragmented public primary healthcare system. In 1994, the country initiated a sweeping reform of the health system, including primary health care. Bureaucratic reorganization of the Ministry of Health (MOH) and the Social Security Agency (CCSS) led to the integration of all healthcare delivery under the CCSS, from public health activities to tertiary care. Comprehensive multidisciplinary primary healthcare teams (EBAIS)—comprised of a doctor, nurse assistant, community health worker, and data specialist—were created to care for approximately 5,000 patients each. A system of geographic empanelment was implemented to ...

Child health general practice hubs: increasing access to paediatric care in the community

Developing paediatric capabilities of GPs and other healthcare professionals facilitates more healthcare delivery in community setting; "Whole-population approach" also addresses difficulties patients have in obtaining a GP appointment, as well as promoting self-care where appropriate; Attendance at A&E in relevant areas has declined, and patients feel more satisfied with care delivery in a community, as opposed to hospital, setting.

“Year of care:” GP delivered packages of care for long term conditions in inner-city London

In 2007, the borough became a pilot site for the “Year of Care” Project. This involved clinics “redesigning” the annual review that they undertook with patients. The newly-redesigned annual review took the form of a co-productive care plan, where patients were asked what was important to them, and what health outcomes they themselves would like to achieve.                                                 

In 2010, it was decided that ALL general practices in the borough should offer a core Service to people with type-2 diabetes. This involved creating additional packages of ideal care for people with type 2 diabetes across four clinical subgroups: newly diagnosed, controlled ...

Educating and empowering children to make healthy choices across Mexico

In Mexico, one in three children and adolescents are overweight or obese. This increases the risk of diabetes and hypertension, as well as learning and development issues. Additionally, many children are at risk of addiction, teenage pregnancy, and mental health issues.

“Health at your school” is a joint strategy between the Secretary of Public Education and the Secretary of Health (MoH) to address these health risks. It encourages children and adolescents to maintain a healthy body, avoid risky behaviors and acquire healthy habits, through five components: educate for health; curricular autonomy; professionals and students of health at your school; training ...

At Risk Individuals (ARI) programme, Counties Manukau Health (CMH) Auckland, New Zealand

The model of care provides early and planned interventions, establishes general practice as the centre of coordinated healthcare, provides care based on patient set goals and improves access to a range of specialist and community services; uses risk profiling as means to identify and judge patient eligibility; care goals are set and progress overseen by an assigned care coordinator; funded by flexible regime managed by the providers to ensure care goals can be achieved.

Strengthening primary care in Voznesensk, Ukraine

The district of Voznesensk experimented with initiatives, such as provider payment mechanisms, designed to align service delivery with the principles of family medicine, becoming an example for broader primary care reform across Ukraine; effective local leadership, combined with political and financial support, created a stable platform from which bottom-up reforms were built; aligning local initiatives with national priorities proved valuable for gaining legitimacy and support for the initiative; availability and capacity to collect and share data was fundamental for improving communication between health providers and increasing continuity of care. A district-wide electronic patient registration and medical records system was created ...

Strengthening community-based mental health services in Cyprus

New political commitments to mental health reform led the government to pass the Mental Health Act in 1997 to promote community-based mental health care; a wide variety of community-based mental health services have been made available, with emphasis on services for prevention, early treatment, rehabilitation and home care; advocacy from the health workforce motivated reforms and helped define the vision for care transformations; strategic timing was an important contributing factor in achieving political support for mental health reform; partnerships with NGOs and volunteer organizations helped expand the continuum of mental health care.

Strengthening disease prevention services in Albania

The government, which was strongly committed to establishing universal health coverage, launched a four-year Free Check-Up Programme to introduce free screening services for chronic conditions; adopting a proactive approach to prevention was essential for reaching and engaging the target population (all citizens aged between 40 to 65 years); significant efforts were made to improve the systematic collection and monitoring of population health data; government support for activities, and a key partnership with the Health Insurance Institution to reimburse health check-up services, helped embed the initiative into the health system.

Implementing early childhood development centres in Bosnia and Herzegovina

As part of a wider initiative for the social protection of children in post-war Bosnia and Herzegovina, UNICEF partnered with cantons and municipal governments in 2010 to establish Integrated Early Childhood Development (IECD) Centres; a situational analysis and piloting of the approach supported a sharpening of priorities and the development of practical solutions; longstanding partnerships between government actors and development agencies allowed for gradual capacity-building at the subnational level, enabling local uptake of new roles and responsibilities relating to early childhood development; aligning national policy with municipal action encouraged widespread adoption of changes, increasing consistency in approaches and securing sustainability ...

Designing a national diabetes plan for Slovenia

The Ministry of Health convened a working group to develop a national diabetes strategy. After several years of deliberation among working-group members, the finalized National Diabetes Strategy was approved by the government in 2010; an active patient association supported patient engagement and involvement throughout the initiative’s planning and implementation process; meaningful stakeholder engagement across professions and institutions helped develop a common vision for the initiative; building trust between stakeholders took time, but was necessary to allow functional teamwork and effective plan development; oversight from the Ministry of Health fostered important linkages across activities, ensuring that changes to service delivery ...