Oct. 11, 2016 Europe

Using medical trains to improve access to health services across Kazakhstan

Kazakhstan was ranked among countries with the lowest life expectancy in the WHO European Region; health professionals were distributed inequitably across the country and geographic disparities in health status were seen between rural and urban populations.

The concept of transport medicine was conceived: Using the country’s existing transportation infrastructure, a series of trains now travel to stations across the country to provide health services to rural populations; aligning the initiative with overarching health system reforms (the State Health Care Development Programme for 2011–2015 “Salamatty Kazakhstan”), and gaining cross-sector buy-in from the government, helped to support implementation of medical ...

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Oct. 4, 2016 Europe

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 ...

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Oct. 4, 2016 Europe

Integrating nutrition programmes in primary care in Kyrgyzstan

A programme to distribute micronutrient sprinkles, locally known as “Gulazyk”, was introduced with donor support. Following successful piloting of the programme, activities were scaled up nationally in 2011; aligning with existing infrastructure and services helped support and stabilize reforms implemented under the initiative; building trust between primary care providers and patients was essential for ensuring uptake of micronutrient supplementation; community health volunteers aided trust building; developing a consistent message across all providers, even those not directly involved with the initiative, safeguarded changes against being undermined at different care levels; encouraging participation of mothers and community members proved valuable in overcoming ...

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Oct. 4, 2016 Europe

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 ...

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Oct. 4, 2016 Europe

Exploring new provider-payment models to incentivize performance improvements in Hungary

The Care Coordination Pilot was launched in 1999 to explore ways to improve the coordination and quality of health services. Under the pilot, Care Coordinator Organizations (run by health providers from general practices or polyclinics) acted as virtual fund holders for capitation-based health care budgets within their local catchment areas; carefully chosen financial incentives guided performance improvements by rewarding efficiency, incentivizing preventive care and encouraging treatment in lower-level settings; empowering professionals with new responsibilities helped to overcome provider dissatisfaction; extensive data collection supported analysis and comparison of local organizational arrangements.

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Oct. 4, 2016 Europe

Introducing community-based lifestyle clinics to improve population health in Malta

Lifestyle Clinics offering healthy-living support were introduced across Malta to expand availability of health promotion and disease prevention services; a motivated, multidisciplinary group of primary care professionals led the initiative through collaborative teamwork; the initiative capitalized on recent government policies supporting chronic disease prevention and a newly-established postgraduate community nursing programme; an initial information campaign helped raise awareness and gain public acceptance for new services; patients responded well to being offered a more active role in their health; further, patients play a key advocacy role in expanding the initiative.

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Oct. 4, 2016 Europe

Developing guidelines to reduce under-five child mortality in the Republic of Moldova

The government developed an under-five child mortality reduction initiative and established new standards and protocols for the observation of childhood illness; research conducted prior to the initiative identified the root causes of problems and provided evidence of the need to act; guidance and support from the Ministry of Health led to coordinated intersectoral action Educating and expanding providers’ competencies challenged pre-held attitudes regarding the detection and treatment of childhood illness; joint-sector delivery by health providers and social workers facilitated more comprehensive and coordinated care for patients; national ownership over the initiative was important; activities were fully integrated into national standards ...

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Sept. 22, 2016 Europe

Strengthening the response to noncommunicable disease in Turkmenistan

The government developed the National Health 2020 Action Plan 2014–2020 to guide action on noncommunicable disease; international attention on key issues helped generate national momentum and political will for health reform; a strong understanding of key challenges, supported with baseline population health data, facilitated the development of the Plan and allowed tailoring of activities to population needs; intersectoral partnerships across government ministries helped to keep the Plan on the political agenda and safeguarded health reforms against being undermined by other sectors’ policies; aligning with the existing primary care infrastructure facilitated the adoption of the Plan; a strong public communication ...

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Sept. 22, 2016 Europe

Establishing ambulatory care for patients with tuberculosis in Uzbekistan

Médecins Sans Frontières (MSF), in partnership with the Government of the Republic of Karakalpakstan, introduced ambulatory care from day one (ACD1) as an alternative model for TB care; a strong understanding of service delivery challenges led to a solution that met patients’ needs; a supportive political and legal framework, developed prior to implementation, helped to sustainably embed reforms within the health system; strong relationships between key actors who had a history of working together aided the initiative.

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Sept. 22, 2016 Europe

Integrating health and social care in Highland, Scotland

A lead organization model was introduced in Highland to promote greater integration between health care and social services. This new management structure united previously fragmented professional groups, serving to streamline service delivery and improve working relationships; broad political support for integrated care created a favourable environment for change; strong support from local senior management drove the initiative forward; extensive local engagement across all care levels ensured widespread buy-in for the initiative and reduced resistance to change across stakeholder groups; design and implementation of the initiative was iterative and not every detail was worked out prior to its launch; leaders stressed ...

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