Person-centred sexual and reproductive health (PCSRH) care refers to care that is respectful of and responsive to people's preferences, needs, and values, and which empowers them to take charge of their own sexual and reproductive health (SRH). It is an important indicator of SRH rights and quality of care. Despite the recognition of the importance of PCSRH, there is a gap in standardized measurement in some SRH services, as well as a lack of guidance on how similar person-centred care measures could be applied across the SRH continuum. Drawing on validated scales for measuring person-centred family planning, abortion, prenatal and intrapartum care, we propose a set of items that could be validated in future studies to measure PCSRH in a standardized way. A standardized approach to measurement will help highlight gaps across services and facilitate efforts to improve person-centred care across the SRH continuum.
This growing repository holds publications, multimedia, toolkits, news and events with information and insights about integrated people-centred health services. Share your resources! Follow us!
This growing repository holds publications, multimedia, toolkits, news and events with information and insights about integrated people-centred health services. Share your resources! Follow us!
Publications
Integrated care is at its heart about health, social care and wider services being better coordinated around people, families, and communities. This requires those who plan, design, and deliver services to understand what is important to people on an individual and collective basis. People’s circumstances and aspirations may change with their health conditions and social situations and through new challenges arising in wider society. It is therefore important that opportunities to influence and co-produce services are not a one-off exercise, but rather are ongoing and responsive to people’s interests and perspectives. Professor Robin Miller and Dr Caroline Jackson (Social Care theme) have been collaborating with research partners in Europe and Canada to understand how people with lived experience of health and/or social care can influence the development of integrated care. The first report from the research is now available for download: Citizen Leadership & Integrated Care Report.
Multimedia
On 7 April 2023, the World Health Organization observed its 75th birthday. WHO’s 75th?anniversary year is an opportunity to look back at public health successes that have improved quality of life during the last seven decades. It is also an opportunity to motivate action to tackle the health challenges of today and tomorrow. #HealthForAll #WHO75 More information: https://www.who.int/campaigns/75-years-of-improving-public-health
In recognition of Universal Health Coverage Day, Management Sciences for Health convened a group of policymakers and practitioners on December 15, 2022, to examine person-centered primary health care as the foundation of achieving UHC and Sustainable Development Goal 3. Half-way into the lifespan of the SDGs, what needs to be done to ensure that communities are involved in the design of their primary health care systems? What are global best practices for primary health care and what are we learning from them? How can we ensure these experiences are brought to bear as we approach 2030?
Toolkits
Health professions education has a growing obligation to develop practitioners who are conscious of health inequalities and the sociocultural dynamics of health care. This obligation is reflected in many of the competency and regulatory frameworks that drive current curricula. The central aim of integrated care is to improve patient experiences across health care settings by enhancing service coordination. Although addressing health inequalities is one of the core purposes of integrated care and its systems, educators have little guidance on how to effectively translate this into teaching activities. The reality of health care funding and constraints means that integrated care services may struggle to challenge health inequalities in a meaningful way. Patients from minoritised and marginalised backgrounds are more likely to fall through the cracks between health care services, experiencing fragmented care and negative effects on their physical and mental health due to poor integration. Further, scholars have continually drawn attention to two key issues: first, today's graduates' lack of awareness of social determinants of health and, second, the necessity for practitioners to take action in challenging the conditions that contribute to health inequalities.
This toolkit brings together those with first-hand experience of designing, delivering, evaluating and participating in a Longitudinal Integrated Clerkship (LIC) within a UK Higher Education Institution and those working closely on programmes focussing on Health Education England (HEE)'s and NHS England's national priorities. In August 2022, a collaborative workshop was held for students and tutors participating in a London-based LIC in 2021–2022, faculty with prior experience in running LICs, and HEE representatives. The aim of the workshop was to co-produce a toolkit to guide undergraduate institutions, who may wish to introduce an LIC within their medical school curriculum that aligns to these national priorities. Although this toolkit primarily focuses on a UK audience, we anticipate that other health systems facing a need for similar educational reform may also find use for this toolkit.
News
A training course in person-centred care has been carried out in the Democratic Republic of the Congo by researchers at The University of Gothenburg Center for Person-centred Care (GPCC) in Sweden. The course participants had various professions such as midwives, nurses and physicians. The researchers can report on a very positive reception and great commitment, with the potential to have a great future impact.
Ministers of Health of the Region of the Americas agreed on a new policy to address the fragmentation of health systems, a problem that affects the organization, management, and delivery of care in almost the entire Region. The Policy on Integrated Care for Improved Health Outcomes was adopted by the 30th Pan American Sanitary Conference of the Pan American Health Organization (PAHO), which meets this week in Washington, DC.
Events
4th Health for All Film Festival
Nearly 800 filmmakers from 106 countries have submitted short films for the 4th edition of the WHO Health for All Film Festival, on themes ranging from the trauma of war to living with COVID-19. Some 90 films have been chosen for the shortlist, for review by a jury of international artists and development leaders, before the announcement of the winners in June 2023.From April 6, the public is invited to watch, comment and share their favorite film using #Film4Health. Jurors will watch individually 15 short films (3 to 8 minutes in length each) over April Each jury team will have an online discussion to decide on the award winners at the end of April The online Award ceremony will take place in early June
Join us in a celebration of international “What matters to you?” Day at this webinar showcasing research on participatory approaches in various contexts and settings related to health care. The first three presentations will cover results and study protocols from projects in GPCC’s new strategic research focus area “Development of partnerships between patient representatives, the general public and healthcare organizations and decision-making systems”. The final presentation by our international scientific advisor Maria J. Santana (University of Calgary, Alberta), will cover public and patient engagement in health research. For over a decade The University of Gothenburg Centre for Person-centred Care (GPCC) has been performing multidisciplinary interventional and explorative studies on person-centred care in a wide variety of health care settings. Effects show significantly improved quality of care, increased patient satisfaction and reduced costs. GPCC also works with utilisation, implementation and education. Moderators: Annika Lindström, Autism Sweden, and Member of the GPCC Person Council for Patients and Relatives/Carers & John Chaplin, Professor, GPCC Speakers: Patient and public involvement in healthcare: A systematic mapping review of systematic reviews, Jana Bergholtz, Patient co-researcher, GPCC, Sweden. Patient and public involvement in research and drug development: Study design for assessing the impact of EUPATI’s education in Sweden, Kiana Kiani, PhD-student, GPCC, Sweden. Co-production to reduce involuntary loneliness in Swedish senior citizens: Jenny Milton, PhD, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden and Elin Siira, PhD, Halmstad University, Sweden. Public and Patient Engagement in Health Research: Maria Jose Santana, Professor, University of Calgary, Canada.
Blog
Approximately 1 in every 10 children has a disability and in developing countries, fewer than one out of 10 of them go to school (1) (2). Persons with disabilities experience overlapping deprivations that contribute to marginalization, significant discrimination, and ultimately, exclusion in societal participation, perpetrating the vicious cycle of disability and poverty (3) (4). Early childhood is the time when the impact of disability into adulthood can be maximally mitigated. It is, therefore, crucial for identification to be carried out at the earliest possible instance and appropriate intervention is provided. In the Philippines, efforts are underway to implement a system on prevention, early identification, referral, and intervention for delays, disorders, and disabilities in early childhood in select subnational areas. This is a project that is being implemented through the national Early Childhood Care and Development Council and the Department of Health with support from UNICEF and Humanity and Inclusion. Important lessons can be taken forward from the design and initial implementation of this system. First, it was necessary to work around the locally existing Early Childhood Care and Development (ECCD) tool that has been normed for Filipino children ages 0-4 years. This tool is the ECCD Checklist Records 1 and 2 for children ages 0-3 years and 1 month, and those 3 years and 1 month to 4 years and 11 months, respectively. Because the tool targets two separate age bands that can be reached with distinct service delivery platforms, close collaboration between health and early learning services was necessary from design to implementation. Second, the design of the system had to be responsive to the local health and early learning systems context for the feasibility of implementation throughout the care pathway. This required several stakeholder consultations, the development of simplified tools and referral mechanisms across the care pathway, iterative revisions of these tools based on end-user feedback, and cadre-specific capacity-building activities. Third, in a middle-income country (MIC) with devolved governance, engagement and buy-in of the local chief executive (mayor or governor) for every town/city or province were critical for both effectiveness and sustainability. The implementation of the system involves more than one sector (health and social services) and local ordinances had to be drafted to support its institutionalization. Buy-in of local chief executives (LCE) also opened the possibility of having budget allocations in the annual local budgeting process. Finally, it cannot be overemphasized that identification of delays and disabilities is inevitably demand generating. This simply means that the supply side of the system has to be ready to respond to the demand that is being created and provide appropriate services for the children identified with disabilities. Therefore, for the initial implementation of this system, parallel work with service providers and other partners at both primary and referral facilities was necessary to ensure that there was some degree of supply-side readiness before the implementation. The initial gains in the upstream work on health financing that established the four social health insurance packages for children with mobility, hearing, visual, and developmental disabilities complement this downstream work and offers the possibility of eventual scale-up. Figure 1. System on Prevention, Early Identification, Referral, and Intervention for Delays, Disorders, and Disabilities in Early Childhood (simplified schema for the health sector) Bibliography UNICEF, WHO. Assistive Technology for Children with Disabilities: Creating Opportunities for Education, Inclusion and Participation (2015). Geneva : World Health Organization, 2015. United Nations Children's Fund. State of the World's Children 2013: Children with Disabilities. New York : United Nations Children's Fund, 2013. Poverty and Disability in Low and Middle Income Countries . Banks LM, Kuper H, Polack S. 12, 2017, PLoS One, Vol. 12, pp. 1-19. B, Rohwerder. Disability inclusion: Topic Guide. United Kingdom : GSDRC University of Birmingham, November 2015. World Health Organization and The World Bank. World Report on Disability . Geneva : World Health Organization, 2011. Ma. Bella P. Ponferrada, MD, MPH Former Health Specialist, UNICEF Philippines, worked with UNICEF Philippines as Health Specialist for Children with Disabilities and Integrated ECD in the First 1,000 Days, from September 2019 to August 2021.
There has been growing interest and experience of community health workers (CHWs) in recent years, especially with the goal of Universal Health Coverage. Typically, the CHWs have provided combinations of health promotion messages, treatment of childhood illnesses, malaria-control measures, nutrition interventions, family planning, and screening and supervised treatment for HIV and TB. Many CHW programs function semi-autonomously with supplies and supervision coming with varying regularity from health facilities. For many years, this community-based health care approach included the training of traditional birth attendants (TBAs). TBAs were, for the most part, given short training courses and sent back to their communities with little or no continuing connection with health facilities. The approach was halted twenty years ago when it became clear that trained TBAs were not making any impact on maternal and newborn deaths from complications of pregnancy and childbirth. A Skilled Birth Attendant (SBA) policy, to train and deploy greater numbers of obstetricians and midwives, has subsequently proven very effective. More recently, however, it has become clear that not all communities or all members of communities have benefitted equally, focussing greater attention on the social determinants of health. Afghanistan’s maternal and newborn health services illustrate these policies and trends. In 2002, the national maternal mortality ratio in Afghanistan was estimated at 1600 per 100,000 births. By 2014, that had been reduced to 660 (Ministry of Public Health). Three factors contributed to this improvement. The first was the end of war in 2002, followed by a time of improving prosperity, education, roads and transportation. The second was a government commitment to a policy of skilled birth attendance and the establishment of rural-based midwifery schools, which trained sufficient midwives to staff the newly established health infrastructure. The third was the training of 28,000 CHWs, a male and female in each community. These CHWs, especially the women, were able to provide health education, family planning methods and other primary care services to women who were still culturally constrained in their ability to reach health facility services. By 2010, the rate of SBAs had risen rapidly to 50%, but was only 22% in the most remote communities. The modern contraceptive prevalence rate was 20%. Sixty percent of women attended antenatal care at a clinic at least once, but only 18% completed the target of four attendances. National surveys have confirmed that the problems are the same as in so many countries, namely distance and the availability and costs of transport. Since 2010, there has been little improvement in use of these services. The emphasis on SBAs worldwide has not completely prevented explorations of the potential for community-based interventions by CHWs and TBAs. Field trials have shown successful implementation of presumptive treatment of malaria and provision of iron and folic acid tablets during pregnancy by CHWs. Programmes of preparation for a home delivery and the supply of delivery kits to help ensure a clean delivery and safe cord-cutting have well-recognised track records. In recent years, the supply of Misoprostol tablets to prevent postpartum haemorrhage in home deliveries has been shown to significantly reduce what is still the main cause of maternal death worldwide. Finally, many programmes have demonstrated the ability of CHWs and TBAs to provide basic newborn care, perform resuscitation, and both prevent and treat newborn sepsis. Recognition of the barriers to maternal care in health facilities for many families, together with the demonstrated potential of CHWs and TBAs to provide essential care suggest the potential of more integrated programs between facility and CHWs. In most countries, this requires removing the bureaucratic barriers between professional obstetric and midwifery care and community-based care programs. This, therefore, for example, is an important goal of the National Reproductive, Maternal, Newborn, Child and Adolescent Health Strategy, 2016 to 2021, for Afghanistan.