This study examined the perceptions of a sample of Australian people living with dementia regarding the person-centred care and support they received from health professionals and family.
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
This Discussion Paper starts at the local level and reimagines primary health care (PHC) and the PHC workforce from the perspective of people living in rural and underserved urban areas of low- and middle-income countries (LMICs). Drawing on research evidence and successful examples, it presents a “start local” health service delivery model, health system design framework, and financing models intended to ensure high-quality local comprehensive PHC is available and accessible to all. Core PHC team members (community health workers, registered nurses, specialist family physicians, and administrators) and other health practitioners are generalists in their disciplines, working together in collaborative practice as the frontline providers of care that responds to the health needs of the population they serve. The most successful model of education and training for local comprehensive PHC is socially accountable, immersive community-engaged education woven into a facilitated education and training pathway starting with recruiting local students from rural and underserved communities. Successful attraction, recruitment, and retention of PHC team members results from the systematic approach of the Workforce Stability Framework with the three main tasks of plan, recruit, and retain supported by a long-term strategy and five conditions for success. High-quality local comprehensive PHC is successful in improving local population health when it is part of an integrated health system that connects clusters of autonomous local health service delivery organizations through partnerships with regional referral centers and other specialist service organizations that value the expertise of local PHC providers. All levels of the health system (local, regional, and national) are enhanced by intersectoral collaboration with active participation of all Partnership Pentagram members (policy makers, health administrators, health professionals, academics, and communities), underpinned by a local health needs, focused national health strategy, up-front local investments in PHC infrastructure and personnel, and funding models that reward achieving health outcomes.
Multimedia
Communities in Costa Rica were badly affected by the COVID-19 pandemic. A project in 2020, coordinated by the government of Costa Rica and PAHO/WHO country office showed that community engagement in primary health care could be a path to better tackling wider health and social challenges.
To create regular and institutionalised dialogue between governments and the people they serve, it is vital to break down barriers hindering meaningful participation. If these spaces are well designed and used regularly, they have the power to become a potent tool for more responsive and implementable policies. The WHO Handbook on Social Participation for UHC provides practical guidance for policymakers, drawing from country experiences, on how to engage with the population, communities and civil society by creating, strengthening, and sustaining participatory spaces for health decision making. World Health Organization YouTube Channel
Toolkits
Social participation is an important means for governments to develop responsive health policies and programmes, which are more likely to be implemented by a broad stakeholder group. It is at the heart of the inclusive governance needed for countries to stake their individual paths towards Universal Health Coverage while ensuring that no one is left behind. As simple as it may seem in theory, it is a complex undertaking in practice, one which policy-makers struggle with. The Handbook on Social Participation for UHC is thus designed to provide practical guidance, anchored in conceptual clarifications, on strengthening meaningful government engagement with the population, communities, and civil society for national health policy-making. It draws on best practices and lessons learned to support government institutions in setting up, fine-tuning, improving, and institutionalizing new or existing participatory health governance mechanisms. The handbook follows through the different tasks which policy-makers must reflect on and undertake when bringing in people’s voice into health policy-making. Examples include creating an enabling environment for participation, ensuring good representation, strengthening capacities, increasing policy-uptake of participatory process results, and sustaining participatory engagement over time. A fundamental premise of the handbook rests on the idea that policy-makers can leverage format and design elements of a participatory process to address power dynamics amongst participants, thereby fostering more meaningful contributions to the process. Download WHO Handbook on Social Participation for UHC
The UHC Partnership helps deliver WHO’s support and technical expertise in advancing universal health coverage through a primary health care approach in 115 countries, representing a population of at least 3 billion people. The UHC Partnership is one of WHO’s largest platforms for international cooperation on universal health coverage (UHC) and primary health care (PHC). It comprises a broad mix of health experts working hand in hand to promote UHC and PHC by fostering policy dialogue on strategic planning and health systems governance, developing health financing strategies and supporting their implementation, and enabling effective development cooperation in countries. Our aim is to strengthen country capacities and reinforce the leadership of the Ministry of Health in building resilient and effective health systems in a sustainable manner. We bridge the gap between global commitments and country implementation on the ground. Since its inception in 2011, the UHC Partnership has expanded steadily, reaching 115 member countries worldwide.
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
13/12/22 - 15/12/22
2nd International Conference on Public Health in Africa
Kigali Convention Centre, Kigali, Rwanda | 13-15 December 2022 CPHIA 2022 will provide a unique platform for African researchers, policymakers and stakeholders to come together and share perspectives and research findings in public health while ushering in a new era of strengthened scientific collaboration and innovation across the continent. Building on CPHIA 2021, this year’s conference will also serve as a catalyst to build more resilient health systems that allow African countries to better prepare for and manage emerging health threats while also addressing long-standing infectious diseases. Conference Tracks: Track 1 Epidemiology, Diagnostics and Clinical Management of Emerging and Re-emerging High Consequence Infectious Diseases (HCID) in Africa Track 2 Increasing Local Production in Africa: Advocacy, Research and Development Capacity in Diagnostics, Therapeutics and Vaccine Manufacturing Track 3 Strengthening Health Systems for Equitable and Universal Health Coverage in Africa Track 4 Women in Health – From Recipients to Providers to Leaders Track 5 The COVID-19 pandemic – Lessons Learned for Future Health Threats, Prevention, Preparedness and Response Track 6 Digitalization, Modeling and Analytics to Support an Effective Public Health Response, from Outbreaks to Pandemics and Beyond Track 8 A Renewed Focus on Africa’s Major Infectious Diseases: HIV, TB, Malaria and NTDs Track 9 Non-Communicable Diseases – A Growing Public Health Threat in Afric
22/03/23 - 24/05/23
23rd International Conference on Integrated Care (ICIC23)
The 23rd International Conference on Integrated Care (ICIC23) in partnership with the Flanders Agency for Health and Care and Visit Flanders will take place at Flanders Meeting & Convention Center Antwerp, Flanders from 22-24 May 2023. With the overarching theme ‘Care in action: how to work together, a participatory approach’, the conference will bring together leaders, researchers, clinicians, managers, citizens, patients and caregivers from around the world who are engaged in the design and delivery of integrated health and social care. ICIC23 International Conference on Integrated Care - 22-24 May 2023 from Foundation for Integrated Care on Vimeo.
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.