Little prior research focused on person-centred care and support (PCCS) for dementia in home, community or outpatient care. We aimed to describe what constitutes PCCS, how to implement it, and considerations for women who comprise the majority of affected persons (with dementia, carers). Despite the paucity of research on PCCS for dementia, synthesis of knowledge from diverse studies into a Framework provides interim guidance for those planning or evaluating dementia services in outpatient, home or community settings. Further research is needed to elaborate the Framework, evaluate PCCS for dementia, explore determinants, and develop strategies to implement and scale-up PCCS approaches. Such studies should explore how to tailor PCCS needs and preferences based on input from persons with dementia, and by sex/gender and other intersectional factors such as ethnicity or culture.
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
Frailty, a multifaceted geriatric condition, is an emerging global health problem. Integrated care models designed to meet the complex needs of the older people with frailty are required. Early identification of innovative models may inform policymakers and other stakeholders of service delivery alternatives they can introduce and locally adapt so as to tackle system fragmentation and lack of coordination. This study used horizon scanning methodologies to systematically search for, prioritise and assess new integrated care models for older people with frailty and investigated experts’ views on barriers and facilitators to the adoption of horizon scanning in health services research.
Multimedia
Our planet and our health are inextricably interlinked. The air we breathe, the food we eat, the resources that we consume for livelihoods, shelter, healing and recreation all determine our quality of life and well-being. Our existence relies on the resources and services provided by our planet, but we are dangerously close to exhausting their benefits. The consequences of unsustainable production and consumption have disturbed the balance of our environment. Climate change, more frequent and intense natural disasters, biodiversity loss and pollution are all disproportionately affecting the people who are least capable of protecting themselves. In terms of health impacts, these events increase the incidence of injuries, malnutrition, vector-borne diseases like dengue fever, and noncommunicable diseases such as asthma, chronic respiratory diseases, stroke, heart attack and many others. Health for all can only be achieved in a healthy planet that serves everyone equitably regardless of their race, gender, age, religion or wealth. It requires societies that equip people and communities to care for the environment, and strong leadership that protects the most vulnerable while creating a clear path towards a sustainable future. Primary health care approach Countries have declared their commitment to achieving universal health coverage by building people-centred, resilient and sustainable health systems that uphold the human right to health, promote social justice, empower individuals and communities and address the determinants of health. This approach is known as primary health care. It is widely regarded as the most inclusive, equitable and cost-effective way to achieve universal health coverage. Primary health care brings essential health services closer to people’s everyday environments, but it also increases health literacy in households and communities, giving people the knowledge and tools they need to take charge of their own health. The approach connects communities with systems that are centred on their needs and preferences, and addresses the factors affecting their health and well-being such as water and sanitation issues, pollution and more. Country action Countries across the world have been using primary health care principles to strengthen their health systems in the face of unprecedented challenges, including the COVID-19 pandemic and other disease outbreaks, human-induced and natural disasters such as climate change and conflict. Lessons and experiences documented through WHO’s series of stories from the field illustrate how this approach can be a powerful way to ensure that health systems and communities are mobilized as part of the movement to create sustainable societies, focused on what matters most to people, without breaching ecological limits. Colombia is building healthy communities by equipping people with the knowledge and skills they need to choose healthier lifestyles and care for their environment. ©PAHO/WHO Pacific Island Countries are bringing mental health support to communities to help them cope with the impacts of climate change and COVID-19 on their lives and livelihoods. ©WHO/Yoshi Shimizu Rwanda is building community health posts to reduce walking time to health facilities to under 25 minutes by 2024 from the previous 95 minutes. ©WHO/Alice Rutaremara Sudan is empowering communities to speak up about their health priorities to ensure that they are involved in making the decisions that affect their health. ©WHO/North Darfur Sub-office Trinidad and Tobago is equipping people to prevent and manage noncommunicable diseases such as diabetes and hypertension, which are being exacerbated across the world by environmental factors. ©PAHO/WHO/Denith McNicolls These countries are among the 115 countries and territories to which the UHC Partnership helps deliver WHO’s support in implementing a primary health care approach with the goal of accelerating progress towards health for all. The Partnership is one of WHO’s largest initiatives for international cooperation for universal health coverage. We thank the European Union, the Grand Duchy of Luxembourg, Irish Aid, the French Ministry for Europe and Foreign Affairs, the Government of Japan – Ministry of Health, Labour and Welfare, the United Kingdom – Foreign, Commonwealth & Development Office, Belgium, Canada and Germany for their funding support to the UHC Partnership.
Dr. Niamh Lennox-Chhugani, CEO of the International Foundation for Integrated Care explains the 9 Pillars of Integrated Care. Dr. Niamh Lennox-Chhugani, CEO of the International Foundation for Integrated Care explains the 9 Pillars of Integrated Care. from Foundation for Integrated Care on Vimeo.
Toolkits
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.
Providing people with person-centred, coordinated care, focusing on goals and preferences, whilst offering opportunities to consider realistic treatment and care options. Anticipatory care planning (ACP) is a process involving a number of steps. ACP involves conversations between individuals, their families, carers, and professionals. It helps people communicate goals and preferences, and gives them opportunities to consider realistic options and plan for future changes in their health and care that can be recorded, shared and reviewed. ACP is a person-centred, proactive approach to help people consider what is important to them and plan for their future care. Planning ahead can help people feel more in control and able to manage any changes in their health and wellbeing. People should be offered opportunities to take part in care planning and receive information about its benefits. Here are four key steps that we have identified working with health and social care professionals actively involved in ACP. These steps are based on previous ihub work on ACP in Scotland. There are a range of tools and resources that can be used to support each of the four steps.
News
UHC2030 is asking for contributions to a multi-stakeholder review called 'The State of UHC Commitment'. As part of this monitoring, UHC2030 would like to tell the stories of people in your country. Telling people’s stories can help governments and people around the world understand what UHC can mean to people. We are asking you to submit a story because we believe you have a story to tell about a positive and/or negative experience with accessing health care, with the quality of the care you got, or with paying for your care. Submit your story here before 31 October 2021 How do I create my story? Click here for instructions
affecTive basEd iNtegrateD carE for betteR Quality of Life (TeNDER) is a multi-sectoral project funded by Horizon 2020, the EU Framework Programme for Research and Innovation (end 2019 to end 2022), to develop an integrated care model to manage multi-morbidity in patients with Alzheimer’s disease (and other forms of dementia), Parkinson’s disease, and cardiovascular disease. By combining user-friendly technologies and substantial research experience, TeNDER project aims to help improve the quality of life of patients and those who surround them. Moreover, it will test ways to ease communication between different health and care providers who treat patients with multi-morbidities. After careful preparations, TeNDER is ready for 2021 and the first wave of pilots. During the pre-piloting phase, consortium partners laid out the legal and ethical framework of the project, defined the technical architecture of the services TeNDER will provide, consolidated the system for gathering data and analysing results, and consulted future users, among other things. "In addition, we developed use case scenarios, stories that reflect real-life situations and help us conceptualise how users will interact with our tools. To complement this exercise – and despite the difficulties the COVID-19 pandemic posed – we safely reached patients, carers, and professionals to reflect on the technology and TeNDER tools." TeNDER partners in Germany, Italy, Slovenia, and Spain conducted nearly 200 surveys and 61 interviews with patients, caregivers, and medical and social professionals. The results provided invaluable insight into the ways the TeNDER system will be used on the ground: “I would like to have more autonomy. And that when I communicate with people, they understand all that I want to say.” (patient with Parkinson’s Disease) “Some days, when I returned from work, I found her on the floor and she couldn’t explain what had happened. It would be very useful to know what happens [while I’m gone] and to be alerted if she has fallen.” (caregiver of a patient with dementia) “It would be nice if you could also encourage patients to exercise regularly, and monitor their vital signs, too. As a physician, I would benefit from reading the reports before seeing the patient.” (neurologist) The importance of the pre-piloting phase During this preparation phase, we not only identified what patients, caregivers, and other participants need, but we also worked with TeNDER’s technical partners to ensure their input is integrated into the system design. Furthermore, we translated complex procedures into less technical terms. Careful preparation helps projects like TeNDER stick to timelines, reduce failure rates, and above all, achieve societal impact for the benefit of patients and those who surround them. Learn more about TeNDER
Events
WONCA World Rural Health Conference 2022
Our theme will explore how communities can be, and are, empowered to improve their own health and the health of those around them. We will hear from experts and presenters from all over the world in various sectors, including Health, Science, Engineering, the Arts, and NGO's of all shapes and sizes. Community Empowerment for Health goes beyond the traditional methods of information sharing and consultation. It involves a change in power relations, and enables people to have more control and responsibility for their own health and well-being. Various sectors can reach out to communities to create empowerment opportunities to become more informed and more influential by giving them confidence, skills, resources and power to shape and influence their health. This action-oriented conference is intended to foster a high level of meaningful dialogue and cooperation amongst stakeholders, all committed to rural health improvement.
WONCA Europe 2022 Conference takes place from 28 June to 1 July 2022 and will be held conjointly with RCGP (Royal College of General Practitioners) 2022 Annual Conference as one event. Registration, programme and further information
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.