VII Astana Economic Forum Astana, Kazakhstan, May 21-23, 2014

1. Identifying areas for health services delivery strengthening towards people-centred, high quality, coordinated/integrated care Dr Juan Tello Health Services Delivery Programme, Programme Manager Division of Health Systems and Public Health WHO Regional Office for Europe VII Astana Economic Forum Astana, Kazakhstan, May 21-23, 2014

2. Health and development: Regional & global commitments

3. How can health services delivery strengthening contribute to improved health outcomes?

4. Improvement of health and development: an interaction of the context, system, services delivery Epidemiological Cultural Financing Performance improvement Model of care Organization of providers People-centred care Governance Resources Leadership & management Socio-demographic Economic SERVICES SYSTEM CONTEXT

5. What is the health services delivery function? Comprehensiveness of core services across care continuum for all Continuing health care process Model of care Organization of providers Promotion/prevention Life course Coordinated Integrated Continuous learning & performance improvement People-centred care Accessible Quality Leadership & management Responsiveness to individuals, communities, populations health needs Effectiveness and efficiency of interventions

6. System changes and innovations SERVICES • Decentralization for tailored services [e.g. Denmark, Sweden, Norway, Finland] • Public-private mix for expanded access/responsiveness [e.g. Croatia] Governance Financing Model of care • Bundle payments, risk-adjusted capitation/fee for service [e.g. Netherlands, UK] • Performance based, quality payments [e.g. UK, France, Hungary] People-centred care People-centred care Leadership & management Resources • Expanded role of family physicians, nurses [e.g. Turkey, Estonia] • Technology enabled services delivery [e.g. Sweden, Denmark, Netherlands]

7. Evolving context and challenges this presents Communication revolution; increasing voice & expectations of public Double burden of disease, multi/co-morbidities, new risk factors (e.g. obesity) Epidemiology Cultural People-centred care Economics Demographics Population ageing; demographic transition; urbanization; migration Liberalization & marketization; unequal economic growth; new technologies

8. Examples from Kazakhstan Source: WHO Regional Office for Europe, Health for All database

9. Examples from Kazakhstan NCDs are estimated to account for 78% of all deaths Notes: Proportional mortality (% of total deaths, all ages, 2010) Source: WHO Regional Office for Europe

10. Recalling our common vision: “…practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community…[services] forming an integral part of the country’s health system…care as close as possible to where people live and work…a continuing health-care process…” Declaration of Alma-Ata (1978) Achieving PHC principle & values in practice?

11. Identifying key areas for action PEOPLE CULTURE RESOURCES POLICIES CARE Comprehensiveness People-centred care INFORMATION COMPETENCIES Continuity Coordination Accessibility Efficiency/ Effectiveness SERVICES SYSTEM SYSTEM CONTEXT CONTEXT Recall…

12. Care: examples in practice • Gate-keeping systems E.g. Moldova; Romania strict gatekeeping; Serbia ‘chosen dr’; Georgia; Ireland family medicine as coordinator of services • Group (multi-)practice teams E.g. Slovakia shared practice with specialists; Ukraine HIV/TB/IDU services in triple pathology sites; Norway nutritionist, OT/PT, RN, GPs practices; Belgium mental health specialists with GPs • Task-shifting E.g. Lithuania cardiologists for diagnostics, GP-led treatment; Bulgaria community nurse-led home care; Cyprus mental health nurse

13. Competencies: examples in practice • Enhanced clinical profile E.g. Lithuania; Ukraine; Bulgaria broadened scope of GPs; Netherlands occupational therapist-led for cancer patients; Austria geriatricians leading out-patient care • Professional interpersonal skills E.g. Serbia social supports for palliative care; Ukraine, Norway patient communication skills and motivational interviewing • Public health literacy E.g. Norway healthy life centres; Belgium de-stigmatizing mental health

14. Information: examples in practice • Electronic patient records E.g. Lithuania patient records linked PHC/specialists; Germany; Estonia; Belgium national patient record system • mHealth and e-solutions E.g. Denmark SMS appointment reminders; Netherlands; Sweden telemedicine; Ireland tablets for nurses • Research and innovations E.g. Romania; Ukraine methodological process for performance assessment; Serbia; Lithuania; Austria international trainings

15. Concepts for priority setting and strategic planning Developing a Framework for Action in the WHO European Region Experiences from implementing transformations Tools and instruments for leading and managing change **IN PROGRESS** Compendium of initiatives in the WHO European Region towards more coordinated/integrated health services delivery

16. For comments or questions: ContactCIHSD@euro.who.int Or visit http://www.euro.who.int/en/health-topics/Health-systems VII Astana Economic Forum Astana, Kazakhstan, May 21-23, 2014