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Hernan Montenegro Coordinator Services Organization and Clinical Interventions

European Forum for Primary Care: "Twinning Population Health and Primary Care" Barcelona, Spain, 1-2 September, 2014 WHO Strategy on People-Centered and Integrated Health Services (PCIHS). Hernan Montenegro Coordinator Services Organization and Clinical Interventions

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Hernan Montenegro Coordinator Services Organization and Clinical Interventions

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  1. European Forum for Primary Care: "Twinning Population Health and Primary Care"Barcelona, Spain, 1-2 September, 2014WHO Strategy on People-Centered and Integrated Health Services (PCIHS) Hernan Montenegro Coordinator Services Organization and Clinical Interventions Service Delivery and Safety (SDS)

  2. Content • Rationale • Strategy analytical framework • Strategic directions on PCIHS • Strategy implementation • Next steps

  3. Ongoing challenges for health • Access – 1/3 of people with mental health disorders in HICs receive treatment, as low as 2% in LMICs • Availability – 58% of countries have any palliative care program • Acceptability – delivering women experience verbal abuse, condescension, intimidation and even physical abuse • Quality of care – international survey of clinical practice for heart failure found only 59% of quality of care indicators achieve, under clinical trial conditions

  4. Emerging challenges for health services • Non-communicable diseases: • multiple-morbidities • long-term, continuous care • Service fragmentation • Existing and growing inequities • Recognition of the significant challenges to reforming health service delivery systems

  5. Ongoing challenges for health Lack of coordination Coordination Of Care, Medical Errors, And Safety Among Sicker Adults In Eleven Countries, 2011

  6. Emerging challenges and opportunities • Demographic and Epidemiological Transition • Socio-political factors: • concerns about health care costs, and cost-efficiency • Increasingly active and organized consumers • Technological advances: • Patient self-monitoring and self-management • Linkages between health care providers (e.g. electronic medical records) • Globalization: • Export of unhealthy lifestyles • Medical tourism

  7. Building on Global Commitments • Reinvigorating Primary Health Care (WHR 2008) • Health systems strengthening (Everybody’s Business 2007) • Universal Health Coverage (WHR 2010) • Rio Declaration on social determinants (2011) • Prevention and control of NCDs (UNGASS 2011) • Multiple regional reports • Growing global commitments– but can service delivery systems deliver?

  8. Source: WHO, Primary Health Care- Now More than Ever, World Health Report, 2008

  9. Understanding People Centered and Integrated Health Services Universal Health Coverage People Centered Care Integrated Health Services People centered and integrated care to support UHC -The best case scenario-

  10. Proposed analytical framework

  11. Core principles guiding People-Centered and Integrated Care • Comprehensive • Equitable • Sustainable • Co-ordinated • Continuous • Holistic • Preventative • Empowering Co-produced Respectful Rights and responsibilities approach Collaborative care Shared accountability Evidence-informed Whole-systems thinking

  12. Examples of interventions for each Strategic Action

  13. Strategy implementation Country context • Low income countries • Middle income countries • High income countries • Some special cases: • Fragile/conflict affected states • Small island states • Large federal states

  14. Strategy implementation • Country-led • Equity-focused • Ensuring that people’s voices are heard • Recognizing interdependence • Sharing knowledge • Learning/action cycles

  15. Strategy implementation Some key issues for health workforce (HWF) • HWF planning and skills mix • Capacity gaps and distribution • New roles and functions (e.g. network planning and management; clinical integration) • Regulation (e.g. certification, re-certification, flexibility to relocate) • Teamwork, multi-disciplinary teams and inter-professional collaboration • Organizational culture • Innovation and learning with bottom-up approaches • Performance assessment and mutual accountability • Co-production of health • Compensation, incentives and motivation • In service training and career development path • Competencies (e.g. systems thinking, teamwork, negotiation, conflict resolution) • Inter-professional training • Interim short training courses to compensate for lack of specialists

  16. Next steps • Refine, publish and disseminate two versions of the Strategy: • Shorter version for policy-makers • Larger version for broader technical audience • Mobilize resources in support of Strategy • Start rolling out implementation of Strategy jointly with other partners during 2nd semester of 2014

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