Integrated primary health care at the core of health services delivery. Juan Tello, Programme Manager Health Services Delivery Programme
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1 Integrated primary health at the core of health services delivery Juan Tello, Programme Manager Health Services Delivery Programme Ljubljana 14 June 2016
2 Driven by values Based on sound financing Focused on quality Principle for managing change Ljubljana charter on reforming health Oriented towards PHC Develop health policy Listen to citizen s voice and choice Reshape health delivery Reorient human resources for health Strengthen management Learn from experience Centred on people Targeted on health
3 Regional commitments Global commitments Global and regional commitments on primary health and services delivery overtime World Health Report Primary health : now more than ever SDGs WHA global framework Global framework on integrated, peoplecentred services endorsed Alma-Ata Declaration PHC approach towards Health for All goal World Health Report Services delivery as one of four core functions World Health Report Universal Health Coverage Set of principles for reforming health systems in Europe Commitment to HS strengthening Commitment to peoplecentred health systems Ljubljana Charter Tallinn Charter Health 2020 Peoplecentred HS EFFA IHSD European Framework for Action on Integrated Health Services Delivery put to 66th RC Priorities for health system strengthening
4 PHC in the 21st century Financial constraints Epidemiological burden INNOVATIONS PUBLIC EXPECT- ATIONS Population ageing TECHNOLOGY WORKFORCE
5 Evolution of the model of De-institutionalized E.g. mental health Multiple settings E.g. rehabilitation People-centred E.g. life course Multi providers E.g. new competencies Closer to home E.g. long term Virtual E.g. tele
6 Model of defines organization, management and improvement HIV Diab etes Mental health Tertiary Palliative Acut e Secondary Treatment People 2 nd prevent Primary Promote Prevent
7 Developmental perspective to health services delivery Stages Conventional Disease-oriented Coordinated services Integrated services Properties Continuum Model of Selective primary Disease management Care management Whole-person Organization of providers Vertical Linkages Horizontal Collaborative Management of services Management of production Management of resources Management for performance Management for outcomes Continuous improvement Quality of inputs Quality of outputs Quality of processes Quality of outcomes
8 Mapping stages along continuum of services delivery Continuous performance improvement Quality outcomes 4 Conventional ( 4) Disease-oriented ( 5 8) Coordinated services ( 9 12) Integrated services delivery ( 13) Quality processes 3 Quality outputs 2 Quality inputs 1 Managing services Model of 1 Vertical 2 Linkages 3 Horizontal 4 Collaborative = 12 6 Coordinated Disease-oriented services Organization of providers
9 Applying stages to identify priority policy options Stages Conventional Disease-oriented Coordinated services Integrated services Value Priority actions Redesign the model of Optimize core processes of services delivery Align other health system enabling functions Strengthen integration with other sectors Change management Focus on strategizing changes with people at the centre, convening a wide range of actors from the outset Focus on implementing changes that disrupt the status quo via pilot projects and a high involvement culture Focus on working across many levers and building coalitions Focus on rolling out and scaling-up changes, from projects to business-as-usual
10 Response: Avenues for integration Focus on population health including determinants, environment PHC & PUBLIC HEALTH PHC & HOSPITALS Focus in transitions across levels of, pathways HSD & SOCIAL CARE Focus on Long term, home, community
11 Putting the pieces together: a Framework for Action PEOPLE Identifying health needs Tackling determinants Empowering populations Engaging patients SERVICES Reorienting the model of Organizing providers & settings Managing services delivery Improving performance SYSTE M Rearranging accountability Aligning incentives Preparing a competent workforce Promoting rational use of medicines Innovating health technologies Rolling out e-health CHANGE Strategizing with people at the centre Implementing transformations Enabling sustainable change
12 Implementation package Find all available resources online at:
13 WHO Regional Office for Europe WHO Division Regional of Office Office for Europe for Europe Division Health Systems of of Health Systems and Public Health and Health Public Systems Health and Public Health CONTACT INFORMATION Health Services Delivery Programme Division of Health Systems and Public Health WHO Regional Office for Europe For more information on health services delivery visit
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