Presentation by Dr Albert Francis Domingo, delivered at the meeting on rehabilitation as part of the continuum of people-centred health care, Seoul (Republic of Korea), 13-15 December 2016.

1. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
Universal Health Coverage
Action Framework for the Western Pacific Region
Albert Francis Domingo, MD MSc
Division of NCDs and Health through the Life-Course
WHO Regional Office for the Western Pacific
Email: domingoa@who.int

2. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
Presentation Outline
1. Common health system goals
2. Essential attributes and action domains
3. Health system building blocks as a platform
4. UHC action framework for the Western Pacific Region
5. Designing a holistic model of care
6. Integrating with other health programmes
7. Recap: defining universal health coverage (UHC)

3. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
What do we want from health systems?
• Improve health outcomes
– Reduce exposure to modifiable risk factors
– Prevent complications and further deterioration
• Ensure equitable spread of improved outcomes
– (i.e., leave no one behind)
• Avoid financial risk due to costs of care

4. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
To get what we want, how should we implement
health programmes?
Essential attributes
(1-3/5)
Some domains for action
Quality Regulations and regulatory environment
Effective, responsive individual and population-based
services
Individual, family and community engagement
Efficiency Health system architecture to meet population needs
Incentives for appropriate provision and use of services
Managerial efficiency and effectiveness
Equity Financial protection
Service coverage and access
Non-discrimination

5. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
To get what we want, how should we implement
health programmes?
Essential attributes
(4-5/5)
Some domains for action
Accountability Government leadership and rule of law for health
Partnerships for public policy
Transparent monitoring and evaluation (M&E)
Sustainability and
resilience
Public health preparedness
Community capacity
Health system adaptability and sustainability

6. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
What are the building blocks for ideal
health programmes?
People-Centred Health Care Services
Health
workforce
Resource
generation and
health
financing
Essential
medicines,
commodities
and
technologies
Health
information
system
Good Governance

7. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
UHC Action Framework for the Western Pacific Region

8. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
Designing a Holistic Model of Ear and Hearing Care
Continuum
of Care
Level of Care
Self-care Family and
household
level
Community
level
General
primary care
District
hospitals
Referral
hospitals
A B C D E F
Health
Promotion
1
Disease
Prevention
2
Screening, Risk
Assessment, and
Diagnosis
3
Treatment and
Rehabilitation
4

9. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
The Continuum of Care
Health
Risk
exposure
Risk contact
Latent
disease/injury
Early
disease/
injury
Disease
progression
Advanced
disease/injury
Chronic
Disease or
impairment
Death
Primary Prevention:
Reduce risk exposure
Secondary
Prevention:
Detect and intervene
early
Tertiary Prevention:
Reduce progress or
complications of
established disease
ResourceGeneration,
Financing,Stewardship
Interventions

10. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
A Sample Holistic Model of Care for Diabetes
Continuum
of Care
Level of Care
Self-care Family and
household
level
Community
level
General
primary care
District
hospitals
Referral
hospitals
A B C D E F
Health
Promotion
1 Healthy
lifestyle
Healthy
lifestyle
Regulation of the
sale and
marketing of
sugar-sweetened
beverages
Disease
Prevention
2 Risk factor
screening
through medical
history
Outpatient
nutrition
counselling
Screening, Risk
Assessment, and
Diagnosis
3 Careful
assessment of
family history
Early detection
Fasting plasma
glucose
screening
HbA1C
screening
Treatment and
Rehabilitation
4 Adherence to
medication
Foot care
Community-
based
rehabilitation
Patient support
groups
Periodic eye
examination
Diabetic registry
Surgery and/or
hemodialysis as
indicated
Assistive devices
Specialist
management of
co-morbid
diseases (TB)

11. Self-harm and
interpersonal violence;
unintentional injuries;
transport injuries
Major NCDs: Diabetes,
urogenital, blood, and
endocrine diseases;
cardiovascular diseases;
chronic respiratory
diseases; neoplasms
Mental and
substance use disorders
Other NCDs
Maternal and
neonatal disorders
HIV/AIDS and TB
Diarrhea, lower respiratory,
and other common
infectious diseases
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0-6 7-27 28-364 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+
Causes of Death over the Life-Course in the Western Pacific Region (2013, both sexes)
Forces of nature, war, and legal intervention Nutritional deficiencies
Other communicable, maternal, neonatal, and nutritional diseases Neglected tropical diseases and malaria
days years
Data from the Global Burden of Disease (2013) as published in The Lancet

12. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
How can we integrate rehabilitation with
other health programmes?
Consider linkages with
• Noncommunicable
diseases
• Occupational health
• Urban health
• Healthy ageing

13. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
What is Universal Health Coverage (UHC)?
• All people having access to quality health services
without suffering the financial hardship associated
with paying for care
– All people (population coverage)
– having access to quality health services (service coverage)
– without suffering financial hardship associated with paying
for care (financial risk protection)

14. Rehabilitation as Part of the Continuum of People-Centred Health Care
13-15 December 2016 | Seoul, Republic of Korea
HEALTH AND THE ENVIRONMENT
Division of Noncommunicable Diseases and Health through the Lifecourse
Albert Francis Domingo, MD MSc
Email: domingoa@who.int