Strengthening people-centred health systems in the WHO European Region: framework for action on integrated health services delivery
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Presented by Dr Hans Kluge, Director and Dr Juan Tello, Programme Manager, Health Systems and Public Health, WHO/Europe, at the 66th session of the WHO Regional Committee for Europe.
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Strengthening people-centred health systems in the WHO European Region: framework for action on integrated health services delivery
- 1. Strengthening people-centred health systems in the WHO European Region: framework for action on integrated health services delivery Dr Hans Kluge, Director Dr Juan Tello, Programme Manager Health Systems and Public Health
- 2. CALL FOR ACTION Photo: Eliza Snow
- 3. SDGs HEALTH SYSTEM COMMITMENTS Health 2020 EUR/RC66 RESOLUTIONS Integrated, people-centred health services Policy alignment
- 4. Final consultation meeting, 3–4 May 2016 Copenhagen, Denmark 23rd SCRC 4th session, May 2016 Geneva, Switzerland Kick-off technical meeting 3–5 Feb. 2014 Istanbul, Turkey 2nd annual technical meeting 17–18 Feb. 2015 Istanbul, Turkey 23rd SCRC 2nd session 26–27 Nov. 2015 Paris, France Launch of process at 5th anniversary conference of the Tallinn Charter 18 Oct. 2013 Tallinn, Estonia Stakeholder consultation 1 April 2014 Brussels, Belgium The outcome of a three-year process…
- 5. Identifying needs Engaging patients Empowering populations Designing care Organizing providers and settings Managing services delivery Improving performance Rearranging accountability Aligning incentives Preparing a competent workforce Promoting responsible use of medicines Innovating health technologies Rolling out e-health Tackling determinants CHANGE Strategizing with people at the centre Implementing transformations Enabling sustainable change PEOPLE SERVICES SYSTEM European Framework for Action on Integrated Health Services Delivery © World Health Organization 2016
- 7. Country assessments Ad hoc training courses Tailored technical assistance Intercountry collaboration Definitions of key concepts Analysis of data Access to networks Facilitation of the changes Repository of evidence Actionable policy recommen- dations Implementation package products
- 8. This presentation is dedicated to the family, friends and colleagues of Dr Salidat Kairbekova 1961–2016
- 9. CONTACT INFORMATION Health Services Delivery Programme UN City, Copenhagen, Denmark Email: eucihsd@who.int Division of Health Systems and Public Health WHO European Centre for Primary Health Care Almaty, Kazakhstan Email: eurocphc@who.int For more information on health services delivery at the WHO European Regional Office for Europe, visit: http://www.euro.who.int/health-service-delivery.
Editor's Notes
- Key messages Formal welcome, [distinguished guests] It is a pleasure to present to you today seeking your endorsement of the European Framework for Action on Integrated Health Services Delivery. This work is the outcome of a three year process and takes forward the first of the priority areas for strengthening people-centred health systems agreed to at our last Regional Committee meeting in 2015: transforming health services delivery.
- Key message: This work is a testament to the Regional Director’s commitment to public health and ensuring a primary health care approach is realized. It is as much a reflection of the momentum across all Member States’ to transform health services delivery and ensure our health systems are fit for purpose to meet population health needs. Just as this photo illustrates, the transformations we are talking about call for a team effort. Not only for alignment across our policies, but also in practice, to ensure that across our health systems – from national policy makers, to regional health authorities, health managers, practitioners and patients themselves – are quite literally ‘on board’ with the changes for optimal gains.
- Key messages Importantly, these considerations our founded on a common set of priorities and values agreed across the region. For example, in committing to the SDGs, making progress calls for access to quality, essential health services that are safe and acceptable to all people and communities. We have also long recognized the link between well-performing health systems and population health and well-being; including in the Ljubljana Charter celebrated just this year on its 20th anniversary, or the Tallinn charter for health and development. Health 2020 and the recently adopted global framework on integrated, people centred both set out a vision for services that are modeled around populations and individuals and in those commitments put to the RC this year, we have worked to find alignment across the priority areas put forward.
- Key message To identify a priority list of actions, that uphold a systems-focus and ensue an outcome oriented approach, we started out now three years ago with a process that would aim to be as participatory and evidence-rich as possible. This work was laid out in a roadmap launched at the 5th anniversary conference of the Tallinn Charter in 2013 As part of this process, a network of technical focal points was convened, with requests for nominations put to all MOH across MS; in Feb 2014, a first kick off technical meeting was held in Istanbul, with appointed focal points and invited experts That same year, a stakeholder meeting, inviting partnered organizations like the OCED and EU, as well as patient associations and provider networks were invited to a one-day consultation in Brussels; both meetings served as platforms to exchange ideas and experiences from practice. Last year, focal points from countries and experts were invited for a second annual technical meeting in Istanbul, where a refined framework was presented and discussed; and from which the current framework has taken shape. In the months that have followed; the processes in preparation of this coming European Regional Committee in the fall have taken precedent. This includes in Nov of last year, a presentation of the Framework at the SCRC meeting in Paris; over the month of March and April an online consultation with Member States was put in place; followed by a final consultation meeting in May, attended by over 170 participants.
- Key message Through an iterative process, of simplifying and prioritizing entry points and key high-leverage areas for change in transforming services delivery, a framework of four domains and respective areas for action was identified. EFFA takes form as these, with three core domains and one cross-cutting domain; sequenced to start with people as the guiding focus (their needs; the determinants of health; and their involvement as engaged and empowered individuals in their health and health services); the second domain – services – signals those key properties of services to be improved upon, with specific decisions on the design and focus taking direction from the specific context of health needs and previous decisions taken – the third domain – systems – aims to find the alignment as mentioned with other health system functions at the unique interface between services and the health system for sustainable, system-wide change Throughout, the change process is at play, having a key role in first building momentum but also implementing new practices and further rolling-out piloted ideas and projects In this way, the Framework for Action is itself a resource for undertaking health services delivery transformations. By way of identifying and sequencing a priority list of key areas that call for attention, it works to prioritize efforts and account for the most pertinent interactions and interdependencies at play.
- Key message: Taking these changes forward - we are wholly committed to supporting MS with the assistance needed to undertake transformations This commitment has been solidified with the support of the Government of Kazakhstan, and the opening of a new centre focused on services delivery, and excellence in primary care. To quote our Regional Director at the opening of the centre in 2015, the Centre makes Almaty not only the “birthplace of primary health care, but also its home” and we are excited to take this next phase of work forward through the centre.
- Key messages: How will the Centre take on its role as an implementation hub? The new Centre on Primary Health Care has been designed to support MS to delve into these areas through key, focused entry points, that can be clustered along three streams of work: PHC and Public Health: placing focus on population health, in particular the social determinants of health and environment and health, this work stream works through accountability and financing arrangements to strengthen PHC and public health integration PHC and Hospitals: focused on the delivery of services across levels of care, including care pathways and transitions, this work stream tackles the delivery of services with and across PHC and hospitals, with a focus on priority health improvement areas including NCDs, TB, palliative care, HIV and EPHOs. HSD and social care: this third stream of work focuses on aspects such as long-term care, home care, telecare and community care, in the context of chronicity, multimorbidities, ageing and mental health. Importantly, supporting implementation is not a ‘next stage’ process – it has been a core focus throughout. To date a number of resources have been developed and are currently available online – providing information, evidence, experiences, and tools for taking on transformations in health services delivery This includes – a concept note on health services – as applied in the framework; a compendium of case examples on transforming health services – with one example from each of the Region’s 53 MS; as well as an accompanied guide for developing case studies; a series of assessment on ambulatory care sensitive conditions have also been conducted and recently a concept note and resource guide for self-assessment has been published; We have also recently published a document cataloguing over 500 examples of resources available to support transformations by the FFA key strategies. These and other resources are all available at out website accessed through the WHO EURO webpage; under the services delivery section. Together we will take forward the vision for integrated health services delivery and our shared commitment to people-centred health systems.
- Key message: To conclude, as previously expressed by our Regional Director, the Division extends our sincere condolences to the family, friends and colleagues at the Ministry of Health and Social Development of Kazakhstan for the untimely passing of Dr Salidat Kairbekova Dr Kairbekova played an integral role in the proposal and eventual approval of the Centre for Primary Health Care. We will work tirelessly to ensure her passion and commitment to primary care and public service translates into the work of the Centre.
- Key message Thank you for your attention. I would also like to take a moment to recognize the number of people that have contributed to this work over the past three years, oversee by Health Services Delivery Programme Manager Juan Tello. Thank you to his team and the numerous partners including all Member State technical focal points that have contributed throughout.