Integrated health and community systems strengthening for improved contraceptive access and uptake in Nampula province, Mozambique

As with all types of interventions, the integration of health services demands an adjustment to contextual characteristics, ranging from the burden of disease to society and culture. Thus, in developing countries across Africa, efforts towards the integration of health services overwhelmingly focus on communicable diseases and family planning, and aim to involve existing community structures in the delivery of health services.

Such is the case of the USAID-funded Strengthening Communities through Integrated Programming (SCIP) project in Nampula province, Mozambique. This project, implemented from 2009 to 2015 by Pathfinder International and its partners, worked to increase access to contraceptive services by strengthening and better integrating health and community systems.

 Toward the end of the project, Pathfinder observed a nearly 400 percent increase in couple years of protection (CYP). Furthermore, they found that the distribution of all contraceptive methods had increased, suggesting improved method choice and minimized health provider bias. Recognizing the ...

How stakeholder participation can contribute to systematic reviews of complex interventions

Although patient and public involvement in research is a requirement for research funding in many countries, the knowledge base for how to effectively involve people —and evidence of the effectiveness of involvement—is weak. This article describes how methods used in participatory health research were used to involve patients, clients, providers and community health workers across all stages of a realist review. Sustained involvement enabled better identification of the components of the complex intervention of communitybased peer support. It also challenged assumptions of how peer support is constructed, leading the review team to question whether the process of designing and implementing interventions has more influence on effectiveness than previously recognised in empirical studies. We conclude with a discussion on when sustained involvement should be used, and the challenges of incorporating it into the traditional researcher-led approach to systematic reviews.

People-centred health systems, a bottom-up approach: where theory meets empery

BACKGROUND AND METHODS:

Health systems are complex and constantly adapt to changing demands. These complex-adaptive characteristics are rarely considered in the current bureaucratic top-down approaches to health system reforms aimed to constrain demand and expenditure growth. The economic focus fails to address the needs of patients, providers and communities, and ultimately results in declining effectiveness and efficiency of the health care system as well as the health of the wider community. A needs-focused complex-adaptive health system can be represented by the 'healthcare vortex' model; how to build a needs-focused complex-adaptive health system is illustrated by Eastern Deanery AIDS Relief Program approaches in the poor neighbourhoods of Nairobi, Kenya.

FINDINGS AND CONCLUSIONS:

A small group of nurses and community health workers focused on the care of terminally ill HIV/AIDS patients. This work identified additional problems: tuberculosis (TB) was underdiagnosed and undertreated, a local TB-technician was trained to run a local ...

People centred Care in theory and practice

On the 23-25 May 2016, the 16th International Conference on Integrated Care in Barcelona attracted 1200 delegates from nearly 50 countries, and a further 600 persons per day watching events via the live stream.

One of the highlights of the conference, is the speech of Dr Angela Coulter, Senior Research Scientist, from The Nuffield Department of Population Health (NDPH), University of Oxford, UK, about "People centred Care in theory and practice".

People centred Care in theory and practice

On the 23-25 May 2016, the 16th International Conference on Integrated Care in Barcelona attracted 1200 delegates from nearly 50 countries, and a further 600 persons per day watching events via the live stream.

One of the highlights of the conference, is the speech of Dr Angela Coulter, Senior Research Scientist, from The Nuffield Department of Population Health (NDPH), University of Oxford, UK, about "People centred Care in theory and practice".

Meeting the Needs of the Growing Very Old Population: Policy Implications for a Global Challenge

Very old adults are one of the fastest-growing age groups worldwide. Yet they rarely constitute a targeted group for public policies. Drawing on the results of the centenarian studies presented in this special issue, we highlight major challenges that arise from the increase of this population. We outline several promising approaches for policy makers and professionals to develop evidence-based policies and programs that are tailored to the needs of very old adults and their families. We focus our discussion on three key topics essential to life care: the importance of integrated care to meet the complex care needs of the very old; the balance between formal and informal care; and the development of suitable places for living. Besides more specific measures, we propose that policies promoting the social integration of very old adults in their communities would be particularly helpful, as these may benefit not only the very old and ...

House of Generations Schwaz: A one-stop shop for providing health and social services in Austria

The Municipality of Schwaz reorganized local health and social services around the purpose-built House of Generations; co-location of services increased coordination and improved access for vulnerable groups; shared living spaces, group activities and cooperative initiatives within the House of Generations generated a sense of community, fostering a supportive and inclusive environment for vulnerable groups; strong leadership helped forge effective partnerships with municipal and regional politicians through clearly communicating aims and objectives, contributing to the initiative’s successful development; extensive involvement and linkages with the wider community generated a new hub for community-based health and social services.

Break the Cycle of Violence: A Miami-Area Community Drives Change

Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was held in May 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health.

One highlight of the meeting was interviewing community collaborations funded by The BUILD Health Challenge. The BUILD Health Challenge is a national awards program designed to support community collaborations that are working to give everyone a fair chance to be healthy.

Overview

The Liberty City Community Collaborative for Change targets a Miami-area community that is characterized by poverty, lack of food access, low educational attainment levels, and violence, including disproportionately high rates of physical, sexual, and child abuse. These attributes lead to trauma, chronic stress, and mental and physical health outcomes, such as depression, anxiety, substance abuse, sleeping disorders, high blood pressure, and strokes. 

About the Practical Playbook National Meeting

Key stakeholders from across sectors – representing professional associations, community ...

Break the Cycle of Violence: A Miami-Area Community Drives Change

Bringing Public Health and Primary Care Together: The Practical Playbook National Meeting was held in May 2016. The meeting was a milestone event towards advancing robust collaborations that improve population health.

One highlight of the meeting was interviewing community collaborations funded by The BUILD Health Challenge. The BUILD Health Challenge is a national awards program designed to support community collaborations that are working to give everyone a fair chance to be healthy.

Overview

The Liberty City Community Collaborative for Change targets a Miami-area community that is characterized by poverty, lack of food access, low educational attainment levels, and violence, including disproportionately high rates of physical, sexual, and child abuse. These attributes lead to trauma, chronic stress, and mental and physical health outcomes, such as depression, anxiety, substance abuse, sleeping disorders, high blood pressure, and strokes. 

About the Practical Playbook National Meeting

Key stakeholders from across sectors – representing professional associations, community ...

The multispecialty community provider (MCP) emerging care model and contract framework

Across the country, NHS leaders have been developing sustainability and transformation plans (STPs) to implement the NHS Five Year Forward View. Nearly all of the STPs involve creating new models of accountable care provision.  Some are planning MCPs, others the bigger primary and acute care systems (PACS) model, under which all hospital services are also included under a single  form of integrated provision. The underlying logic of an MCP is that by focusing on prevention and redesigning care, it is possible to improve health and wellbeing, achieve better quality, reduce  avoidable hospital admissions and elective activity, and unlock more efficient ways of delivering care.

This document defines what being a multispecialty community provider (MCP) means by assembling features from the 14 MCP vanguards into a common framework.

Integrated primary and acute care systems (PACS) - Describing the care model and the business model

A new framework to help local areas establish a single primary and acute care system (PACS) has been published by NHS England, as well as another for improving the lives of care home residents.

Under a PACS, hospital, primary, community, mental health and social care services align their goals and incentives to improve the health and wellbeing of the population.

The announcement comes following the publication in July of a framework for the multispecialty community provider (MCP) model.

Open Forum Events: Urgent Care - Improving Patient Flow Conference

The Urgent Care: Improving Patient Flow conference agenda has been developed to explore the current patient flow trends within the hospital urgent care system. Delegates will gain a greater understanding of how the problems occur from the start of the process, with the patient having attended the A & E department, through to the discharge process, returning back into the community and home. Our line-up of expert speakers will provide insight, opinion and stimulate debate as to how to relieve the burden on hospitals and reduce the pressures of compromised patient flow. We will showcase a number of initiatives and examples of best practice from throughout the health and social care system and there will be ample opportunity for interactive discussion and networking amongst fellow professionals and peers.

What’s integration got to do with it?

Observations and Lessons from the Franciscus Gasthuis & Vlietland Study Trip to North-West London.

Coming Problems in Behavioral Health Care

People with serious mental health and substance abuse disorders remain among the most neglected stigmatized in our health and social services systems. Many with profoundi disabilities are impoverished, are unable to work and at risk of homelessness.

Fortunatelly, the  Affordable Care Act (ACA) and expansions and implementation of the Mental Health Parity and Addiction Equity of 2008 provided a significant turning point in addressing these challenges vital to the nation´s health. 

Using Information Communication Technology in Models of Integrated Community-Based Primary Health Care: Exploring ICT in the iCOACH Study

Information and communication technology (ICT) is a promising enabler to support delivery of integrated care by inter-disciplinary teams by supporting information sharing across professional and  organizational boundaries; arguably a crucial aspect of successful models of integrated care

Identification of influencing factors and strategies to improve communication between general practitioners and community nurses: a qualitative focus group study

As the number of patients with complex healthcare needs grows, inter-professionaal collaboration between primary care professionals must be constantly optimized. General practitioners (GPs) and community nurses (CNs) are key professions in primary care; however, poor GP-CN communication is common, and research into the factors influencing its quality is limited. 

The perceived impact of family physicians on the district health system in South Africa: a cross-sectional survey

The 2008 World Health Report "Primary Health Care-Now More Than Ever" defines strong Primary Health Care (PHC) systems as those systems which offer first contact care that is patient-centred with an orientation to the patient´s family and community context, embedded in a service that is comprehensive, integrated, continuos, and community-orientated, and in which patient-care is well co-ordinated. This report warned against oversimplified approaches to PHC in developing countries, which only focus on priority deseases or rely on unsupported health workers who are poorly equipped for the complexity of PHC. The World Health Assembly supports the report´s recommendation that PHC should be offered by a multidisciplinary team that includes a family physician. 

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to stregthen African health systems in order to address communicable and non-communicable diseases. The aim of this article was to assess the position of civil society-led community home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demand arise. 

Primary health services at district level in South Africa: a critique of the primary health care approach

The rhetoric of primary health care philosophy in the district health system is widely cited as a fundamental component of the health transformation process in post-apartheid South Africa. Despite, South Africa´s progress and attempts at implementing primary health care, various factors still limit its success.

Case management for integrated care of frail older people in community settings

Demographic changes and advances in medical care and technology have led to an ageing population. Despite gains in life expectancy, compression of morbidity in later life has not been achieved, meaning that although growing numbers of older people are living longer, they are doing so with one or more long?term conditions. A key driving force for international policy agendas worldwide is to improve the quality, efficiency and safety of health and care services through the delivery of effective integrated care systems. Integrated care can be broadly defined as "an organising principle for care delivery that aims to improve patient care and experience through improved coordination", and such approaches are being increasingly implemented as a key policy in many countries. This review will focus on case management as one service model for delivering integrated care, among others. 

Integrated primary and acute care systems (PACS) - Describing the care model and the business model

A new framework to help local areas establish a single primary and acute care system (PACS) has been published by NHS England. Under a PACS, hospital, primary, community, mental health and social care services align their goals and incentives to improve the health and wellbeing of the population.

The announcement comes following the publication in July of a framework for the multispecialty community provider (MCP) model.

The multispecialty community provider (MCP) emerging care model and contract framework

Across the country, NHS leaders have been developing sustainability and transformation plans (STPs) to implement the NHS Five Year Forward View. Nearly all of the STPs involve creating new models of accountable care provision.  Some are planning MCPs, others the bigger primary and acute care systems (PACS) model, under which all hospital services are also included under a single  form of integrated provision. The underlying logic of an MCP is that by focusing on prevention and redesigning care, it is possible to improve health and wellbeing, achieve better quality, reduce  avoidable hospital admissions and elective activity, and unlock more efficient ways of delivering care.

This document defines what being a multispecialty community provider (MCP) means by assembling features from the 14 MCP vanguards into a common framework.

16th World Congress on Public Health 2020, Public health for the future of humanity: analysis, advocacy and action

The global public health community will be meeting at a critical time for our planet. Global temperatures lie far beyond historical records and there are real fears that we are reaching a tipping point. Threats to food and water supply, poverty and inequalities are leading to mass migration and conflict.

The theme of the World Congress, Public Health for the Future of Humanity: Analysis, Advocacy, and Action, reflects the commitment that the global public health community must make visible the threats to health, and must challenge and hold to account those with the power to make a difference.

Read more about the plenary programme of the World Congress on Public Health here.

An unprecedented challenge: Italy’s first response to COVID-19

This report tells the story of the first phase of Italy’s response to the COVID-19 virus, which in many people transformed into the dreaded illness known as COVID-19, leading to unprecedented death tolls across the world. Readers should note that the report is an unfinished story. It was written in the midst of the initial phase of the pandemic in a climate of constant and daily change as the country responded to this unprecedented challenge. While early lessons will surely need to be revisited, this report is a first account of Italy’s immediate experience with COVID-19, dealing with different aspects of the response as the first country that experienced widescale community transmission in Europe.

Driving and accelerating a 'one system' response: why COVID-19 has shone a spotlight on Integrated Care

High performing health and social care systems provide exceptional care, quality and experiences for patients, caregivers and providers. Pivotal to this, is how we work across health and social care as one team. The need for integrated care is a global priority and is poised to address fragmentation and accelerate the improvements that are needed. During a global pandemic, the need to work as an integrated system is even more pressing and gives us an opportunity to pause, reflect and respond.

In situations where systems are subjected to unprecedented pressure, organizations and sectors may respond from the lens of what can their individual organization or sector do, rather than responding as a cohesive and interconnected system.

Organizations that have embraced collaborative models of response and care and were already working to advance integration pre-pandemic appear to be more effective in responding as one connected team and community.

This webinar will ...

People as Partners in Care

Digital Solutions: Adoption, Adaption and their role in post-Covid19 health and social care delivery

As each integrated care building block is reliant on information, digital solutions could be seen as the cement that holds the blocks together. Albeit, the arguments for greater use and investment have become increasingly compelling, the rate of adoption remains below expectations; that is until COVID-19.

Since the outbreak of COVID-19, countries have seen a rapid citizen-led proliferation of digital solutions being used for remote working, socialisation between family, friends and communities, and education, to name but a few. This rapid pace of change has been mirrored by national and local government and public health through the use of social media to effectively reach individuals to provide guidance, support, collect well-being and COVID infection data, and undertake tracing through Apps. Furthermore, many countries have created fully functioning field hospitals with IT departments working around the clock to ensure these new care facilities can be up and running to provide safe ...

Care during and beyond the COVID-19 Crisis: Workforce Capacity and Capability

Why communities must be at the centre of the Coronavirus disease 2019 response: Lessons from Ebola and human immunodeficiency virus in Africa

As the Coronavirus disease 2019 (COVID-19) pandemic has spread globally, with no effective treatment or vaccine yet available, governments in many countries have put in place social interventions to control the outbreak. Communities are complex and only their members can inform public health experts about their lived realities, the community’s understanding of the outbreak and what will work locally to reduce transmission. 

Community-based antiretroviral therapy versus standard clinic-based services for HIV in South Africa and Uganda (DO ART): a randomised trial

Maintaining high levels of adherence to antiretroviral therapy (ART) is a challenge across settings and populations. Understanding the relative importance of different barriers to adherence will help inform the targeting of different interventions and future research priorities.

Community-based delivery of antiretroviral therapy (ART) for HIV, including ART initiation, clinical and laboratory monitoring, and refills, could reduce barriers to treatment and improve viral suppression, reducing the gap in access to care for individuals who have detectable HIV viral load, including men who are less likely than women to be virally suppressed. The aim to test the effect of community-based ART delivery on viral suppression among people living with HIV not on ART.

An unblinded, home-randomized trial (DO ART) of community-based ART administration compare with the clinic in rural and peri-urban settings in KwaZulu-Natal, South Africa and Sheema District, Uganda.

Collaborative Experience Success Stories in Integrated Care of Older People: A Narrative Analysis

With the increasing differentiation of organisations involved in the pursuit of public health, there is also a growing need for inter?organisational integration. Starting from the concepts of differentiation and integration, this article is attempting a theoretical reconstruction based on published research on inter?organisational integration in public health and related welfare services.

The call for integrated care has been induced by demographic change, increased fragmentation of the welfare sector and increased demand for technically and more expensive care solutions. There is a wide variety of strategies and initiatives to improve care continuity and coordination for people with chronic diseases, not least for older people with complex care needs who require care from multiple providers.

Inter-organisational collaboration is crucial in the care of older people, as is the development of integrated care. Storytelling in organisations is one way of understanding how to achieve successful collaboration. This article provides insights into ...

Use of Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) for the screening of frailty and components of comprehensive geriatric assessment

Comprehensive geriatric assessment (CGA)—a key tool for geriatric medicine—is commonly used to assess older people’s health status and frailty. However, performing CGA in outpatient clinics is difficult because the assessment of cognition, activities of daily living (ADLs), depression, quality of life (QoL), nutrition, medications and social conditions is time consuming and requires the cooperation of medical staff. Frailty—an aspect of geriatric medicine that indicates the weakness of the body—is a critical measure of older adults’ physical function.

The Dementia Assessment Sheet for Community-based Integrated Care System 8-items (DASC-8) is a validated and simple rating scale, developed for the classification of setting glycemic targets based on cognition and ADL for older adults with diabetes mellitus. As cognitive function and ADL are key elements of frailty in a broad sense and in CGA, we examined whether the DASC-8 category is useful for the ...

Effect of an integrated care model for pre-frail and frail older people living in community

The objective of this article is to evaluate the effect of an integrated care model for pre-frail and frail community-dwelling older people.

Patient engagement, autonomy, access to mental care services – the case for integrated care in Crete

Access to comprehensive primary care (PC) services is imperative to address the complex biopsychosocial needs of patients with mental illness and their families, while it holds the potential to safeguard mental health and enhance resilience in communities. Integration of mental health and social care services in primary care has not yet been achieved, while access to such services for the mentally ill is still hindered by patient-, provider- and system-oriented barriers. Improving service integration, quality and access requires active engagement of patients and families in the design and planning of services.

Interprofessional collaboration, interdisciplinary approaches and sound deliberative processes are only the start of initiating discussions to establish the needs of local communities. Mapping care paths, involving stakeholders and engaging in practice-based research are impeded by the organisation and design of care provision, including siloed processes and semantic ambiguity in establishing common ground. Academic centres ought to act as hubs ...

Effectiveness of integrated care on delaying chronic kidney disease progression in rural communities of Thailand (ESCORT-2) trials

In developing countries, renal specialists are scarce and physician-to-patient contact time is limited. While conventional hospital-based, physician-oriented approach has been the main focus of chronic kidney disease (CKD) care, a comprehensive multidisciplinary health care program (Integrated CKD Care) has been introduced as an alternate intervention to delay CKD progression in a community population. The main objective is to assess effectiveness of Integrated CKD Care in delaying CKD progression.

Effectiveness of a pathway-driven eHealth-based integrated care model (PEICM) for community-based hypertension management in China: study protocol for a randomized controlled trial

The prevalence of hypertension is high and increasing in China in recent years. The treatment and control of hypertension calls for long-term management beyond hospital, which is hard to implement in traditional care settings. Integrated care combined with information technology can promote high-quality healthcare services across the life-course. However, few studies have applied a customized integrated care model in community-based hypertension management in China, catering to the emerging “three-manager” mode. This study aims to identify the effectiveness of a pathway-driven eHealth-based integrated model that implemented as a full-featured telehealth system to facilitate standardized management of hypertension in China.

The European Health Data Space: A step towards digital and integrated care systems

In December 2021, EGIDE, the Expert Group for integrated Care and Digital Health Europe, has launched a paper ‘The European Health Data Space: A step towards digital and integrated care systems’.

The paper aims to represent the views of the chronic disease community. It provides a unique combination of perspectives from academia, healthcare professionals, patients and industry. The authors acknowledge too many patients across Europe are experiencing fragmented and delayed care. COVID-19 has highlighted the weaknesses of our healthcare systems and the need for rapid transformation. The European Health Data Space can act as a catalyst for change in several important areas.

Integrated care in every community

Our health and care needs are changing, with more people living longer often with multiple long term conditions. This animation explains the challenges facing the health and care system and how partnerships are being formed between the NHS, local government and the third sector to integrate care and better meet our health and care needs now and in the future. A BSL (British Sign Language) version of this video can be found here: https://youtu.be/b51AdiQf1w4

AICIC23 All-Ireland Conference on Integrated Care | 23 March 2022 | Dublin UCD

Improving the lives of people living with dementia

The 24th International Conference on Integrated Care (ICIC24)

The 24th International Conference on Integrated Care (ICIC24) in partnership with IFIC Ireland and the International Journal of Integrated Care (IJIC) and supported by the Department of Health, Northern Ireland and Visit Belfast will take place in ICC Belfast on 22-24 April 2024, with the overarching theme ‘Taking the leap: making integrated care a reality for people and communities’, the conference will bring together leaders, researchers, clinicians, managers, community representatives, patients and caregivers from around the world who are engaged in the design and delivery of integrated health and care.