IPCHS

Contents tagged: decentralization

July 28, 2016 Americas Publication

Strengthening governance and accountability, Coordinating services within and across sectors

Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes ...

brazil, care coordination, care integration, colombia, decentralization, integrated delivery systems, managed competition, qualitative research

Sept. 22, 2016 Europe Practice

Strengthening governance and accountability, Reorienting the model of care, Coordinating services within and across sectors

Establishing ambulatory care for patients with tuberculosis in Uzbekistan

Médecins Sans Frontières (MSF), in partnership with the Government of the Republic of Karakalpakstan, introduced ambulatory care from day one (ACD1) as an alternative model for TB care; a strong understanding of service delivery challenges led to a solution that met patients’ needs; a supportive political and legal framework, developed prior to implementation, helped to sustainably embed reforms within the health system; strong relationships between key actors who had a history of working together aided the initiative.

ambulatory care from day one (acd1), community care, decentralization, medecins sans frontieres, tuberculosis

Oct. 11, 2016 Europe Practice

Strengthening governance and accountability, Reorienting the model of care, Creating an enabling environment

Strengthening primary care in Voznesensk, Ukraine

The district of Voznesensk experimented with initiatives, such as provider payment mechanisms, designed to align service delivery with the principles of family medicine, becoming an example for broader primary care reform across Ukraine; effective local leadership, combined with political and financial support, created a stable platform from which bottom-up reforms were built; aligning local initiatives with national priorities proved valuable for gaining legitimacy and support for the initiative; availability and capacity to collect and share data was fundamental for improving communication between health providers and increasing continuity of care. A district-wide electronic patient registration and medical records system was created to support this.

decentralization, electronic medical records, general practitioners, primary care, provider payment models

March 6, 2017 Western Pacific Practice

Engaging and empowering people and communities, Strengthening governance and accountability, Reorienting the model of care, Coordinating services within and across sectors, Creating an enabling environment

Strengthening universal health coverage through role delineation in the Solomon Islands

To achieve effective coverage of services, Role Delineation Policy (RDP) was developed following extensive consultation. The RDP defines service delivery packages for six levels of health facilities: rural health centres, area and urban health centres, general hospitals and the national referral hospital; successful advocacy led to inclusion of Universal Health Coverage in the National Development Plan, and to Role Delineation being the central unifying feature of the National Health Strategic Plan, 2016-2020, based on initial implementation experiences, the RDP was revised and will be sequentially will be implemented in rural provinces commencing in 2017.

decentralization, national planning, policy development, role delineation, universal health coverage

Jan. 17, 2020 Americas Practice

Comprehensive Primary Health Care Reform in Costa Rica

In the past, Costa Rica was characterized by a duplicative and fragmented public primary healthcare system. In 1994, the country initiated a sweeping reform of the health system, including primary health care. Bureaucratic reorganization of the Ministry of Health (MOH) and the Social Security Agency (CCSS) led to the integration of all healthcare delivery under the CCSS, from public health activities to tertiary care. Comprehensive multidisciplinary primary healthcare teams (EBAIS)—comprised of a doctor, nurse assistant, community health worker, and data specialist—were created to care for approximately 5,000 patients each. A system of geographic empanelment was implemented to assign every Costa Rican to one of the newly-formed EBAIS teams. Finally, quality assurance mechanisms were initiated and promoted data collection and feedback central as a central function of the EBAIS teams. The first EBAIS team was established in 1995 and by 2002, there were 818 active teams throughout the ...

decentralization, multidisciplinary teams, primary health care reform, universal health coverage

Jan. 21, 2020 Americas Multimedia

High Quality Primary Health Care in Action: The Story of Costa Rica

Costa Rica’s primary health care system is supported by robust integrated care teams that provide comprehensive, coordinated, continuous, and person-centered care to empaneled populations. As a result, health outcomes in Costa Rica are consistently strong and improving.

universal health coverage, primary health care reform, multidisciplinary teams, decentralization

Jan. 21, 2020 Americas Publication

Engaging and empowering people and communities, Coordinating services within and across sectors, Creating an enabling environment

Building a Thriving Primary Health Care System: The story of Costa Rica

Situated in Central America, Costa Rica’s 4.9 million citizens have access to one of the most effective primary health care systems in the world. The country’s unique, team-based model of primary care service delivery successfully combines preventive and curative care to provide comprehensive primary health care to nearly all Costa Rican citizens. This case study examines the process by which Costa Rica developed its laudable primary health care system, fully describes the functioning of the system through both clinical and patient perspectives, and elucidates key lessons about primary health care delivery that can be learned from the Costa Rican experience.

community health workers, cooperation, family centred care, health unit, integrated health services, national services, decentralization, technical assistance, multidisciplinary teams, primary health care reform, universal health coverage

Jan. 21, 2020 Americas Publication

Engaging and empowering people and communities, Coordinating services within and across sectors, Creating an enabling environment

Primary Health Care That Works: The Costa Rican Experience

Long considered a paragon among low- and middle-income countries in its provision of primary health care, Costa Rica reformed its primary health care system in 1994 using a model that, despite its success, has been generally understudied: basic integrated health care teams. This case study provides a detailed description of Costa Rica’s innovative implementation of four critical service delivery reforms and explains how those reforms supported the provision of the four essential functions of primary health care: first-contact access, coordination, continuity, and comprehensiveness. As countries around the world pursue high-quality universal health coverage to attain the Sustainable Development Goals, Costa Rica’s experiences provide valuable lessons about both the types of primary health care reforms needed and potential mechanisms through which these reforms can be successfully implemented.

organization of care, mortality, middle-income countries, health, delivery reform, public health, acces to care, universal health coverage, decentralization, multidisciplinary teams, population, primary health care reform, systems of care clinics

May 9, 2023 Global Publication

Integration of HIV care into maternal and child health services in the global IeDEA consortium

The WHO recommends the integration of routine HIV services within maternal and child health (MCH) services to reduce the fragmentation of and to promote retention in care for pregnant and postpartum women living with HIV (WWH) and their infants and children exposed to HIV (ICEH). During 2020–2021, we surveyed 202 HIV treatment sites across 40 low- and middle-income countries within the global International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.

care model, decentralization, hiv service delivery, infant, postpartum, pregnant women, service & deployment models