Enhancing governance and health system accountability for people centered healthcare: an exploratory study of community scorecards in Afghanistan

BACKGROUND:

The premise of patient-centered care is to empower patients to become active participants in their own care and receive health services focused on their individual needs and preferences. Afghanistan has evidenced enormous gains in coverage and utilization, but the quality of care remains suboptimal, as evidenced in the balanced scorecard (BSC) performance assessments. In the United States and throughout Africa and Asia, community scorecards (CSC) have proved effective in improving accountability and responsiveness of services. This study represents the first attempt to assess CSC feasibility in a fragile context (Afghanistan) through joint engagement of service providers and community members in the design of patient-centered services with the objective of assessing impact on service delivery and perceived quality of care.

METHODS:

Six primary healthcare facilities were randomly selected in three provinces (Bamyan, Takhar and Nangarhar) and communities in their catchment area were selected for the study. Employing a multi-stakeholder strategy ...

Implementing people-centred health systems governance in 3 provinces and 11 districts of Afghanistan: a case study

Action learning for health system governance: the reward and challenge of co-production

Health policy and systems research (HPSR) is centrally concerned with people, their relationships and the actions and practices they can implement towards better health systems. These concerns suggest that HPS researchers must work in direct engagement with the practitioners and practice central to the inquiry, acknowledging their tacit knowledge and drawing it into generating new insights into health system functioning. Social science perspectives are of particular importance in this field because health policies and health systems are themselves social and political constructs. However, how can social science methodologies such as action research and narrative and appreciative enquiry enable such research, and how can methodologies from different disciplines be woven together to construct and make meaning of evidence for 'this' field? This article seeks to present 'methodological musings' on these points, to prompt wider discussion on the practice of HPSR. It draws on one long-term collaborative action learning research project being ...

IHF 40th World Hospital Congress

The IHF 40th World Hospital Congress will be held 31 October – 3 November 2016 in Durban, South Africa with the theme: Addressing the Challenge of Patient-centered Care and Safety.

The World Hospital Congress of the International Hospital Federation (IHF) is a unique global forum that brings together key drivers of national and international policy, management, financial trends and solutions in healthcare management and service delivery. Through this forum multidisciplinary exchange of knowledge, expertise and experiences are facilitated, together with dialogue on best practices in leadership in hospital and healthcare management and delivery of services.

For further information please click here: IHF 40th World Hospital Congress

Health service planning contributes to policy dialogue around strengthening district health systems: an example from DR Congo 2008–2013

Good governance for health (part of Strategy 3 of the Framework on Integrated People-Centred Health Services) involves broad, continuous and consultative policy dialogue on crucial health sector issues amongst and between all relevant social, technical and political stakeholders. Ideally, policy dialogue should also be based on the best available evidence. This paper demonstrates how building and maintaining data and evidence on relevant health sector issues, in this case the essential health services package in DRC, can contribute to rational policy dialogue over a sustained period of time. 

Background

Briefing note: Policy dialogue: What it is and how it can contribute to evidence-informed decision-making

This briefing note brings together knowledge generated through the EU-Luxembourg-WHO Universal Health Coverage Partnership, which currently supports policy dialogue processes in 28 countries.

Good governance for health (part of Strategy 3 of the Framework on Integrated People-Centred Health Services) involves broad, continuous and consultative policy dialogue on crucial health sector issues amongst and between all relevant social, technical and political stakeholders. Yet there exists little guidance and analysis on what actually constitutes policy dialogue, how it can contribute to better policies, and what countries can concretely do to better engage in participatory dialogue processes. This Briefing note is a first attempt at making sense of the policy dialogue literature and experiences in using it in health and in low- and middle-income countries. It further examines the following questions:

- What is poilcy dialogue?

- How can the policy dialogue contribute to improving a policy and decision making process?

- What are the possible ...

Governance for new care models

Dr Rachael Addicott, Senior Research Fellow from The King’s Fund, discussed about her research into governance for new care models during the event on Multi-specialty community providers and primary and acute care systems (7 June 2016)

If you are interested in other presentations from this event, click here

Governance for new care models

Dr Rachael Addicott, Senior Research Fellow from The King’s Fund, discussed about her research into governance for new care models during the event on Multi-specialty community providers and primary and acute care systems (7 June 2016)

If you are interested in other presentations from this event, click here

Power and Integrated Health Care: Shifting from Governance to Governmentality

Integrated care occurs within micro, meso and macro levels of governance structures, which are shaped by complex power dynamics. Yet theoretically-led notions of power, and scrutiny of its meanings and its functioning, are neglected in the literature on integrated care. We explore an alternative approach. Following a discussion on governance, two streams of theorising power are presented: mainstream and second-stream. Mainstream concepts are based on the notion of power-as-capacity, of one agent ­having the capacity to influence another—so the overall idea is ‘power over ’. Studies on integrated care ­typically employ mainstream ideas, which yield rather limited analyses. Second-stream concepts focus on ­strategies and relations of power—how it is channelled, negotiated and (re)produced. These notions align well with the contemporary shift away from the idea that power is centralised, towards more fluid ideas of power as dispersed and (re)negotiated throughout a range of societal structures, networks and ...

The integration of health and social care services

The Government is committed to the introduction of a single-tier health service, supported by universal health insurance (UHI). Under UHI, everyone will be insured for a standard package of primary and hospital care services, including mental health services. It is understood that primary and hospital care will be funded mainly via the UHI system and social care services and public health services will be funded by general taxation. While funded separately, these services will need to be delivered in an integrated manner around the needs of the person. This review considers the international evidence in relation to mechanisms and structures used to integrate health services (provided under UHI) and social care services.

Governance and accountability in new care models

The current focus on new care models, and place-based systems of care, requires organisations to work together to deliver services. How well these new systems are led, directed and held to account will be crucial to their success. This one-day conference will help those who are considering how governance and accountability will work in these new, place-based systems.

The theory and practice of integrative health care governance: the case of New Zealand´s alliances

The purpose of this paper is to outline the theory and practice of governance for integrated care, using the case of New Zealand´s healthcare alliances.

This paper argued that the new "experimental" governance models are needed for effective development of integrated care, illustrated through the example of alliance governance in New Zealand. While the alliances are in a relatively incipient state, they hold considerable promise when compared with the alternatives: corporate, democratic or clinical governance. Alliance governance provides for a different way of working, and for boldstering clinical leadership as central to this. 

The theory and practice of integrative health care governance: The case of New Zealand’s alliances

The purpose of this paper is to outline the theory and practice of governance for integrated care, using the case of New Zealand´s healthcare alliances.

Longing for Integrated Care: The Importance of Effective Governance

"Integrated care is not about creating a multidisciplinary offer/supply, but it is about creating an integrative answerd to the most important issues of people in need. A holistic approach seems logical, but it means a lot of for how we organise our health care and welfare systems, and the needed connections with other domains in life"- Mirella M.N. Minkman

Read more...

Professional groups driving change toward patient-centred care: interprofessional working in stroke rehabilitation in Denmark

Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to improve new health policies more effectively. Their aim was to analyse the role and capacity of healht professions in driving organisational change in interprofessional working and patient-centred care.

Governing Collaborative Healthcare Improvement: Lessons From an Atlantic Canadian Case

The Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease (AHC) Quality Improvement Collaborative (QIC) in Eastern Canada provided an approach to spur system-level reform across multiple health systems for patients and families living with chronic disease. Developed and led by senior executives with a unique governance approach and involving clinical front-line teams, the AHC serves as a practical example of leadership creating and driving momentum for achieving success in collaborative health system improvements 

Good collaborative practice: reforming capacity building governance of international health research partnerships

In  line with the policy objetives of the United Nations sustainable Development Goals, this commentary seeks to examine the extent which provisions of international health research guidance promote capacity building and equitable partnerships in global health research. Theri evaluation finds that governance of collaborative research partnership, in resource- constrained settigns is limited but has improved with the implementation guidance of the International Ethical Guidelines for Health- related Research Involving Humans by The Council for International Organizations of Medical Sciences (CIOMS 2016)

Good collaborative practice: reforming capacity building governance of international health research partnerships

In line with the policy objectives of the United Nations sustainable Development Goals, this commentary seeks to examine to which provisions of international health research guidance promote capacity building and equitable partnerships in global health research. This evaluation finds that governance of collaborative research partnerships, and in particular capacity building, in resource-constrained settings is limited but has improved with the implementation guidance of the International Ethical Guidelines for Health-related Research Involving Humans by The Council for International Organizations of Medical Sciences (CIOMS) (2016). 

Translating the Elements of Health Governance for Integrated Care from Theory to Practice: A Case Study Approach

Against a paucity of evidence, a model describing elements of health governance best suited to achieving integrated care internationally was developed. The aim of this study was to explore how health meso-level organizations used, or planned to use, the governance elements. 

The impact of cash transfers on social determinants of health and health inequalities in sub-Saharan Africa: a systematic review

Cash transfers (CTs) are now high on the agenda of most governments in low-and middle- income countries. Within the field of health promotion, CTs constitute a healthy public policy initiative as they have the potential to address the social determinants of health and health inequalities. A systematic review was conducted to synthesise the evidence on CTs´impacts on social determinants of health and health inequalities in sub-Saharan Africa, and to identify the barriers and facilitators of effective CTs.

Developing patient safety system using WHO tool in hospitals in Oman

Oman is progressively implementing the Patient Safety Friendly Hospital Iniciative (PSFHI), a tool formulated by the World Health Organization (WHO) to achieve optimal patient safety in hospitals. This paper  describes its implementation in selected government and private hospitals in Oman and analyses the performance of four hospitals whose implementations of PSFHI were assessed by WHO. 

International healthcare worker migration in Asia Pacific: International policy responses

The growth of the international migration of health workers in recent decades has taken place in the context of the transnationalisation of healthcare provision as well as of governance and policy responses. This paper examines international policy responses to cross-border health worker migration in the Asia Pacific region. These include multilateral (global and regional) and bilateral policy agreements, policy dialogue, "circular" and key themes of health workforce planning and management.

Coordinating Mental and Physical Health Care in Rural Australia: An Integrated Model for Primary Care Settings

The "GP Clinic" providers primary health care to people using community mental health services in a small town in Australia. This article examines the factors that have driven successful integration in this rural location. Integrated physical and mental health service models that focus on building local service provider relationships and are responsive to community needs and outcomes may be more beneficial in rural settings than top down approaches that focus on policies, formal structures, and governance. 

Public involvement in health research systems: a governance framework

Growing interest in public involvement in health research has led to organisational and policy change. Additionally, an emerging body of policy-oriented scholarship has begun to identify the organisational and network arrangements that shape public involvement activity. Such developments suggest the need to clearly conceptualise and characterise public involvement in health research in terms of governance.

Regional organisations supporting health sector responses to climate change in Southeast Asia

The role played by regional organisations in climate change adaptation and health is growing in Southeast Asia, with the Asian Development Bank and the Asia-Pacific Regional Forum on Health and Environment both supporting health and adaptation initiatives. There is, however, a lack of empirical research on the value that regional organisations add to national health-related adaptation. This qualitative research compares regional project and governance-based models of adaptation and health support in Southeast Asia, providing an analysis of strengths and weaknesses of each, as well as possibilities for improvement.

Civil society participation in global public private partnerships for health

The growth of global public-private partnerships for health has opened up new spaces for civil society participation in global health governance. Such participation is often justified by the claim that civil society organizations, because of their independence and links to communities, can help address democratic deficits in global-level decision-making processes. This article examines the notion of ‘civil society engagement’ within major public–private partnerships for health, where civil society is often said to play a particularly important role in mediating between public and private spheres.

Innovation of the governance of integrated care

Interest in integrated care is growing. This is reflected in the rising numbers of scientific publications, IJIC’s increased impact factor and the increasing number of participants at IFIC’s international conferences. It is stimulating to see that organizations like the World Health Organisation are developing conceptual frameworks that embrace integrated care. At the same time we know that integrated care does not become reality automatically; it takes a long timeframe. That can be conflicting with ambitions like ‘implementing good practices as fast as possible’ and with the pressure to deliver results in politically set tight time frames.

Developing more participatory and accountable institutions for health: identifying health system research priorities for the Sustainable Development Goal-era

Health policy and systems research (HPSR) is vital to guiding global institutions, funders, policymakers, activists and implementers in developing and enacting strategies to achieve the Sustainable Development Goals.  The findings from this exercise identify HPSR funding priorities and future areas for evidence production and policy engagement.

The Governance of National Community Health Worker Programmes in Low- and Middle-Income Countries: An Empirically Based Framework of Governance Principles, Purposes and Tasks

National community health worker (CHW) programmes are increasingly regarded as an integral component of primary healthcare (PHC) in low- and middle-income countries (LMICs). At the interface of the formal health system and communities, CHW programmes evolve in context specific ways, with unique cadres and a variety of vertical and horizontal relationships. These programmes need to be appropriately governed if they are to succeed, yet there is little evidence or guidance on what this entails in practice. Based on empirical observations of South Africa’s community-based health sector and informed by theoretical insights on governance, this paper proposes a practical framework for the design and strengthening of CHW programme governance at scale.

Strengthening national health research systems in the WHO African Region – progress towards universal health coverage

Health challenges and health systems set-ups differ, warranting contextualised healthcare interventions to move towards universal health coverage. As such, there is emphasis on generation of contextualized evidence to solve local challenges. However, weak research capacity and inadequate resources remain an impendiment to quality research in the African region. WHO African Region (WHO AFRO) facilitated the adoption of a regional strategy for strengthening national health research systems (NHRS) in 2015. This article assessed the progress in strengthening NHRS among the 47 member states of the WHO AFRO.

Stakeholder Perceptions and Context of the Implementation of Performance-Based Financing in District Hospitals in Mali

To improve the performance of the healthcare system, Mali’s government implemented a pilot project of performance-based financing (PBF) in the field of reproductive health. It was established in the Koulikoro region. This research analyses the process of implementing PBF at district hospital (DH) level, something which has rarely been done in Africa.

Government leadership that supports community-lead integrated care: An analysis of advances and missteps

Integrated care that substantively impacts population health as well as provides quality care requires buy-in, engagement and commitment over time by a plethora of  government and community groups. There is considerable evidence of the complexity of care models that work such that long term commitment is required to truly impact health. These days, beyond work opportunities, most municipal government and community leaders realise that good quality health services are critical to retaining and recruiting residents, especially noteworthy as an issue in rural communities.  How do places manage bottom-up, top-down tensions as politics and control issues intervene across differrent levels of government? What sort of governmental leadership inspires community engagement versus chronic frustration?

A conceptual framework for capacity strengthening of health research in conflict: the case of the Middle East and North Africa region

In conflict settings, research capacities have often been de-prioritized as resources are diverted to emergency needs, such as addressing elevated morbidity, mortality and health system challenges directly and/or indirectly associated to war. This has had an adverse long-term impact in such protracted conflicts such as those found in the Middle East and North Africa region (MENA), where research knowledge and skills have often been compromised. This paper proposes a conceptual framework for health research capacity strengthening that adapts existing models and frameworks in low- and middle-income countries and uses the knowledge of the MENA context to contextualise them for conflict settings.

Towards integrated care systems (ICSs) Leading for integrated care

Leading across integrated care systems and integrated care partnerships (ICPs) requires a range of skills. These include being able to walk in other people’s shoes; having a constancy of purpose while retaining flexibility; and building the evidence base for change as a key tool for persuading the unconvinced of the need to redesign our model of care delivery.

Building on the recent report, "Leading for integrated care", this event will provide insights into the different leadership skills and behaviours needed to successfully secure more integrated care.

You will be able to hear from a range of different speakers from across the UK about how individual leaders from local government and the NHS are working in partnership to redesign services and in some instances place a greater emphasis on wellness.

Suitable Scales; Rethinking Scale for Innovative Integrated Care Governance

For organising person centered care, an important issue is how to deal with scale. This addresses what to organise on what level (in the neighbourhood, local, in the region, or national). With the increasing complexity of organising integrated care in networks, scale issues are an ingredient of integrated care governance. However, there is a lack of empirical studies that treat scale as an object of study in itself. Scale is an outcome of the interplay between many different interests, values and perceptions of people involved in the broader social and political processes. Five factors for suitable scales are discussed, emphasising the relevance for integrated care governance. These factors show, that the classical micro-meso-macro thinking oversimplify reality and more knowledge about suitable scales is required.

Towards a values framework for integrated health services: an international Delphi study

In order to organize person-centered health services for a growing number of people with multiple complex health and social care needs, a shift from fragmented to integrated health services delivery has to take place. For the organization of governance in integrated health services, it is important to better understand the underlying factors that drive collaboration, decision-making and behavior between individuals and organizations.

Key role of governance and accountability to achieve integrated people-centred health services

Models of integrated care continue to evolve globally with the goal to deliver more integrated people-centred health services. These models are characterized by innovative collaborations and partnerships across sectors. One enduring question relates to the best governance structures for these complex, multi-player systems and networks. Governance encompasses all aspects of managing health services delivery to support health system goals, including financing, human resources, and technology, and it is a critical instrument to strengthen public and institutional performance.

The current pandemic is a good reminder that circumstances and environments strongly influence health and well-being. It emphasizes the need to focus on whole-systems health, which cuts across political, economic, and social landscapes. Whole-system health requires governance that is agile and can respond quickly to emerging changes to manage the complex interdependent partnerships in integrated health systems. It further points to the need for diffusion of governance from a state/health services centred ...

Seventy-third World Health Assembly (WHA73)

The World Health Assembly is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board.

This year, the 73rd World Health Assembly is held virtually in light of the ongoing COVID-19 pandemic.

A reduced (de minimis) meeting was held on 18-19 May 2020.

The resumed WHA73 will take place from 9-14 November 2020.

You will be able follow proceedings on WHO webcast.

All documents can be found on the main documents page for the WHA73.

Realising the True Value of Integrated Care: Beyond COVID-19

Stronger and more resilient care systems and communities are better able to cope, respond and adapt to new challenges and crises such as the current COVID-19 pandemic. They are able to quickly come together to ‘act as one’ and collaborate across disciplines and sectors towards a common goal. This is the essence of integrated care and this is what the International Foundation for Integrated Care (IFIC) stands for – creating a more connected health and care system.

A reflection on the development of Integrated Health Services Networks in the Americas

In October 2009, the 49^th Directing Council of the Pan American Health Organization (PAHO) approved the resolution “Integrated Networks of Health Services based on Primary Health Care” (IHSDN). The approval of this resolution formalized the commitment of the countries of the Americas to advance in the creation, development, and strengthening of IHSDNs in the Region, and constitutes until today a cooperation mandate for PAHO.

The resolution was accompanied by an important position paper called “Integrated Health Services Networks. Concepts, policy options and roadmap” published in May 2010. This document provided an action guide to implement the IHSDN, including a new definition of fourteen attributes grouped into four categories (care model, governance and strategy, organization and management, and allocation and incentives) to be met by integrated service networks. The importance of this is that the attributes offered leaders, managers, researchers, and those interested in general in this matter, a clear ...

Research in Integrated Care: The Need for More Emergent, People-Centred Approaches

The International Foundation for Integrated Care (IFIC) recently celebrated its 20^th International Conference (ICIC20) through a virtual event that brought together patients and carers, academics, care professionals, NGOs, policy-makers and industry partners from across the global integrated care community. The International Journal for Integrated Care (IJIC) used this opportunity to host a workshop on published research in integrated care, specifically to reflect on the quality of existing scientific enquiry. A lively discussion on the current state of integrated care research concluded that there remained significant shortcomings to current methodologies – for example, in their ability to provide the depth of understanding required to support the knowledge needed to best inform policy and practice, particularly when addressing people-centredness. In part, the debate recognized how the nature of existing research funding, and prevailing attitudes and preferences towards certain research methodologies, were partly to blame (as has been noted by IJIC previously). The ...

21st International Conference on Integrated Care (ICIC21)

The Leadership of Co-Production in Health and Social Care Integration in Scotland: A Qualitative Study

The involvement of citizens in the production and creation of public services has become a central tenet for administrations internationally. In Scotland, co-production has underpinned the integration of health and social care via the Public Bodies (Joint Working) (Scotland) Act 2014. We report on a qualitative study that examined the experiences and perspectives of local and national leaders in Scotland on undertaking and sustaining co-production in public services. By adopting a meso and macro perspective, we interviewed senior planning officers from eight health and social care partnership areas in Scotland and key actors in national agencies. The findings suggest that an overly complex Scottish governance landscape undermines the sustainability of co-production efforts. As part of a COVID-19 recovery, both the implementation of meaningful co-production and coordinated leadership for health and social care in Scotland need to be addressed, as should the development of evaluation capacities of those working across health ...

What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium

Although many countries have been implementing integrated care, the scale-up remains difficult. Macro-level system barriers play an important role. By selecting three key policies, which have implemented integrated care in Belgium over the last 10 years, we aim to go beyond the identification of their specific barriers and facilitators to obtain an overarching generic view.

Designing and Governing Responsive Local Care Systems – Insights from a Scoping Review of Paramedics in Integrated Models of Care

Programs that fill gaps in fractured health and social services in response to local needs can provide insight on enacting integrated care. Grassroots programs and the changing roles of paramedics within them were analyzed to explore how the health workforce, organizations and governance could support integrated care. In this study, five concepts were identified for fostering integrated care in local systems: single point-of-entry care pathways; flexible and mobile workforce; geographically-based cross-cutting organizations; permissive regulation; and assessing system-level value.

Voice, agency, empowerment - handbook on social participation for universal health coverage

Social participation is an important means for governments to develop responsive health policies and programmes, which are more likely to be implemented by a broad stakeholder group. It is at the heart of the inclusive governance needed for countries to stake their individual paths towards Universal Health Coverage while ensuring that no one is left behind.

As simple as it may seem in theory, it is a complex undertaking in practice, one which policy-makers struggle with. The Handbook on Social Participation for UHC is thus designed to provide practical guidance, anchored in conceptual clarifications, on strengthening meaningful government engagement with the population, communities, and civil society for national health policy-making. It draws on best practices and lessons learned to support government institutions in setting up, fine-tuning, improving, and institutionalizing new or existing participatory health governance mechanisms.

The handbook follows through the different tasks which policy-makers must reflect on and undertake ...

Integrating Health and Social Services in Finland: Regional Approaches and Governance Models

The study explores regional approaches to integrated care, focusing on regions with regular municipality-based and integrated unified health and social care administration. The aim is to describe a governance approach that supports care integration in the regions.

Decision-Making Dilemmas within Integrated Care Service Networks: A Systematic Literature Review

The diverse nature of people’s care needs requires collaboration between different organisations and sectors. One way of achieving such collaboration is through integrated care service networks. Decision-making is considered an important aspect of network governance and key to achieve further integration of care services. As integrated care scholars only implicitly seem to touch upon the issue of decision-making, we aimed to identify multiple decision-making dilemmas.

Skill-mix Innovation, Effectiveness and Implementation: Improving Primary and Chronic Care

What are skill-mix innovations and why are they relevant? This systemic analysis of health workforce skill-mix innovations provides an overview of the evidence and lessons for implementation across multiple countries.

The authors focus on six core segments of health systems: health promotion and prevention, acute care, chronic care, long-term and palliative care, as well as access for vulnerable groups and people living in underserved areas.

Primary health care case studies in the context of the COVID-19 pandemic

Overview

A vision for primary health care in the 21st century

In 1978 world leaders, international organizations and health authorities gathered in Alma-Ata (now Almaty), Kazakhstan, and released the Declaration of Alma-Ata on Primary Health Care, which remains a landmark document in the history of global health. The Alma-Ata Declaration established a standard of public commitment to making community-driven, quality health care accessible, both physically and financially, for all. This was the forerunner of the Global Strategy for Health for All by the Year 2000 that was pursued by WHO and its partners for the rest of the 20th century, and of Sustainable Development Goal (SDG) 3: “Ensure healthy lives and promote well-being for all at all ages” by 2030.

A Vision for Primary Health Care in the 21st Century provides the rationale for and foundation of the Astana Declaration, with its continued political focus on the right to integrated, quality, personal and population-level primary care; on health as a multisectoral ...