1.1 Engaging and empowering individuals and families. In order to achieve better clinical outcomes through co-production of care, particularly for noncommunicable and chronic diseases, individuals and families need to be active participants in their care. This step is fundamental because people themselves will spend the most time living with and responding to their own health needs, and will be the ones making choices regarding healthy behaviours and their ability to self-care. Empowerment is also about care that is delivered in an equal and reciprocal relationship between, on the one hand, clinical and non-clinical professionals and, on the other, the individuals using these care services, their families, and communities, thereby improving the care experience.

• Health education

• Shared clinical decision-making between individuals, families, carers and providers

• Self-management, including personal care assessment and treatment plans

• Knowledge of health system navigation

• Patient satisfaction surveys

1.2 Engaging and empowering communities. This approach will enable communities to voice their needs and so influence the way in which care is funded, planned and provided. It will help to build confidence, trust, mutual respect and the creation of social networks, because people’s physical and mental well-being depends on strong and enduring relationships. It strengthens the capacity of communities to organize themselves and generate changes in their living environments.

• Community delivered care

• Community health workers

• Development of civil society

1.3 Engaging and empowering informal carers. Family members and other care-givers play a critical role in the provision of health care. Carers must receive adequate education in order to be able to provide high quality interventions, and to serve as advocates for the recipients of care, both within the health system and at policy level. Additionally, carers have their own needs for personal fulfilment and require emotional support to sustain their role.

• Education for informal carers

• Informal carer networks

• Peer support and expert patient groups

• Caring for the carers

• Respite care

1.4 Reaching the underserved and marginalized.This approach is of paramount importance for guaranteeing universal access to health services. It is essential in order to fulfill broader societal goals such as equity, social justice and solidarity, and helps to create social cohesion. It requires actions at all levels of the health sector, and concerted action with other sectors and all segments of society, in order to address the other determinants of health and health equity.

• Integration of health equity goals into health sector objectives

• Provision of outreach services for the underserved, including mobile units, transport systems and telemedicine

• Contracting out of services when warranted

• Expansion of primary care-based systems