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 ...

Educating and empowering children to make healthy choices across Mexico

In Mexico, one in three children and adolescents are overweight or obese. This increases the risk of diabetes and hypertension, as well as learning and development issues. Additionally, many children are at risk of addiction, teenage pregnancy, and mental health issues.

“Health at your school” is a joint strategy between the Secretary of Public Education and the Secretary of Health (MoH) to address these health risks. It encourages children and adolescents to maintain a healthy body, avoid risky behaviors and acquire healthy habits, through five components: educate for health; curricular autonomy; professionals and students of health at your school; training ...

At Risk Individuals (ARI) programme, Counties Manukau Health (CMH) Auckland, New Zealand

The model of care provides early and planned interventions, establishes general practice as the centre of coordinated healthcare, provides care based on patient set goals and improves access to a range of specialist and community services; uses risk profiling as means to identify and judge patient eligibility; care goals are set and progress overseen by an assigned care coordinator; funded by flexible regime managed by the providers to ensure care goals can be achieved.

Using medical trains to improve access to health services across Kazakhstan

Kazakhstan was ranked among countries with the lowest life expectancy in the WHO European Region; health professionals were distributed inequitably across the country and geographic disparities in health status were seen between rural and urban populations.

The concept of transport medicine was conceived: Using the country’s existing transportation infrastructure, a series of trains now travel to stations across the country to provide health services to rural populations; aligning the initiative with overarching health system reforms (the State Health Care Development Programme for 2011–2015 “Salamatty Kazakhstan”), and gaining cross-sector buy-in from the government, helped to support implementation of medical ...

Implementing early childhood development centres in Bosnia and Herzegovina

As part of a wider initiative for the social protection of children in post-war Bosnia and Herzegovina, UNICEF partnered with cantons and municipal governments in 2010 to establish Integrated Early Childhood Development (IECD) Centres; a situational analysis and piloting of the approach supported a sharpening of priorities and the development of practical solutions; longstanding partnerships between government actors and development agencies allowed for gradual capacity-building at the subnational level, enabling local uptake of new roles and responsibilities relating to early childhood development; aligning national policy with municipal action encouraged widespread adoption of changes, increasing consistency in approaches and securing sustainability ...

Integrating nutrition programmes in primary care in Kyrgyzstan

A programme to distribute micronutrient sprinkles, locally known as “Gulazyk”, was introduced with donor support. Following successful piloting of the programme, activities were scaled up nationally in 2011; aligning with existing infrastructure and services helped support and stabilize reforms implemented under the initiative; building trust between primary care providers and patients was essential for ensuring uptake of micronutrient supplementation; community health volunteers aided trust building; developing a consistent message across all providers, even those not directly involved with the initiative, safeguarded changes against being undermined at different care levels; encouraging participation of mothers and community members proved valuable in overcoming ...

Exploring new provider-payment models to incentivize performance improvements in Hungary

The Care Coordination Pilot was launched in 1999 to explore ways to improve the coordination and quality of health services. Under the pilot, Care Coordinator Organizations (run by health providers from general practices or polyclinics) acted as virtual fund holders for capitation-based health care budgets within their local catchment areas; carefully chosen financial incentives guided performance improvements by rewarding efficiency, incentivizing preventive care and encouraging treatment in lower-level settings; empowering professionals with new responsibilities helped to overcome provider dissatisfaction; extensive data collection supported analysis and comparison of local organizational arrangements.

Introducing community-based lifestyle clinics to improve population health in Malta

Lifestyle Clinics offering healthy-living support were introduced across Malta to expand availability of health promotion and disease prevention services; a motivated, multidisciplinary group of primary care professionals led the initiative through collaborative teamwork; the initiative capitalized on recent government policies supporting chronic disease prevention and a newly-established postgraduate community nursing programme; an initial information campaign helped raise awareness and gain public acceptance for new services; patients responded well to being offered a more active role in their health; further, patients play a key advocacy role in expanding the initiative.

Developing guidelines to reduce under-five child mortality in the Republic of Moldova

The government developed an under-five child mortality reduction initiative and established new standards and protocols for the observation of childhood illness; research conducted prior to the initiative identified the root causes of problems and provided evidence of the need to act; guidance and support from the Ministry of Health led to coordinated intersectoral action Educating and expanding providers’ competencies challenged pre-held attitudes regarding the detection and treatment of childhood illness; joint-sector delivery by health providers and social workers facilitated more comprehensive and coordinated care for patients; national ownership over the initiative was important; activities were fully integrated into national standards ...

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.