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.

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 ...

Strengthening disease prevention services in Albania

The government, which was strongly committed to establishing universal health coverage, launched a four-year Free Check-Up Programme to introduce free screening services for chronic conditions; adopting a proactive approach to prevention was essential for reaching and engaging the target population (all citizens aged between 40 to 65 years); significant efforts were made to improve the systematic collection and monitoring of population health data; government support for activities, and a key partnership with the Health Insurance Institution to reimburse health check-up services, helped embed the initiative into the health system.

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 ...

Designing a national diabetes plan for Slovenia

The Ministry of Health convened a working group to develop a national diabetes strategy. After several years of deliberation among working-group members, the finalized National Diabetes Strategy was approved by the government in 2010; an active patient association supported patient engagement and involvement throughout the initiative’s planning and implementation process; meaningful stakeholder engagement across professions and institutions helped develop a common vision for the initiative; building trust between stakeholders took time, but was necessary to allow functional teamwork and effective plan development; oversight from the Ministry of Health fostered important linkages across activities, ensuring that changes to service delivery ...

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.

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 ...

Strengthening the response to noncommunicable disease in Turkmenistan

The government developed the National Health 2020 Action Plan 2014–2020 to guide action on noncommunicable disease; international attention on key issues helped generate national momentum and political will for health reform; a strong understanding of key challenges, supported with baseline population health data, facilitated the development of the Plan and allowed tailoring of activities to population needs; intersectoral partnerships across government ministries helped to keep the Plan on the political agenda and safeguarded health reforms against being undermined by other sectors’ policies; aligning with the existing primary care infrastructure facilitated the adoption of the Plan; a strong public communication ...