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 ...

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.

Outpatient rehabilitation services for working-age patients with brain injuries in Bern, Switzerland

An outpatient rehabilitation centre specifically adapted to the needs of working-age patients recovering from brain injuries was opened in Bern; Direct clinical experience of the multi-professional leadership team helped draw awareness to service delivery gaps and aided the design of practical services to address observed needs; co-location of providers within the rehabilitation centre increased service coordination and improved access for patients, while external networking between providers helped generate referrals; gradual expansion of the initiative allowed time for sufficient resources to be collected and necessary partnerships to be established, ensuring steady and sustainable growth. 

Telerehabilitation for patients with chronic obstructive pulmonary disease (COPD) in Denmark

A pilot programme to test home-based telerehabilitation for COPD patients was designed and implemented by researchers at Aalborg University; a supportive political and legislative environment provided a platform for furthering the development of e-health and telemedicine; partnerships with stakeholders outside the health sector supported the development of telemedicine and helped drive service delivery transformations; patients were given a more active role in care and new collaborative partnerships between patients and providers were developed; success of the initial pilot led to a larger-scale study with greater involvement of regional and municipal actors.

National rollout of Healthy Life Centres in Norway

Municipally-managed Healthy Life Centres staffed by multidisciplinary public health teams were established across Norway to advance local health promotion; government commitment to addressing chronic disease through strengthening health promotion provided a platform for change and fostered widespread scale-up of activities; the Healthy Life Centre concept was invented locally and continues to depend on locally-driven efforts, with municipalities given significant autonomy over activities; a structured approach to the rollout of Healthy Life Centres from the outset (including research, piloting and creation of national guidelines) ensured accountability and systematic evaluation; collaborative partnerships between primary care providers, Centre staff and patients proved integral ...

Implementing an integrated cardiology programme in Eastern Lithuania to improve cardiovascular health

The initiative strengthened cardiovascular care in primary and secondary settings, providing new training and equipment to providers to establish infrastructure for improved cardiology care outside of specialist settings; a detailed situational analysis informed the initiative’s design and provided evidence supporting the intervention; strong leadership by senior management at Vilnius University Hospital provided technical expertise and generated stakeholder support, while backing from the Ministry of Health added legitimacy to activities; extensive engagement of providers from the beginning was necessary for overcoming an individualistic culture and building collaborative relationships; distribution of a standardized cardiology equipment package to participating locations established basic ...

Shifting acute care delivery from hospitals to homes in Ireland

Community-based acute care services delivered by mobile nursing teams were introduced by Caredoc, a private nonprofit organization contracted by the Irish Health Services Executive; first-hand insights of providers enabled identification of services delivery challenges and supported development of relevant solutions; supportive senior management generated momentum for change and helped secure necessary approval for activities from authorities; stakeholder engagement was described as time consuming, but crucial to success; electronic medical records and new technologies facilitated the creation of a simple, connected and user-friendly service; training for nursing staff was important for establishing the necessary clinical competencies to deliver acute care services ...