IPCHS Practices

Learn from real-life experiences with health services reform. We distinguish three types: emerging, promising and leading practices. Share your practice by clicking "Add practice".

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Jan. 17, 2020 Americas

Engaging and empowering people and communities, Strengthening governance and accountability, Reorienting the model of care, Coordinating services within and across sectors, Creating an enabling environment

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 ...

Oct. 4, 2016 Europe

Strengthening governance and accountability, Reorienting the model of care, Coordinating services within and across sectors

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 ...

Sept. 22, 2016 Europe

Strengthening governance and accountability, Reorienting the model of care, Coordinating services within and across sectors

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.

Sept. 7, 2016 Europe

Strengthening governance and accountability, Creating an enabling environment

Introducing evidence-based guidelines through a best practice accreditation programme to improve care quality in Spain

The Best Practice Spotlight Organization accreditation model (developed by the Registered Nurses’ Association of Ontario in Canada) was rolled out in Spain to encourage care organizations to improve adherence to best practice guidelines; while the initiative activated a well-established and structured programme model, flexibility in implementation supported the tailoring of new practices to local needs; providers were given lead roles in implementing the accreditation programme within their respective organizations, providing them with ownership over the initiative and increasing their acceptance of new practices; a focus on generating and comparing data, as well as strengthening the evaluation of care practices, motivated ...

Sept. 7, 2016 Europe

Strengthening governance and accountability, Coordinating services within and across sectors

Developing an integrated information system in the Former Yugoslav Republic of Macedonia

The Ministry of Health designed and implemented a web-based appointment platform to streamline information flows and reduce artificially-inflated waiting times. Additional features, such as e-referral and e-prescription applications, have since been incorporated into the information system; a comprehensive investigation at the beginning of the initiative supported the development of an informed solution to directly address key challenges; alignment with previous investments in technological infrastructure enabled rapid uptake of the new information system by providers and more economical use of existing resources; an effective communication plan, including public campaigns and efforts to gain public trust, helped ensure widespread uptake of the ...

Sept. 6, 2016 Europe

Strengthening governance and accountability, Coordinating services within and across sectors, Creating an enabling environment

Developing an integrated e-health system in Croatia to drive care improvements

An electronic Central Health Information System (CEZIH) was introduced by the government to connect stakeholders and provide real-time data on patients and providers; a strong government commitment and top-down leadership established the necessary conditions for the widespread adoption of e-health; data collected through the e-health system helped drive performance improvements; a new payment model for primary care providers was introduced and realigned financial incentives encouraged positive changes in clinical practice; ongoing trainings supported providers to uptake and capitalize on new technologies; a patient e-portal helped engage patients in their own care.

June 24, 2016 Europe

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 ...

June 24, 2016 Europe

Strengthening governance and accountability, Creating an enabling environment

Implementing clinical audits to improve care standards in Turkey

Clinical audits were implemented to improve adherence to national guidelines through increasing transparency and accountability for service delivery across health care institutions; lengthy discussions with stakeholders and clear communication of the initiative’s aims were essential for establishing sufficient buy-in to begin implementation; establishing data collection and analysis systems was a critical step for improving and optimizing care. Strong data collection, followed up with monitoring and evaluation, was paramount to the initiative’s success; while the initiative was led by the Ministry of Health, regional health authorities played an increasingly important role in supporting auditing processes and providing local oversight ...

May 26, 2016 Americas

Enhancing primary healthcare delivery in the inner-city community in Toronto, Canada

A very participatory evaluation process with broad involvement of all stakeholders, including patient and community members, led to consensus on priorities and gaps in services; prioritization of an innovative, patient-centred, model of health and social care led to development of an integrative Family Health team working from a social determinants of health lens; multiple partnerships support long-term sustainability and educational collaboration; supportive leadership and internal champions created momentum for change and mitigated internal and external barriers to change; active and ongoing engagement of patients, community and health team members in program design and implementation.