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 ...

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.

Creating a sustainable model of spine care in underserved communities in Botswana

As identified in the Global Burden of Disease report (2012), spine disorders present an enormous burden on individuals, their families, communities and societies and are the leading cause of disability worldwide. In Botswana, the burden of low back pain has been estimated to be the 5^th leading cause of disability adjusted life years (DALYS) in 2013 and neck and back pain combined is ranked as the number 1 cause of years lived with disability (YLDs), increasing from the third position in 1990 to the first position in 2013.  In the developing world the burden of spine disorders is expected ...

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 ...

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.