Empanelment, sometimes referred to as rostering, is a process that assigns responsibility for the delivery of promotive, preventive, curative and rehabilitative care for individuals and populations to specific health care facilities, teams or providers.
Although elements of empanelment are implemented in health systems across the globe, there is no universally accepted definition of the term. The JLN People-Centered Integrated Care (PCIC) collaborative, facilitated by Ariadne Labs and Qualis Health, is working to refine and harmonize the existing definitions of empanelment into one encompassing understanding to ensure global relevance and incorporate a people-centered, integrated approach to this foundational area of primary care service delivery.
The PCIC collaborative gathered in Accra, Ghana, in March 2018, for its second meeting to continue the work set out at the October 2017 scoping workshop. Country representatives built on their previous work, including the sharing of their experiences and co-creation of a knowledge product that will accelerate two foundational elements of high-functioning primary care systems – empanelment and the effective use of multidisciplinary teams. Twenty-one participants representing Ghana, Indonesia, Malaysia, Morocco, Mongolia, South Korea, Sudan and Vietnam attended the three-day workshop.
Country Experiences with Empanelment and Multidisciplinary Teams
The sharing of country experiences with empanelment and multidisciplinary teams was one of the highlights of the collaborative meeting. Dr. Nik Mazlina, a family medicine specialist in Malaysia’s Ministry of Health, discussed how they were able to increase patient enrollment from 23 percent to 60 percent in one month by going door-to-door to identify and assign patients to specific clinics. Participants discovered that Indonesia, Ghana and Sudan had also used door-to-door strategies.
Dr. Jargalsaikhan Badarch, an associate professor, researcher and lecturer at the Mongolian National University of Medical Science, described a similar door-to-door household approach performed by Visiting Home Services teams, which provide registration services 2-3 times a year to enroll all populations. These teams – made up of a physician, nurse, public health worker, and a driver – also offer telehealth services that provide free health check-ups and screening tests to remote populations who would not otherwise be able to access these services.
Participants also discussed how empanelment leads to effective utilization of teams, representing an important conceptual link between the collaborative’s two areas of focus. Another link occurs when community-based members of a multi-disciplinary primary health care team offer contextual local knowledge of the individuals and families assigned to a facility. These team members are a critical link to individuals in a geographic region who may not be on a list for empanelment due to not utilizing primary care services.
Empanelment in Ghana’s Health System
Dr. Isaac Morrison, president of the Society of Private Medical and Dental Practitioners in Ghana, provided the participants with an overview of the Ghanaian health system. Ghana is divided into ten regions, each of which operates within specific legislative frameworks to provide health care to its population. The district, subdistrict and community levels of the Ghanaian health system make up the country’s primary health care system.
For example, the community level is the first level of contact a patient would have with a health care worker. These community-level services are provided at community-based health planning and service compounds. These compounds provide cost-effective and basic quality services to up to 5,000 people and are operated by a district management team.
The collaborative organized a site visit to the Shai Osudoku district in the Greater Accra Region with the Ghana Health Services Head Office and the National Health Insurance Authority. Collaborative members visited the Shai Osudoku district offices, Shai Odsukou District Hospital and Ayikuma compound. At each of these facilities, the participants learned about the district’s innovative work.
At the Ayikuma compound, participants learned how community health nurses and health workers reach out to members of the community to conduct health screenings, provide antenatal care delivery and deliver health education. At community durbar meetings, community members discuss local priorities for health and sanitation and plan focal activities for the compound. Seeing Ghana’s health care system in action provided context for the rest of the discussions and for the collaborative’s work going forward.
After considering a range of resources that might be helpful for countries striving to implement or improve empanelment, the collaborative has decided to develop two products. First, the collaborative will prepare a monograph that includes a consensus definition of empanelment and description of its fundamental role in delivering PCIC to individuals and populations in the context of universal health care. The document will outline key steps in the implementation of empanelment.
The collaborative will also co-develop a tool that will allow countries to assess their status and monitor progress towards implementation of effective empanelment. The tool will address domains such as enabling policies, availability of appropriate information systems and use of panels to provide proactive care. The tool will be designed to assist countries in focusing their efforts on the areas that need the most improvement.
The collaborative will continue to work on these resources and will host a third meeting in 2018 to finalize the products.