The Joint Learning Network for Universal Health Coverage launched the new People-Centered Integrated Care (PCIC) Service Delivery collaborative this past October 2017 in Hanoi, Vietnam.
People-Centered Integrated Care aims to improve the effectiveness of health service delivery—a key component of universal health coverage (UHC)—and to rebalance the care delivery system through strengthening the central role of primary health care (PHC) and promoting care integration and coordination across provider settings.
Given the importance of this new model, the collaborative’s ultimate goal is to increase the knowledge and resources available to countries on PCIC models and the steps and requirements for achieving them.
Through a review of 22 PCIC case studies of PCIC-oriented health systems, the China Health Study identified eight tenets of high-performing PCIC service delivery systems. As part of the joint learning process, a scoping workshop was convened in Hanoi, Vietnam in October 2017 with 19 participants representing China, Ghana, Malaysia, Mongolia, Morocco, South Korea, Sudan and Vietnam. The first workshop brought together practitioners and policymakers from multiple disciplines representing academic institutions, government agencies, and international organizations to identify, discuss and ultimately improve aspects of the PCIC model. As a first step, country participants began the process of collaboratively identifying and prioritizing their countries’ needs for pursuing PCIC.
Developing a Shared Understanding of People-Centered Integrated Care
On the first day, participants became familiar with the PCIC model and its roots in the World Health Organization’s (WHO) Integrated People-Centered Health Service (IPCHS) Framework. The framework’s vision is to ensure that:
1.) All people have equal access to quality health services to support universal health coverage.
2.) Services are co-produced and provided in a way that meets people’s life course needs and preferences.
3.) Services are coordinated across the continuum of care and are comprehensive, safe, effective, timely, efficient, and acceptable.
4.) All health works are motivated, skilled, and operate in a supportive environment.
Prior to the workshop, background work and pre-scoping of participant country interests were conducted to narrow down three focus areas for JLN countries, including empanelment, multidisciplinary teams, and care coordination.
Exploring the Foundation of PCIC Implementation
Identifying common definitions for terms such as empanelment, multidisciplinary teams, and coordination of care was integral to work done in the collaborative. Participants were asked to rank the three focus areas (keeping in mind the criteria of the sequencing of events, feasibility, and usefulness) to two areas, ultimately narrowing down the focus to multidisciplinary teams and empanelment.
Sharing Expertise and Experiences in PCIC
With the foundational knowledge established, participants shared their current experiences with PCIC both formally with a country spotlight session and informally through small and large group discussions throughout the meeting.
- Dr. Nik Mazlina and Dr. Sondi Sararaks of Malaysia shared their experience with the country’s enhanced primary health care system, which was piloted to ensure a people-centered primary health care system that is effective and sustainable, as indicated by increased health outcomes of the populations.
- Representing Ghana, Dr. Isaac Morrison and Dr. Momodou Cham introduced their community-centered care model. The country was divided into small zones with 3,000–4,500 people per zone and community health nurses to plan health services, help patients and provide door-to-door primary care.
- Dr. Hassan Semlali of Morocco described Morocco's primary care centers as a well-utilized entry point for patients. Patients know of the services available and because of the quality control system, they have confidence in the care they receive. If deemed necessary, a patient will be referred for more advanced services.
A large subset of participants shared that they faced the challenge of lacking human resources and training that would be needed to assemble a truly multi-disciplinary team and the challenge of potentially losing patients once they are referred out of the primary care system.
Planning Potential Knowledge Products
Key elements were identified that should be featured in the knowledge product, regardless of the focus area, including people-centered approaches, facilitating access, creating demand, and integrating vertical pathways. Additionally, participants agreed that a product should be adaptable and flexible, user-friendly with visuals and a framework to aid adoption and implementation, and relatively simple to implement with an accompanying implementation roadmap.
Over the course of the four-day scoping workshop, participants offered valuable expertise and discussion on PCIC service delivery, the areas of focus, and potential further exploration of knowledge products. The next step is to continue narrowing the focus area while taking an inventory of existing tools and planning for the development of a new guide to PCIC models