Celebrating the 4th anniversary of the approval of the WHO Framework on integrated and people-centred health services: progress and opportunities ahead
This month marks the fourth anniversary of the approval of the Framework on integrated people-centred health services (IPCHS) and its accompanying resolution WHA69.24 (2016) on “Strengthening integrated people-centred health services” by the World Health Assembly. In May 2016, Member States showed exceptional support to these global commitments and requested WHO to help them implement, adapt, and operationalize this Framework. However, this was not the first time WHO recognized the relevance of health services being managed and delivered so that people, who are active participants of health systems, receive a continuum of care according to their needs throughout the life course. Other previous WHO global and regional commitments, including “People-centred health care: a policy framework” produced by the Western Pacific Region in 2007, the “World health report 2008 on primary health care: now more than ever”, and resolution WHA62.12 (2009) on Primary health care, including health system strengthening, had already emphasized the need to deliver more integrated and people-centred care to improve the health and health care of all people.
Broadly speaking, not only person- and people-centred care but also integrated care approaches have witnessed a significant evolution during these last decades, getting increased and renewed attention (especially from policy makers and academia) accordingly. This trend is well reflected in the growing number of publications released and conferences organized every year, but most importantly, IPCHS-related strategies and interventions are increasingly embedded into national health plans. According to an internal study of the WHO Integrated Health Services department in 2015, national health plans of almost sixty Member States (out of 173 countries analysed) were aligned with the strategies proposed in the Framework on IPCHS. When grouped by income level, national strategies in high-income countries were commonly aligned to IPCHS (60%), while the low-income countries were least frequently aligned (12%), which suggests that unfortunately, prioritizing people and their needs tends to remain a “privilege” for richer countries.
WHO has strongly committed to ensure that all relevant parts of the Organization, at headquarters, regional and country levels are aligned, actively engaged and coordinated in promoting and implementing the Framework on IPCHS during these four years by providing leadership and engaging in partnerships; shaping the research agenda and stimulating the generation, translation and dissemination of knowledge; providing technical support and building sustainable institutional capacity; and monitoring and assessing trends in universal health coverage and how they support people-centred and integrated services. Despite considerable progress made so far, especially in helping countries integrate health services as part of broader health system reforms, a substantial amount of work remains to be done. This work will be particularly relevant in the area of integrating disease-specific and verticalized programmes into wider service delivery platforms based on primary care, respecting and promoting patient’s autonomy and shared decision-making, and improving coordination among the different levels and sites of care within and beyond the health sector, to name just a few.
On the other hand, there appears to be promising opportunities emerging in the horizon for advancing the agenda on integrated, people-centred health services. Firstly, global efforts to promote the delivery on the health-related SDGs and related international commitments to health, such as the UN High-level Meeting on Universal Health Coverage and the Declaration of Astana, will have a critical role in boosting health service delivery reforms. Furthermore, stronger collaboration among global health organizations to support countries provides a key window of opportunity for better coordinated and more effective work in the field by complementing one another’s efforts. A good example of this is the “Global Action Plan for Healthy Lives and Well-being for All” initiative, which brings together twelve multilateral health, development and humanitarian agencies to implement collaborative actions on primary health care, civil society engagement and digital health, among others. Secondly, people-centredness has become a new mantra in policy development, not just in the health sector but in other sectors such as the legal and justice sectors (as a matter of fact, OECD has recently developed criteria for people-centred legal and justice services); most likely, citizens will no longer accept the design and delivery of services for them without them. Thirdly, the experience and evidence base for IPCHS has extensively grown during recent years, which facilitates the transition from preliminary implementation phases characterized by basic questions such as: “why should we change? and “what changes should be promoted?” to more advanced stages that focus on how to make it happen.
Finally, the current global coronavirus crisis has further shed light on the importance of IPCHS, and their associated values and principles can be considered even more relevant during the pandemic. Not only efforts to optimize integration among the different settings and levels of care, including effective coordination with long-term care, but also the ability to respond to people’s comprehensive needs by ensuring access to essential services for dealing with long-standing health problems will be fundamental to confront the challenges posed by COVID-19. As health care systems become overwhelmed by the coronavirus, encouraging and strengthening partnerships with the community in this difficult time is critical to ensure people’s voices are not left behind, so that they can play a key role in shaping system-building endeavors that will better serve our populations as other crises might arise in the near future.