Working in the international context with WHO and others Hernan Montenegro, MD, MPH Health Systems Adviser HIS/PSP WHO, Geneva
What is WHO? UN specialized agency for health (1948) 194 countries (Ministries of Health) collectively decide together with WHO Secretariat on global health priorities and action to save lives and improve health. Headquarters in Geneva, 6 regional offices, 151 country offices Secretariat is staffed by some 7500 health and other experts and support staff Director-General: Dr Margaret Chan 2 WHO: Who we are and What we do 1 July 2013
Objective of WHO The objective of the World Health Organization shall be the attainment by all people of the highest possible level of health (Article 1, Chapter I, WHO Constitution) 3 WHO: Who we are and What we do 1 July 2013
WHO Headquarters and Regions Copenhagen, Denmark Washington DC, USA Geneva, Switzerland Cairo, Egypt New Delhi, India Manila, Philippines Brazzaville, Congo Staff Headquarters: 26.3% Regional Offices: 23.6% Country Offices: 50.1% 4 WHO: Who we are and What we do 1 July 2013
Our approach WHO core functions Providing leadership on matters critical to health and engaging in partnerships Setting norms and standards and promoting and monitoring their implementation Use evidence and research to frame ethical policy options for countries to improve people's health 5 WHO: Who we are and What we do 1 July 2013
Enhancing partnerships WHO works with the support and collaboration of many partners including other UN agencies, donors, NGOs and the private sector. Finding new ways of working with our partners is key to achieving our goals. 6 WHO: Who we are and What we do 1 July 2013
Need for PHC reforms Source: WHO, Primary Health Care- Now More than Ever, World Health Report, 2008
Three dimensions (policy choices) of Universal Coverage as portrayed in WHR
10 UHC for FGPH, Paris 18-19 June 2012
WHO Strategy on High Quality, Integrated People-centred Services to Achieve UHC Forward-looking Evidence-informed, based Action-oriented (how to of health care delivery reform) Develop policy options, strategies and interventions Adaptable to various country settings, contexts Build on WHO's past and current work Build on lessons learnt from Member States and others Participatory and consensus-building approach: Patients, users, communities, CSOs, NGOs Professional associations, etc. 11 TITLE from VIEW and SLIDE MASTER July 1, 2013
Universal Health Coverage (UHC) People-Centred Care (PCC) Integrated Service Delivery (ISD) "Ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship." (WHO, 2010) "Care that is focused and organized around the health needs and expectations of people and communities rather than on diseases." (WHO Glossary) "The management and delivery of health services such that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, diseasemanagement, rehabilitation and palliative care services, through the different levels and sites of care within the health system, and according to their needs throughout the life course." (adapted by PAHO from WHO 2008)
The Attributes of Family Practice (General Practice) Person-centred General Continuous Comprehensive Coordinated Collaborative Family-oriented Community-oriented services
Policy options and intervention levels Information & Exhortation Society Legal & Regulation Community Building Capacity of others Bureaucratic Reforms Family Person UHC with High Quality, Integrated People-centred Services Direct Provider(s) Health Facility National Context Taxes & Subsidies Global & Regional Context Provider Network Service Provision System Financing & Contracting
Country Settings Post-conflict: - Special needs of refugees & displaced people - Specific health needs resulting from conflict - Increase in CDs due to disruption of services & destroyed infrastructure - Security issues - Unstable governance & weak institutional capacity - Damaged infrastructure - Shortages of HRH and other essential supplies Non-functioning functioning delivery system - High dependency from external assistance & financing Low HD: - Low Life Expectancy, high burden of CDs & malnutrition - High reliance on O-O-P contributions & regressive public health spending - Low public health expenditure as % of GDP - Poor governance & weak institutional capacity - Shortages of infrastructure, HRH and other essential supplies - Poorly developed delivery system & predominance of vertical programs - Majority of existing services provided by NGOs & informal providers - Poor information systems and lack of performance assessment - High dependency from external assistance & financing - Inequities that affect the most vulnerable population groups - Quality of care issues, including medicines - Fragmented care -Inefficient use of existing resources - Insufficient participation Very High & High HD: - High Life Expectancy, predominance of NCDs & mental health problems - Aged population - Need for chronic care - High levels of public health spending & low levels of O-O-P contributions - High levels of public service provision Medium HD: - Medium Life Expectancy, double burden of disease: NCDs & CDs - High reliance on O-O-P contributions & regressive public health spending - Low public health expenditure as % of GDP - Poorly organized delivery system with overreliance on vertical programs - Poor information systems and lack of performance assessment
Road Map End May 2012: Concept note drafted August 2012: Terms of Reference developed for studies End of September 2013: First draft of WHO Strategy produced End of December 2013: Second draft of WHO Strategy produced July 2012: Concept note shared with Regional HSS Directors March 2013: Central Repository of Information functioning November 2013: Background Studies completed June 2014: Global/ Regional consultations finalized 17 TITLE from VIEW and SLIDE MASTER July 1, 2013
Strategy development and Background studies Type of work Objective Progress so far Strategy writing Study 1 Field study 1 Field study 2 Systematic review 1 Systematic review 2 Study 2 Write WHO Strategy on high quality people-centred and integrated care to achieve UHC Exploit existing databases according to key service delivery variables to assist situation analysis and developing country clusters that have similar service delivery issues Develop case studies on achieving UHC with people-centred and integrated care Document people's stories while seeking, obtaining or providing care, both positive and negative Gather evidence on the impact of UHC, PCC and ISD Identify evidence-based policies, strategies and interventions conducive to UHC with people-centred and integrated care Identify strategies for managing change and overcoming institutional resistance when introducing service delivery reforms Ongoing Ongoing Contracting out Drafting ToR Ongoing Ongoing Ongoing