European Framework for Action on Integrated Health Services Delivery (EFFA IHSD)

What is the European Framework for Action on Integrated Health Services Delivery?

The European Framework for Action on Integrated Health Services Delivery (EFFA IHSD) is a policy framework that was unanimously endorsed by Member States at the 66th session of the WHO Regional Committee for Europe. Strategically aligned with other commitments, it aims to streamline and accelerate efforts to transform health services delivery in order to advance the Region’s priority of meeting the health challenges of the 21st century.

The EFFA IHSD sets out a shortlist of essential areas for undertaking health services delivery transformations that are results-oriented and focused on systems thinking. It serves as a checklist to ensure that key factors are considered, appropriately sequenced and strategically managed.

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Why is integrated health services delivery needed?

Member States of the WHO European Region and around the world are challenged with managing the growing burden of noncommunicable diseases (NCDs) coupled with longer life expectancies, as well as persistent and re-emerging communicable diseases. The range of responses to these health challenges has become highly diverse and specialized, but is often fragmented and unequally distributed. Advances in research and the increasing organization of patients and populations offer opportunities to rethink how services are designed, organized, managed and improved.

Member States in the Region have called for guidance on addressing these challenges and opportunities and transforming health services delivery in ways that ensure the right care, at the right time, in the right place.

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What is integrated health services delivery?

Integrated health services delivery is an approach to innovating and implementing sustainable services delivery for improving health outcomes; it is a means rather than an end in itself. Anchored in the principles that were first set out in the 1978 Declaration of Alma-Ata’s health-for-all agenda and vision of primary health care, it focuses on designing the optimal conditions for strengthening people-centred health systems. It emphasizes:

  • comprehensive delivery of quality services throughout the life-course;
  • design according to the multidimensional needs of populations and individuals;
  • delivery by a coordinated team of providers working across settings and levels of care;
  • effective management to ensure optimal outcomes and the appropriate use of resources based on the best available evidence;
  • feedback loops to continuously improve performance and tackle the upstream causes of ill health; and 
  • promotion of well-being through intersectoral action.

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What are the benefits of integrated health services?

Integrated health services delivery improves health outcomes. Integrated health services delivery has proven more effective for the management of NCDs and chronic diseases. By strategically targeting, organizing, coordinating and overseeing health services, countries can improve quality of care, secure access, decrease unnecessary hospitalizations and re-hospitalizations, and increase adherence to treatment.

Integrated health services delivery tackles inequity. Integrated health services delivery is equity-enhancing by design. It encourages the selection of services based on the needs and determinants of populations and extends across a broad continuum of types of care, from health protection, health promotion and disease prevention to diagnosis, treatment, disease management, long-term care, rehabilitation and palliative care. Integrated health services directly contribute to improved distribution of health outcomes and enhanced well-being and quality of life – all of which can yield important economic, social and individual benefits.

Integrated health services delivery can be cost-effective. According to the principles of allocative efficiency, improving the distribution of resources should lead to greater efficiency and increased cost–effectiveness. Improvements include better coordination of resources, minimized duplication of procedures, decreased patient discomfort, shorter waiting times and less resource waste.

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How is the EFFA IHSD aligned with other WHO policies?

The EFFA IHSD has sought full alignment with the vision put forward in the WHO Framework on integrated, people-centred health services, adopted by Member States at the Sixty-ninth World Health Assembly. This global Framework identifies 5 interdependent strategies for supporting people-centred and integrated health services delivery. The EFFA IHSD functions as an extension of this work within the context of the Region, directly addressing the health needs and priorities of European Member States.

The EFFA IHSD is also fully aligned with WHO/Europe’s overall policy framework Health 2020, which identifies the strengthening of people-centred health systems as one of its 4 priority areas. To this end, WHO/Europe works intensively with Member States to: (1) transform health services to meet the health challenges of the 21st century; and (2) move towards a Region free of impoverishing out-of-pocket payments. The EFFA IHSD serves as a guide for Member States in the first of these priority areas.

Finally, in an effort to coordinate and complement actions and accelerate the implementation of additional policies in the Region, the EFFA IHSD is aligned with commitments on:

  • NCD outcomes;
  • women’s health;
  • reproductive health; and
  • disease-specific strategies.

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How was the EFFA IHSD developed?

Upholding the vision of Health 2020, the EFFA IHSD focuses on efforts across government and society. It recognizes that everyone has a role to play in the creation of people-centred health services. The development of the EFFA IHSD itself has embodied this approach by promoting broad participation and collective action, establishing opportunities for strategic partnerships and engaging a large number of stakeholders.

To date, partners have convened in discussions, consultations and reviews involving high-level officials from ministries of health; technical focal points on coordinated/integrated health services delivery from all 53 Member States; an international advisory team of academic and organizational experts at the forefront of work in this domain; and public and professional networks representing patients, health and social care providers, special interest groups, international development partners (including the European Commission and the Organisation for Economic Co-operation and Development), and staff from different WHO technical units and offices.

Workshops and consultations involving these partners have taken place in Brussels (Belgium), Copenhagen (Denmark), Istanbul (Turkey) and Boston (United States of America). A final consultation took place in Copenhagen on May 3–4 2016, and delegates tabled the EFFA IHSD and accompanying resolution at the 66th session of the WHO Regional Committee for Europe on 13 September 2016.

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How can countries implement the EFFA IHSD?

The EFFA IHSD is accompanied by an implementation package of resources to support Member States in managing health services delivery transformations. These resources include analytical background documents, knowledge synthesis reports and topic-specific documents on, for example, health workforce competencies, patient engagement and population empowerment, and accountability arrangements for integrated health services delivery.

The implementation package also highlights practical, first-hand experience in a compendium of case profiles and lessons learned from country initiatives to transform health services delivery. This includes assessments of avoidable hospitalizations for ambulatory care sensitive conditions.

The catalogue of resources – including models, guides, toolkits, standards, databases and handbooks – is organized according to areas of action and key strategies. An English and Russian glossary of key terms provides accessible descriptions of concepts, and an inventory of indicators for measuring integrated care also supports countries in the implementation process.

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