Make health systems people centred

Ministry of Health Estonia

Five years on from the signing of the Tallinn Charter: Health Systems for Health and Wealth, which called for greater investment in health systems, ministers and high-level officials met again in Tallinn, Estonia on 17–18 October 2013, at a follow-up meeting called “Health systems for health and wealth in the context of Health 2020”. The current economic crisis has underscored the need to invest in health, and focus more on addressing health inequities, ensuring universal health coverage and protecting health among the most vulnerable populations.

“The Tallinn Charter and Health 2020 are synergistic, as they aim to inspire countries to act on their values to improve health and wealth, to affirm a value-based approach to strengthening health systems and to empower health ministries to lead change for health improvement. Carrying forward the momentum of health-system strengthening takes us further down the road to universal health coverage,” said Zsuzsanna Jakab, WHO Regional Director for Europe, in her opening address.

Ministers, experts and delegates from 38 Member States and representatives of key partners – including the European Commission, the Organisation for Economic Co-operation and Development (OECD), the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria – explained the steps they had taken to implement the Tallinn Charter, and move towards providing universal health coverage. In addition, ministries had focused more on improving accountability and governance through, for example, assessing the performance of their health systems. Tobacco and alcohol control were identified as areas in which effective, evidence-based cross-sectoral policies exist.

Nevertheless, strengthening health systems remains challenging, particularly as many countries face austerity measures, ageing populations, rising citizen expectations and advances in medical technology. Challenges identified by participants included:

  • promoting effective intersectorality;
  • improving health services to address the growing burden of noncommunicable diseases while facing the persisting challenge of preventing and controlling communicable diseases, particularly multidrug-resistant tuberculosis (MDR-TB) and HIV/AIDS;
  • empowering patients to manage their health care needs;
  • combining health-system management and leadership functions;
  • changing the behaviour of frontline health workers; and
  • putting appropriate incentives in place.

People-centred health systems

In strengthening health systems to provide more people-centred care, participants acknowledged the following as key areas for attention:

  • strengthening the public’s health literacy, to empower people to better manage and take responsibility for their health needs;
  • improving the coordination of service provision across all levels to improve the continuity of care;
  • focusing on primary care and community care as the cornerstones for the holistic delivery of services with clear links to public health services; and
  • investing in health-system inputs, including information sharing and the skill set and competences of staff, to complement more coordinated delivery models for health services.

Towards people-centred health systems: targeting efforts to strengthen health systems

Keynote addresses, ministerial panels and plenary discussions over the two-day meeting aimed to take stock of the implementation of the Tallinn Charter and to map a way forward for efforts to strengthen health systems through the lens of Health 2020. Discussions during these sessions highlighted various themes.

  • A whole-of-government, whole-of-society approach is important to ensure transparency, accountability, shared political and civic commitment. A common vision needs to be communicated to lay the foundation for all initiatives for health-system strengthening.
  • The changing health needs across the Region, as the burden of chronic diseases increases with the growing rate of multi-/co-morbidities, demand treatment that is more continuous and proactive in addressing people’s health status.
  • The organization of health services needs to be transformed to offer more coordinated/integrated pathways for the provision of care along the full continuum of services, according to a patient’s needs and preferences.
  • Greater commitment to public health – of key relevance for promoting health and reducing inequalities – is needed to point out the role of public health in primary health care as a unique niche for strengthening services and securing gains in societal, community, family and individual health.
  • Modern technology needs to be used to support improved communication, strengthen data collection and empower patients to manage their health needs. Participants from the host country shared the experience of the Estonian health system as a strong example of using e-health to engage patients.
  • New and innovative approaches to health-system financing are needed that are aligned to service-delivery models necessitated by health trends and applicable in the economic climate.

In discussing these themes, participants acknowledged key cross-cutting challenges, including:

  • strengthening human resources for health, aligning skills and competencies to secure more coordinated/integrated approaches to services delivery; and
  • modernizing information systems and knowledge transfer, an area that needs attention owing to the continuously increasing volume of data that can be supplied through modern technologies.