Transforming integrated health service delivery in the WHO European Region

WHO/Jules Phillips

"Everything starts with people. Without people there is no health system." This sentiment was echoed in keynote presentations, illustrative country cases and expert interventions throughout the 2-day final consultation of the European Framework for Action on Integrated Health Services Delivery in discussions of entry points and processes for integrated health service delivery that took place in Copenhagen, Denmark on 2–3 May 2016. 

Over 170 participants from more than 30 Member States in the WHO European Region, and representatives of professional associations of primary care physicians, nurses, occupational therapists and others, patient organizations, care-givers, other special interest groups, insurers and hospitals, and also international experts from universities and think-tanks, in addition to WHO staff from the African, Eastern Mediterranean and European regions and headquarters, debated the specificities of transforming health service delivery in the context of the four key domains of the Framework for Action: people, services, system and change. 

The event marked the final step in the development of the Framework. The process was launched by the Regional Director in 2013 and has brought together leading experts in the field, and involved exchanges of background material, technical consultations and peer review of early drafts. 

The key themes that emerged during the consultation included:

  • Domain 1: People. Placing people at the centre of care was a recurrent topic. Proactive participation of people and society in their health and initiatives is essential for development. Other stakeholders must be included, and patients, carers, volunteers and peer groups should have a greater role in delivering services.
  • Domain 2: Services. Measuring health service delivery was discussed with regard to both the challenges and its importance. Specifically, the usefulness of reporting hospitalization for conditions requiring ambulatory care as a proxy of performance, as this measure could allow comparisons among countries and provide an entry point for transformation was recognized. 
  • Domain 3: System. Many new possible applications of technology in driving integrated care were described during the meeting. Participants emphasized that focus should be maintained on usability and ensuring that technological advances and innovations actually meet people's needs. Speakers recommended that, to do so, innovations should be advanced in a participatory manner, with the inclusion of key users to ensure relevance. The importance of the workforce – in numbers, roles, scope of practice and competence – was underscored, as were incentives, medicines, coordinated information and governance.
  • Domain 4: Change. Balancing the need for evidence with an acceptable pace of change was highlighted in many discussions. Stronger focus on sustainability and scale-up is needed.

Participants at the meeting agreed that capitalizing on the wealth of information and experience already available and fostering understanding, continuous dialogue and collaboration among actors within and across countries are essential. The recently published compendium of initiatives to transform service delivery, which is part of the implementation package for the Framework, with case profiles from all 53 Member States, provides a starting point for sharing ideas. The global "integratedcare4people" web-based platform, to be launched during the Sixty-ninth World Health Assembly in May 2016, will provide another avenue for networking and information-sharing throughout the Region. 

The European Framework for Action resulting from this consultation will be presented at the 66th session of the WHO Regional Committee for Europe in September 2016. It will represent a significant milestone in strengthening people-centred health systems in the European Region, as set out in Health 2020.