SIXTY-NINTH WORLD HEALTH ASSEMBLY
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Provisional agenda item 16.1
15 April 2016
Framework on integrated,
people-centred health services
Report by the Secretariat
1. The Executive Board at its 138th session in January 2016 noted an earlier version of this report,
1
and adopted resolution EB138.R2. The report has been updated (particularly paragraphs 15, 16 and
18−20) in the light of comments made during the Board’s discussion.
2. Despite significant advances in people’s health and life expectancy in recent years, relative
improvements have been unequal among and within countries. Globally, more than 400 million people
lack access to essential health care.
2
Where it is accessible, care is too often fragmented or of poor
quality, and consequently the responsiveness of the health system and satisfaction with health
services
3
remain low in many countries. For example, fragile and poorly integrated health systems
were crucial contributors to the Ebola virus disease outbreaks in West Africa, and continued lack of
connection between health systems and strengthening capacities within the International Health
Regulations (2005) leaves other countries vulnerable.
3. Many countries still face significant problems of unequal geographical access to health services,
shortages of health workers and weak supply chains. Even for high priority conditions such as
maternal and child health, coverage of basic services (for example, antenatal care and presence of a
skilled birth attendant at delivery) remains low in many countries.
4
Continuity of care is also poor for
many health conditions owing to weak referral systems. The focus on hospital-based, disease-based
and self-contained “silo” curative care models further undermines the ability of health systems to
provide universal, equitable, high-quality and financially sustainable care. Service providers are often
unaccountable to the populations they serve and therefore have limited incentive to provide the
responsive care that matches the needs of their users. People are often unable to make appropriate
decisions about their own health and health care, or exercise control over decisions about their health
and that of their communities.
1
See document 138/37 and the summary record of the Executive Board at its 138th session, tenth meeting, section 2
(document EB138/2016/REC/2).
2
WHO, The World Bank. Tracking universal health coverage: first global monitoring report. Geneva: World Health
Organization; 2015, available online at: http://apps.who.int/iris/bitstream/10665/174536/1/9789241564977_eng.pdf?ua=1,
accessed 4 April 2016.
3
Definition: health services: health services include all services dealing with the promotion, maintenance and
restoration of health. They include both personal and population-based health services.
4
Countdown to 2015: maternal, newborn and child survival. Country profiles. Available at: http://www.countdown
2015mnchcountdown2015mnch.org/country-profiles, accessed 4 April 2016.
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4. Making progress towards the United Nations’ Sustainable Development Goal 3 (Ensure health
lives and promote well-being for all at all ages), including target 3.8 on universal health coverage,
requires countries to move towards ensuring that all people and communities have access to health
services that are high quality, safe and acceptable. Cost-efficient, effective approaches to service
delivery must be maximized for this to be attainable and sustainable. An integrated,
1
people-centred
2
approach is crucial to the development of health systems that can respond to emerging and varied
health challenges, including urbanization, the global tendency towards unhealthy lifestyles, ageing
populations, the dual disease burden of communicable and noncommunicable diseases, multi-
morbidities, rising health care costs, disease outbreaks and other health-care crises.
5. Developing more integrated people-centred care systems has the potential to generate
significant benefits to the health and health care of all people, including improved access to care,
improved health and clinical outcomes, better health literacy and self-care, increased satisfaction with
care, improved job satisfaction for health workers, improved efficiency of services, and reduced
overall costs.
6. In 2009, the Health Assembly adopted resolution WHA62.12, urging improvements in primary
health care and health system strengthening and requesting the Director-General to prepare
implementation plans for the four broad policy directions, including putting people at the centre of
service delivery, and to ensure that these plans span the work of the entire Organization. In addition,
resolution WHA64.9 (2011) on sustainable health financing structures and universal coverage,
adopted in 2011, urges Member States to continue, as appropriate, to invest in and strengthen the
health-delivery systems, in particular primary health care and services, in order to ensure that all
citizens have equitable access to health care, and to ensure that overall resource allocation strikes an
appropriate balance between health promotion, disease prevention, rehabilitation and health-care
provision. United Nations’ General Assembly resolution 64/265 in 2010 on prevention and control of
non-communicable diseases and the subsequent high-level meeting on the prevention and control of
non-communicable diseases (New York, 19–21 September 2011)
3
recommended a focus on primary
care to deliver “prioritized packages of essential interventions”. Moreover, the General Assembly in
its ensuing Political Declaration inter alia encouraged the supporting of primary health care and the
empowerment of people for self-care.
7. Strategic documents and resolutions from all WHO regions and regional committees also call
for a more integrated, people-centred approach to health service delivery. These include the “Road
map for scaling up the human resources for health for improved health service delivery in the African
Region 2012–2025” endorsed by the Regional Committee for Africa in resolution AFR/RC62/R3;
1
Definition: integrated health services: health services that are managed and delivered so that people receive a
continuum of health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation and palliative
care services, coordinated across the different levels and sites of care within and beyond the health sector, and according to
their needs throughout the life course.
2
Definition: people-centred care: an approach to care that consciously adopts individuals’, carers’, families’ and
communities’ perspectives as participants in, and beneficiaries of, trusted health systems that are organized around the
comprehensive needs of people rather than individual diseases, and respects social preferences. People-centred care also
requires that patients have the education and support they need to make decisions and participate in their own care and that
carers are able to attain maximal function within a supportive working environment. People-centred care is broader than
patient and person-centred care, encompassing not only clinical encounters, but also including attention to the health of
people in their communities and their crucial role in shaping health policy and health services.
3
Report of the Secretary-General, document A/66/83
(http://www.un.org/en/ga/search/view_doc.asp?symbol=A/66/83&Lang=E, accessed 4 April 2016).
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resolution CD49.R22 on integrated health service delivery networks based on primary health care and
resolution DC52/5 on social protection as well as the “Strategy for universal access to health and
universal health coverage” in the Region of the Americas; the regional strategy for universal health
coverage endorsed by the Regional Committee for South-East Asia in resolution SEA/RC65/R6;
“Health 2020” (adopted in resolution EUR/RC62/R4) and “Towards people-centred health systems: an
innovative approach for better health systems”
1
in the European Region; resolution EM/RC60/R.2 on
universal health coverage, which calls for the expansion of the provision of integrated people-centred
health services that address the major burden of ill-health and are based on primary health care, and
the “Framework for action on advancing universal health coverage in the Eastern Mediterranean
Region”;
2
and resolution WPR/RC58.R4 which endorsed the policy framework on people-centred
health care as a guide for Member States to develop and implement people-centred health care policies
and interventions according to their national contexts and the action framework on human resources
for health in the Western Pacific Region 2011–2015.
3
8. In response, the Secretariat began an organization-wide collaboration in 2013 to produce a
framework on integrated, people-centred health services. A consortium of leading research institutions
was commissioned to produce a draft which was reviewed by Member States and experts from the
donor community, civil society representatives, representatives from research institutions and the
Secretariat in October 2013, resulting in the completion of a second draft by end of April 2014. The
interim framework on integrated, patient centred health services report was published in March 2015,
after further consideration in the light of the draft global strategy on human resources for health:
Workforce 2030.
4
9. The interim report was reviewed through an extensive consultation process, including: a web-
based public consultation open to individuals and organizations and regional and Member State
consultations. The Secretariat has collated the relevant input in order to update the framework.
Respondents have shown extensive support for the proposed vision, the strategies and the
implementation approach.
10. Pursuant to resolution WHA62.12 on primary health care, including health system strengthening
and other related resolutions, this framework proposes five interdependent strategies for health
services to become more integrated and people-centred. It calls for reforms to reorient health services,
putting individuals, families, carers and communities at their centre, supported by responsive services
that better meet their needs, and that are coordinated both within and beyond the health sector,
irrespective of country setting or development status. These reforms also incorporate a human rights
approach, enshrining access to health care as a basic right, without distinction of ethnicity, religion,
gender, age, disability, political belief, and economic or social condition.
1
WHO Regional Office for Europe. Towards people-centred health systems: an innovative approach for better health
systems. Copenhagen, Regional Office for Europe available at http://www.euro.who.int/__data/assets/pdf_file/0006/186756/
Towards-people-centred-health-systems-an-innovative-approach-for-better-health-outcomes.pdf, accessed 4 April 2016.
2
http://applications.emro.who.int/docs/Technical_Notes_EN_16287.pdf, accessed 4 April 2016.
3
http://www.wpro.who.int/hrh/documents/HRH_Action_Framework.pdf, accessed 4 April 2016.
4
The full draft framework along with its accompanying “overview of the evidence” document can be accessed on the
WHO website, at http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/ (accessed 4 April 2016).
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FRAMEWORK ON INTEGRATED PEOPLE-CENTRED HEALTH SERVICES IN
BRIEF
1
11. The draft framework sets forth a compelling vision in which “all people have equal access to
quality health services that are co-produced
2
in a way that meets their life course needs, are
coordinated across the continuum of care, and are comprehensive, safe, effective, timely, efficient and
acceptable; and all carers are motivated, skilled and operate in a supportive environment”. The
framework is based on experience and evidence gained recently in different countries and
wide-ranging consultation with experts at the global, regional and national levels, informed by related
global policy commitments, regional strategies and initiatives in the area of universal health coverage,
health systems strengthening, social determinants of health, and the core values and principles of
primary health care: the right to health, social justice, solidarity and participation.
12. Realization of integrated people-centred health services will depend on health system inputs,
including the availability, accessibility and quality of health workers and the services they provide.
The draft global strategy on human resources for health outlines the medium-term actions needed to
ensure equitable access to a skilled and motivated health workforce within a fully functioning health
system. As such, efforts have been made to form firm links between the framework on integrated,
people-centred health services and the global strategy, including aligning human resources for health
investment frameworks at national and global levels to future needs of health systems. Integrated,
people-centred health services require particular health workers with relevant skills. In addition to the
benefits to communities and populations, the benefits of an integrated people-centred care approach
also extend to health workers, including: improved job satisfaction; more balanced workloads and
fewer instances of burnout; and education and training opportunities to learn new skills, such as
working in team-based health care environments.
13. For the development of this framework, four different types of country settings have been
analysed: low-, middle- and high-income countries, and countries facing special circumstances, such
as conflict, and fragile States, small island States and large federal States. Given that health systems
are highly context-specific, the framework does not propose a single model of people-centred and
integrated health services. Instead, it proposes five interdependent strategies that need to be adopted.
STRATEGIES, POLICY OPTIONS AND INTERVENTIONS
14. The five interdependent strategies are: (1) empowering and engaging people and communities;
(2) strengthening governance and accountability; (3) reorienting the model of care; (4) coordinating
services within and across sectors; and (5) creating an enabling environment. Attainment of these five
strategies cumulatively will help to build more effective health services; lack of progress in one area
will potentially undermine progress in other areas.
1
See http://www.who.int/servicedeliverysafety/areas/people-centred-care/en/ (accessed 4 April 2016).
2
Definition: co-production of health: care that is delivered in an equal and reciprocal relationship between
professionals, people using care services, their families and the communities to which they belong. It implies a long-term
relationship between people, providers and health systems where information, decision-making and service delivery become
shared.
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15. Action towards each strategy is intended to have an influence at different levels – from the way
services are delivered (to individuals, families and communities) to changes in the way organizations,
care systems and policy-making operate. Strategic approaches, potential policy options and
interventions are detailed in the Table for the attainment of each strategy. Some of these potential
policy options and interventions are cross-cutting for several strategic approaches. This
non-exhaustive list has been drafted on the basis of literature reviews, input from technical
consultations and expert opinion; it does not constitute a set of evidence-based guidelines for reform,
as the evidence base for some of these policies and interventions is not fully established. Moreover,
the appropriate mix of policies and interventions to be used at the country level will need to be
designed and developed according to the local context, values and preferences.
Table. Strategies, policy options and interventions for the framework on integrated,
people-centred health services
Strategy 1: Empowering and engaging people and communities
Strategic approach
Policy options and interventions
1.1 Empowering and engaging individuals and families. In
order to achieve better clinical outcomes through co-production
of care, particularly for noncommunicable and chronic diseases,
individuals and families need to be active participants. This step
is fundamental because people themselves will spend the most
time living with and responding to their own health needs and
will be the ones making choices regarding healthy behaviours
and their ability to self-care. Empowerment is also about care that
is delivered in an equal and reciprocal relationship between, on
the one hand, clinical and non-clinical professionals and, on the
other, the individuals using care services, their families, and
communities, thereby improving their care experience.
• health education
1
• informed consent
• shared clinical decision making between
individual, families, carers and providers
• self-management including personal care
assessment and treatment plans
• knowledge of health system navigation
1.2 Empowering and engaging communities. This approach
will enable communities to voice their needs and so influence the
way in which care is funded, planned and provided. It will help to
build confidence, trust, mutual respect and the creation of social
networks, because people’s physical and mental well-being
depends on strong and enduring relationships. It strengthens the
capacity of communities to organize themselves and generate
changes in their living environments.
• community delivered care
• community health workers
• development of civil society
• strengthened social participation in health
1
Definition: health education: any combination of learning experiences designed to help individuals and
communities improve their health, by increasing their knowledge or influencing their attitudes.
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1.3 Empowering and engaging informal carers. Family
members and other care-givers play a critical role in the provision
of health care. Carers must receive adequate training in order to
be able to provide high quality interventions, and to serve as
advocates for the recipients of care, both within the health system
and at the policy level. Additionally, carers have their own needs
for personal fulfilment and require emotional support to sustain
their role.
• training for informal carers
• informal carer networks
• peer support and expert patient groups
• caring for the carers
• respite care
1.4 Reaching the underserved and marginalized. This
approach is of paramount importance for guaranteeing universal
access to quality health services. It is essential for fulfilling
broader societal goals such as equity, social justice and solidarity,
and helps to create social cohesion. It requires actions at all levels
of the health sector, and concerted action with other sectors and
all segments of society, in order to address the other determinants
of health and health equity.
• integration of health equity goals into
health sector objectives
• provision of outreach services for the
underserved including mobile units,
transport systems and telemedicine
• outreach programmes for
disadvantaged/marginalized populations,
who may not receive effective coverage
owing to barriers linked to factors that
include income, education, residence,
gender, ethnicity, working conditions or
migrant status
• contracting out of services when
warranted
• expansion of primary care-based systems
Strategy 2: Strengthening governance and accountability
Strengthening governance requires a participatory approach to policy formulation, decision-making and
performance evaluation at all levels of the health system, from policy-making to the clinical intervention level.
Good governance is transparent, inclusive, reduces vulnerability to corruption and makes the best use of
available resources and information to ensure the best possible results. Good governance is reinforced by a
robust system for mutual accountability among policy-makers, managers, providers and users and by incentives
aligned with a people-centred approach. Establishing a strong policy framework and a compelling narrative for
reform will be important to building a shared vision, as well as setting out how that vision will be achieved.
Strategic approach
Policy options and interventions
2.1 Bolstering participatory governance. Robust governance
mechanisms are needed in order to achieve a coherent and
integrated approach in health care policy, planning and delivery
at all levels of the health system. Governments need to take
responsibility for protecting and enhancing the welfare of their
populations and to build trust and legitimacy with citizens
through effective stewardship. The stewardship role of the health
ministry is essential for good governance in health, and involves
the identification and participation of community stakeholders so
that voices are heard and consensus is achieved. It is also needed
to ensure that the different goals of donor agencies and vertical
programmes tackling specific diseases do not hinder the ability of
health systems to focus on community health and well-being for
all.
• community participation in policy
formulation and evaluation
• community representation at health care
facilities’ boards
• national health policies, strategies and
plans promoting integrated people-
centred health services
• strengthened health services governance
and management at subnational, district
and local levels
• harmonization and alignment of donor
programmes with national policies,
strategies and plans
• decentralization, where appropriate, to
local levels
• comprehensive planning across the
public/private sector
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• strengthened stewardship role of the
health ministry in respect of non-State
actors
• clinical governance
2.2 Enhancing mutual accountability. Essentially, this means
answerability of decision-making, and encompasses both the
“rendering of the account” (that is, providing information about
performance) and the “holding to account” (namely, the
provision of rewards and sanctions). Strengthening accountability
of health systems requires joint action at all levels to improve
services organization and delivery, health policy in health and
non-health sectors, public and private sectors, and people,
towards a common goal.
• health rights and entitlement
• provider report cards
• patient satisfaction surveys
• patient reported outcomes and balanced
scorecard
• performance based financing and
contracting
• population registration with accountable
care provider(s)
Strategy 3: Reorienting the model of care
Strategic approach
Policy options and interventions
3.1 Defining service priorities based on life course needs.
This approach means appraising the package of health services
offered at different levels of the care delivery system based on
the best available evidence, covering the entire life course. It uses
a blend of methods to understand both the particular health needs
of the population, including social preferences, and the cost-
effectiveness of alternative health interventions, guiding decision
making on allocation of resources to health care. It also includes
health technology assessment.
• local health needs assessment based on
existing patterns of communicable and
noncommunicable diseases
• comprehensive packaging of services for
all population groups defined by means of
a participatory and transparent process
• strategic purchasing
• gender, cultural and age-sensitive
services
• health technology assessment
3.2 Revaluing promotion, prevention and public health. This
approach means placing increased emphasis and resources on
promotive, preventive and public health services. Public health
systems include all public, private, and voluntary entities that
contribute to the delivery of essential public health functions
within a defined geographical area.
• monitoring population health status
• population risk stratification
• surveillance, research and control of risks
and threats to public health
• improved financial and human resources
allocated to health promotion and disease
prevention
• public health regulation and enforcement
3.3 Building strong primary care-based systems. Strong
primary care services are essential for reaching the entire
population and guaranteeing universal access to services.
Building such services involves ensuring adequate funding,
appropriate training, and connections to other services and
sectors. This approach promotes coordination and continuous
care over time for people with complex health problems,
facilitating intersectoral action in health. It calls for
interprofessional teams to ensure the provision of comprehensive
services for all. It prioritizes community and family-oriented
models of care as a mainstay of practice with a focus on disease
prevention and health promotion.
• primary care services with a family and
community-based approach
• multidisciplinary primary care teams
• family medicine
• gatekeeping to access other specialized
services
• greater proportion of health expenditure
allocated to primary care
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3.4 Shifting towards more outpatient and ambulatory care.
Service substitution is the process of replacing some forms of
care with those that are more efficient for the health system. The
approach means finding the right balance between primary care,
specialized outpatient care and hospital inpatient care,
recognizing that each has an important role within the health care
delivery system.
• home care, nursing homes and hospices
• repurposing secondary and tertiary
hospitals for acute complex care only
• outpatient surgery
• day hospitals
• progressive patient care
3.5 Innovating and incorporating new technologies. Rapid
technological change is enabling the development of increasingly
innovative care models. New information and communication
technologies allow new types of information integration. When
used appropriately, they can assure continuity of information,
track quality, facilitate patients’ empowerment and reach
geographically isolated communities.
• shared electronic medical record
• telemedicine
• mHealth
Strategy 4: Coordinating services within and across sectors
Services should be coordinated around the needs and demands of people. This result requires integration of
health care providers within and across health care settings, development of referral systems and networks
among levels of care, and the creation of linkages between health and other sectors. It encompasses intersectoral
action at the community level in order to address the social determinants of health and optimize use of scarce
resources, including, at times, through partnerships with the private sector. Coordination does not necessarily
require the merging of the different structures, services or workflows, but rather focuses on improving the
delivery of care through the alignment and harmonizing of the processes and information among the different
services.
Strategic approach
Policy options and interventions
4.1 Coordinating care for individuals. Coordination of care is
not a single activity, but rather a range of strategies that can help
to achieve better continuity of care and enhance the patient’s
experience with services, particularly during care transitions. The
focus for improvement is on the delivery of care to the individual,
with services coordinated around their needs and those of their
families. This approach also covers improved information flows
and maintenance of trustworthy relationships with providers over
time.
• care pathways
• referral and counter-referral systems
• health navigators
• case management
• improved care transition
• team-based care
4.2 Coordinating health programmes and providers. This
approach includes bridging the administrative, informational and
funding gaps between levels of care and providers. This involves
sector components such as pharmaceutical and product safety
regulators, information technology teams working with disease
surveillance systems, allied health teams delivering treatment
plans in collaboration with each other, disease-specific laboratory
services linked to broader services improvement, and provider
networks focused on closer relationships in patient care.
• regional or district-based health service
delivery networks
• purchasing integrated services
• integrating vertical programmes into
national health systems
• incentives for care coordination
4.3 Coordinating across sectors. Successful coordination in
health matters involves multiple actors, both within and beyond
the health sector. It encompasses sectors such as social services,
finance, education, labour, housing, the private sector and law
enforcement, among others. It necessitates strong leadership from
the health ministry to coordinate intersectoral action, including
coordination for early detection and rapid response to health
crises.
• health in all policies
• intersectoral partnerships
• merging of health sector with social
services
• working with education sector to align
professional curriculum towards new
skills needed
• integrating traditional and complementary
medicine with modern health systems
• coordinating preparedness and response
to health crises
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Strategy 5: Creating an enabling environment
In order for the four previous strategies to become an operational reality, it is necessary to create an enabling
environment that brings together all stakeholders to undertake transformational change. This complex task will
involve a diverse set of processes to bring about the necessary changes in leadership and management,
information systems, methods to improve quality, reorientation of the workforce, legislative frameworks,
financial arrangements, and incentives.
Strategic approach
Policy options and interventions
5.1 Strengthening leadership and management for change.
New forms of collaborative leadership that help to bring together
multiple stakeholders are needed for successful reform of health
services. All health care professionals, and especially clinicians,
need to be engaged in management and leadership for change in
continuous partnership with local communities. Achieving
people-centred and integrated care requires the application of
complex processes and service innovations that warrant an
underlying change management strategy.
• transformational and distributed
leadership
• change management strategies
5.2 Strengthening information systems and knowledge
management. Development of information systems and an
organizational culture that supports monitoring and evaluation,
knowledge sharing and using data in decision-making is also a
prerequisite for transformational change.
• development of information systems
• systems research
• knowledge management
5.3 Striving for quality improvement and safety. Institutions
and providers need to strive constantly for quality improvement
and safety. These efforts include both technical and perceived
quality.
• quality assurance
• creating a culture of safety
• continuous quality improvement
5.4 Reorienting the health workforce. Special attention needs
to be given to readying the health workforce with an appropriate
skills mix in order equitably and sustainably to meet population
health needs. Health workers must be organized around teams
and supported with adequate processes of work, clear roles and
expectations, guidelines, opportunities to correct competency
gaps, supportive feedback, fair wage, and a suitable work
environment and incentives.
• tackling health workforce shortages and
maldistribution
• health workforce training
• multi-professional teams working across
organizational boundaries
• improving working conditions and
compensation mechanisms
• provider support groups
• strengthening professional associations
5.5 Aligning regulatory frameworks. Regulation plays a key
role in establishing the rules within which professionals and
organizations must operate within more people-centred and
integrated health systems – for example, in terms of setting new
quality standards and/or paying against performance targets.
• aligning regulatory framework
5.6 Improving funding and reforming payment systems.
Changes in the way care is funded and paid for are also needed to
promote adequate levels of funding and the right mix of financial
incentives in a system that supports the integration of care
between providers and settings and protection of patients against
undue out-of-pocket expenditures on health.
• assuring sufficient health system
financing and aligning resource allocation
with reform priorities
• mixed payment models based on
capitation
• bundled payments
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IMPLEMENTATION APPROACH
16. The lessons of history need to be acknowledged: the successful reorientation of health services
will most likely be a long journey and will need sustained political commitment. Ultimately, each
country or local jurisdiction needs to set its own goals for integrated and people-centred health
services, and develop its own strategies for achieving these goals. The strategies must respond to the
local context, existing barriers and the values held by people within the State or area, and should be
achievable given the current health service delivery system and the financial and political resources
available. Efforts should primarily concentrate on improving access to services for underserved and
marginalized populations, on placing increased emphasis and resources on promotive, preventive and
public health services and on strengthening district-level health services, among others. Given that this
framework is fundamentally transformative in its implications for the future of health systems, system
leaders must adopt strategies for change to ensure the effective alignment of strategies and processes
that promote people-centred and integrated care. Delivering high-quality, people-centred care and
integrated health services requires the creation and nurturing of collective engagement, commonly-
held values, effective communication and transparency. The implementation approach, therefore, of
this framework is as follows:
(a) Country-led: strategies for pursuing integrated people-centred health services should be
developed and led by countries, with external support where necessary, and should respond to
local conditions and contexts.
(b) Equity-focused: efforts to enhance equity are a necessary part of people-centred and
integrated health care strategies. Efforts can target immediate factors driving inequitable service
utilization, but may also address more fundamental social determinants.
(c) Participatory: the notion of people-centred and integrated health services puts informed
and empowered people at the centre of the health system. Therefore, processes to develop
national strategies for such services should ensure accountability to local stakeholders and,
especially, to disadvantaged populations.
(d) Systems strengthening: service delivery depends on effective information and financing
systems, and the availability of skilled and motivated health workers. Changes made to service
delivery will inevitably have ramifications across the entire health system.
(e) Evidence-based practice with iterative learning/action cycles: decisions at all levels
should be based on the best available evidence. Quality improvement methodology shows that
success is most likely when there are iterative learning and action cycles that track changes in
the service delivery system, identify emerging problems and bring stakeholders together to
solve them.
(f) Results-oriented: a key focus should be on the ongoing monitoring of progress through
specific and measurable objectives and results.
(g) Ethics-based: by making sure that care optimized the risk benefit ratio in all interventions,
respects the individual’s right to make informed and autonomous decisions, safeguards privacy,
protects the most vulnerable, and ensures the fair distribution of resources.
(h) Sustainable: planning, managing and delivering care that is equitable, efficient, effective
and that contributes to long-term development in a sustainable manner.
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THE ROLE OF STAKEHOLDERS
17. The role of stakeholders in this framework is as follows:
(a) Member States: countries committed to moving towards people-centred and integrated
health services should develop and communicate a clear vision, setting sound strategies and
regulatory frameworks that facilitate the way towards their achievement. This process needs to
be country-led and involves co-production between all government sectors, providers and the
people that they serve. Governments need to secure adequate funding for reform and
implementation research. This process has to be replicated at both subnational and local levels.
(b) Individuals, families and communities: They constitute the main focus of attention of the
framework. Policy formulation, health services organization and co-production of health
services should be developed and implemented in partnership with individuals, families and
communities.
(c) Civil society organizations: as representatives of patients, families, communities and
carers, these organizations have an important role to play in advocating for more people-centred
and integrated health services, as well as in empowering their members to be able to better
manage their own health concerns and engage with the health system.
(d) Health service providers: these constitute a fundamental component of the framework.
Policy formulation, health services organization and co-production of health services should be
developed and implemented in partnership with service providers, as in the case of individuals,
families and communities.
(e) Academic, training and research institutions: these bodies have an important role to play
in developing new professional curricula for the health workforce, training the health workforce,
and conducting health systems and implementation research efforts.
(f) Professional and students associations: these organizations can play important roles in
adopting and endorsing new practices, and in providing support to their members.
(g) Private sector: regulatory steps should be taken to assure that reforms to increase care
integration and people-centredness apply equally to public and private service providers,
including for profit, non-for-profit, and faith-based organizations. Partnerships with private
sector industry, such as pharmaceutical and medical device industries, can also be pursued when
appropriate.
(h) Health insurers: these entities should guarantee sufficient financing for service delivery
reform and reorient payment systems and purchasing practices to incentivise more integrated,
people-centred approaches to care.
(i) Development partners: these should, except under exceptional circumstances where rapid
or unique action is required, seek to integrate their support to health service delivery into
countries’ own health systems. They can also help to share technical knowledge about different
approaches to promoting more people-centred and integrated services.
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(j) Secretariat: the role of the Secretariat will be to drive policies that can support the
development of people-centred and integrated health services across the world. The adoption of
integrated people-centred health services, and the five key strategies identified in this
framework, will therefore require sustained advocacy and technical cooperation efforts.
PROGRESS MONITORING
18. As the framework represents a new programme of work for WHO, there are no universally
utilized indicators to measure progress in establishing integrated people-centred health services. The
Global Health Observatory, the monitoring and evaluation frameworks for universal health coverage
and the Sustainable Development Goals, and the Global Reference List of 100 Core Health Indicators
1
– none includes measures of integration or people-centredness. Given this situation, the framework
proposes performing research and development on indicators to track global progress on integrated
people-centred health services. This effort will convene international partners to develop appropriate
metrics for these critical, but less frequently measured domains of health care.
19. The elaboration of these indicators will facilitate the development of the medium- and long-
term goals and targets that are needed to monitor progress in the implementation of the framework at
the global, regional and national levels.
ACTION BY THE HEALTH ASSEMBLY
20. The Health Assembly is invited to adopt the draft resolution recommended by the Executive
Board in resolution EB138.R2.
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1
See http://www.who.int/healthinfo/indicators/2015/en/, accessed 4 April 2016.