What it is
What others have done
What to ask
How to succeed

What is coordination and why is it important?

Care coordination is defined by the appropriate management of care between providers and across all levels of care and time, including community-based services. 567 Systems that achieve strong coordination of care facilitate appropriate treatment and follow-up and have resultant reductions in unnecessary care and readmissions. 567 Coordination of care relies on proactive outreach on the part of health care teams and robust information and communication systems within and across levels of care.  Listed below are central questions for stakeholders to consider when planning and implementing system reforms and interventions that prioritize coordination:

  • What are some barriers to coordination?
  • In what ways can systems support coordination?
  • What policies, strategies, and infrastructure should be in place to support coordinated care?

Coordination is an important function for creating the linkages between health and nonhealth sectors and networks within and among levels of care (i.e. horizontal and vertical integration) that support PHC in effectively meeting the complex needs of patients throughout their life course. 8 Coordination should be prioritized alongside first contact accessibility, continuity, coordination, and person-centeredness to strengthen and deliver high-quality primary health care for all. 59

  • Fragmentation in healthcare delivery refers to the systematic misalignment of incentives that lead to downstream inefficiencies, such as the poor or inefficient allocation of resources, that disrupt care and can harm patients. 10  Fragmentation often reflects a lack of coordination across levels of care, a roadblock to the delivery of high-quality primary health care. 11 Fragmented health systems adversely affect the quality and cost of care, leading to a loss of continuity and low rates of user satisfaction 111213 Coordinated systems require the integration of providers across and beyond the health sector, strong information systems and two-way referral networks within and across levels of care, and multisectoral and intersectoral collaboration. 14

    At the health system level

    Certain characteristics of the broader health system can inhibit coordination. Competing market incentives among key actors (insurers, providers, and health authorities), for instance payment systems that compensate providers for multiple point-of-care interaction,  can disincentivize collaboration and lead to fragmented coordination networks. To promote coordination at the system-level, policymakers must recognize the potential for interfering political and economic interests and restructure market incentive structures and partnerships to promote collaboration. 15 To sustain coordination efforts, policies governing the function of primary care systems should be protected from turnovers in political leadership and conflicts of interest. 15

    Across and within health networks

    The characteristics of a health system can promote or constrain coordination at the point of care 15 Characteristics that lead to poor working conditions (temporary and/or part-time contracts, insufficient time, fee-for-service pay) and inadequate opportunities for professional development can damage provider motivation and competence to collaborate and coordinate with each other. 1617 In addition, robust information systems must be in place to strengthen coordination and comprehensiveness across the continuum of care. Users can learn more about effective information systems in the Information Systems and Information Systems Use modules.

  • Health systems transformation: integrated care at the frontline

    As put forth by the WHO Framework on Integrated People-Centered Health Services, care should be coordinated around the comprehensive needs of people, taking into account the political, economic, social, and environmental determinants of health. Reoriented care coordination with PHC as the foundation requires a shift toward a community-based and collaborative model of care that is designed to support the complex needs of the patient at the frontline. The frontline comprises the primary health care system and network of frontline health workers and institutions that serve as a patient’s first-contact points with the health system. It also includes channels outside of the formal health infrastructures that empower patients and communities in the co-production of their health and well-being, such as social workers and psychologists. 18 In a PHC-oriented system, the person is at the center of the system, with the majority of their needs met at the frontline. Intersectoral collaborations and networks with the broader health system support PHC in the effort to achieve the best possible health outcomes for a person 22122 Two-way refferals and robust communication networks with the broader health system and/or other sectors 18 aid in appropriate treatment and continuity of care. 19 Two-way referral systems is discussed in greater depth in what policies, strategies, and infrastructure should be in place to support coordinated care: referral management systems.

    Integration helps to promote coordination in service of comprehensiveness by bridging and aligning the skills, services, and resources necessary to meet the complex needs and demands of patients. Integrated health services are managed and delivered so that patients receive a comprehensive set of services (promotive, disease-management, preventative, behavioral, rehabilitative) throughout their life course, coordinated across different levels of care and care settings within and beyond the health sector. 14 To promote integrated service delivery at the frontline, coordination mechanisms should promote linkages between PHC and other sectors either directly involved in the delivery of primary health care, such as private primary care providers, or partnerships with other non-health sectors which harness the potential to increase the capacity of the primary care system to meet the needs and demands of people and communities. In addition, effective coordination mechanisms promote intersectoral action at the community level to address the social determinants of health and ensure the appropriate use of resources, especially in poor-resource settings. 20 The WHO Technical Series Document on Integrating Health Services outlines four avenues for integration with primary care as the hub for service delivery below:

    • Integrating primary care and public health: discussed in greater depth in Comprehensiveness: proactive comprehensive care
    • Integrating primary, secondary and tertiary care: discussed in greater depth in the sections below on vertical and horizontal integration, with case studies in Coordination: What others have done
    • Integrating dedicated health initiatives into primary care: discussed in greater depth in Primary Health Care Policies
    • Integrating sectors: discussed in greater depth in below in coordinating services within and across sectors and private sector participation and engagement

    Integration requires the sustained support of communities and stakeholders at the local, regional, and national level. Steps to integration are country-specific and will depend on the capacity of the system (including the availability of resources and political will) to support integrated service delivery. 21 To enable multisectoral collaboration, coordination efforts must be of mutual benefit to all involved sectors. Conflicting interests, competition for limited resources, and a lack of collaborative thinking among actors challenge the creation and sustainability of policies and initiatives that promote coordination. 2223

    To improve the delivery of care through coordination mechanisms, the WHO Framework on Integrated People-Centered Health Services outlines a range of strategies, policy options, and interventions designed to integrate care providers within and across levels of care, develop referral systems and care networks, and create multi and intersectoral linkages. More information on optimizing care coordination to support the WHO Framework on Integrated People-Centered Health Services can be found in the WHO practice brief on continuity and coordination of care. Additional strategies for multisectoral and intersectoral collaboration are accessible in the WHO report on multi and intersectoral action for improved health and well-being for all.  

    Coordinating across levels of care through vertical and horizontal integration

    To promote better coordination of care, health systems can adopt horizontal and vertical integration strategies. Comprehensive integration achieves a balance of both horizontal and vertical integration. 24

    Horizontal integration involves collaboration across sectors to promote the delivery of comprehensive primary care. By creating linkages within and beyond the health sector, horizontal integration helps to optimize the use of resources and better meet the comprehensive needs of populations. 14 In this way, coordinating proactive outreach and service delivery efforts can help to promote the more efficient use and management of a comprehensive set of services. 25 More information on multi-sectoral and intersectoral action for health is found in the next subheading, coordinating services within and across sectors.

    Vertical integration involves redefining the role and interactions among primary, secondary, and tertiary facilities to promote coordination and service delivery across levels of care. Most initiatives in vertical integration are conceptualized in terms of referral systems. 26 A variety of bureaucratic obstacles challenge referral systems including provider divisions, differing priorities among levels of care, and distinct administrative and budgeting processes. 26 To promote primary care as the first point of contact, referral systems should align with empanelment and gatekeeping structures in place, and promote bidirectional referrals. Strategies to strengthen vertical integration to ensure coordination and continuity can be categorized along three dimensions: 25

    • Redefining facility roles within a vertically integrated network: Redefining the roles of actors will require collaboration and cooperation among health facilities at different levels of the health care system. This process will help to define the range of services facilities will provide and how facilities will support each other across levels of care through supervision mechanisms, technical assistance, and partnerships (such as accountable care organizations). Clearly defined contracts, payment, and incentive structures should be in place.
    • Strengthen relationships among providers: Skill building and technical training opportunities may help to improve the quality of care and competency of providers in facilities, establish interfacility relationships, and promote communication networks across levels of care.
    • Develop formalized facility networks based on the 3-in-1 principle: The 3-in-1 principle redefines the role and interactions among facilities toward a common goal based on “one-system-one population-one pot of resources”. Highly developed networks offer a broad continuum of care across all service lines, enabled through information technology (eHealth) tools.

    Vertical integration is resource-intensive and contingent on the operations of a coordinated system across levels of care, making it difficult to facilitate in low-resource settings lacking strong referral networks and information systems. Additional information on financial, institutional, and logistical barriers to vertical integration and ways forward are available via the JLN Vertical Integration Virtual Learning Exchange.

    Creating effective and efficient horizontal and vertical integration networks is resource and time intensive. Achieving coordination will require a long-term, system-wide commitment to collaboration across and within levels of care and an investment in resources (including strong information technology networks and workforce training programs) to create and sustain this system. More information on strengthening health systems through coordination can be found in the WHO Framework for Action Toward Coordinated/Integrated Health Services Delivery and the World Bank report on Health Reform in China More information on coordination activities and broad approaches to improve the delivery of care can be accessed in the Care Coordination Measures Atlas from the Agency for Healthcare Research and Quality.

    Private sector participation and engagement

    In health care systems with a large proportion of primary care delivery in the private sector, it is essential to ensure that coordination mechanisms are also linked with the private sector to promote continuity of care. However, there are many system-wide challenges and considerations to effective private-sector engagement. Stakeholders should consider the intention and benefit of the partnership, such as whether private services should be complementary or supplementary to public services, the regulatory capacity to oversee private sector development (at local, regional, and national level), and given the for-profit nature of private enterprises, the challenge of attracting private sector expansion in remote and underserved areas. 25 Central policy directives that promote greater private-public collaboration require robust regulatory and supervisory mechanisms, a shared vision for equitable high-quality primary care delivery, and incentives that level the playing field for the entry of the private sector (such as insurance reimbursements equal to public facilities, tax-policies) in both rural and urban areas. 25

    The Joint Learning Network for Universal Coverage has identified five steps to private-sector engagement including: preparing for dialogue with stakeholders by conducting stakeholder analysis, understanding and detailing rationales for engaging the private sector in PHC, actively listening to the private sector, finding areas of common ground and first steps for collaboration and trust, and establishing a regular consultative process with joint agenda setting. 27 Additional information on engaging the private sector and possible forms of partnership including a step-by-step guide to mapping private sector providers from the Joint Learning Network can be accessed here and in the WHO Technical Series Document on the Private Sector, Universal Health Coverage and Primary Care.

    Improve professional working conditions and skills

    As with any intervention or system that requires behavior change on the part of the provider, it is important for health systems to offer professional development opportunities and a motivating work environment. 15 Unsatisfactory working conditions (such as temporary and/or part-time contracts, insufficient time, inadequate remuneration) and limited professional training opportunities hinder coordination mechanisms by damaging provider motivation and attitudes toward collaboration. 1617 More information on building professional development offerings and fostering positive work environments can be accessed in provider motivation mechanisms, provider competence, team-based care organization, and facility management capability and leadership.

  • Care coordination activities and approaches for person-centered care

    As discussed above, the main goal of care coordination is to meet a patient’s needs and preferences in the delivery of high-quality care. In order to effectively coordinate services that are person-centered, patients and families should be full and active participants in their health. This is supported by coordination activities that help to facilitate the transfer of patient needs and preferences to all providers involved in their care, such as proactive care plans and complexity tools. 28 To achieve coordination of high-quality care, patient care activities and information should be well-organized and communicated at the right time and to the right people. 3 Two categories of interventions are commonly used to achieve coordinated care: 3

    • Broad care coordination approaches: Some examples include teamwork, care management (as addressed above), medication management, health information technology, and advanced team care (used to improve health care delivery)
    • Specific care coordination activities: Some examples include establishing accountability and agreeing on responsibility, communicating/sharing knowledge, helping with transitions of care, assessing patient needs and goals, creating a proactive care plan, linking to community resources, and working to align resources with patient and population needs

    To promote PHC-oriented health systems, care coordination activies should be designed primarily to support care of the patient delivered in their community at the grassroots level rather than localized care as the gateway to higher levels of care. As noted in first contact accessibility, primary care systems should be the first point of contact for the majority of a person’s health needs throughout their life course. 22122 In a health system with primary care as the first point of contact, primary care refers (to hospital or specialists) only those problems not manageable within the primary care setting and coordinates all of the care a person receives at different care settings and levels of care (i.e. specialists).

    Additional information on care coordination approaches and activities is described in greater detail in The Agency for Healthcare Research and Quality page on care coordination with links to actionable resources including the Care Coordination Quality Measure for Primary Care (CCQM-PC), a conceptual framework for care coordination, and the Care Coordination Measures Atlas.

    Interoperable Information Systems

    An effective, efficient, and integrated information system is vital to the performance of a health system. Poor transfer of patient information among providers, between patients and their care teams, and across levels of care and sectors leads to gaps in the communication of vital information that is essential to the provision of high-quality care 2930 Coordination relies on the ability of information systems to connect, in a coordinated manner, a wide range of data sources across different settings of care and sectors and reliably communicate this information at the right time and to the right people. 31 This includes the communication of information to higher-levels of care and back to the frontline to ensure continuity of information. The coordinated exchange of information, or interoperability, should enable all providers involved in a person’s care to access, exchange, and cooperatively use information with the goal to optimize the health and well being of a person. 1932 For this reason, it is important to ensure that strong information and communication systems are in place within and across levels of care so patient information is available at the right place and the right time to minimize disruptions in their care experience. 31 More information on strengthening information systems is found in the Information Systems and Information Systems Use modules.

    Referral management systems - closing referral loops

    Referral management systems are a type of information system that can contribute to improved care coordination. Referral management systems can reduce care fragmentation and improve the quality of referrals and transitions. In order to ensure safe and timely referrals or transitions, any referrals made to support patients beyond the scope of the primary care practice should be well-coordinated across the care continuum. 4 To achieve this, a two-way referral system should be in place. A two-way referral system is organized to establish effective communication between physicians within the same and at different levels of the health system. The provider receiving the referral is required to refer the patient back to the referring provider (ideally the patient’s primary care provider) with clear feedback on the care encounter, any treatment provided to the patient, and what needs follow-up and continued management. 19 The importance of two-way referrals must be emphasized and integrated into the daily practice of providers across all levels of care to ensure their consistent and effective use.

    Referral systems may exist at the national level and are often made up of a subset of regional referral networks. In order to effectively manage a referral system, the coverage (including the program or health area), scope (national versus local) and types of actors involved (private, public, primary care, specialty care) must be defined and aligned with logical referral pathways. 33 Defining a clear referral process helps to standardize the ways in which patient information is communicated to relevant providers and track information through appropriate channels over time and ensure a closed referral loop. Referral management systems should track denominators such as the number of referral units, the proportion of referrals fulfilled or not fulfilled, and information on why referrals were not fulfilled on both the patient and provider end (were patients unable to complete the referral due to geographic or financial barriers?). Closing the loop through referral management means tracking whether all relevant patient information is communicated in their care in a timely manner with the desired consultation note in the patient’s record following a referral. 3435

    The configuration of a referral system will vary by setting and range in complexity from a more linear referral system (primary care facilities referring to district hospitals) to a more complex referral system that makes referrals across services within the same facility and across levels of care. Data quality mechanisms with norms and protocols and ongoing training and supervision on the use of the referral system should be in place with standard referral indicators to ensure system performance and appropriate use. Stakeholders can look to the Referral Systems Assessment and Monitoring Toolkit for guidance on how to effectively assess and monitor the performance of referral systems. Additional information on referral systems can be found on the Institute for Healthcare Improvement’s webpage on Closing the Loop on Patient Referrals in Health Care and the Safety Net Medical Home Initiative presentation on Closing the Loop with Referral Management.

    Market incentivization of coordination in health systems and health networks

    Financial disincentives to collaborate (fee-for-service payments that incentivize secondary care) among different levels of care and different stakeholders (insurers, private and public providers, health authorities) can lead to a lack of interest and motivation to coordinate and hinder the capacity of health networks to implement effective coordination mechanisms. 153637 More information on incentivizing coordination mechanisms in the context of the health system and market structure of a nation will be discussed further in Health Financing, forthcoming.

    Strengthening the planning and supervision functions of health authorities

    The broader context and performance of a health system, including processes of organization and authority, the interaction of non-state actors, and local and national needs, influence what actors (at the local, regional, and national network) function to plan, organize, and manage health care networks and perform supervisory and regulatory roles. 15 In order to translate policy into action, the implementation of high-level policy recommendations and initiatives must be supported across all levels of governance and networks within the health system and across sectors. 23 More information on models of governance and national-level strategies for developing unified health initiatives is discussed in Governance and Leadership. More information on adopting a coherent approach to health and well-being across all sectors is found in the WHO Health in All Policies: Framework for Country Action.

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

  • Eighty percent of the Solomon Islands’ population lives in rural areas. However, like many LMICs, the Solomon Islands experiences a disproportionate concentration of resources and qualified staff in urban areas. In addition, many of the rural health centers in place to serve rural populations are run down and require a significant upgrade, repair, or renovation. 38 While some new primary care facilities are being built in rural areas (largely driven by political interests and private funding), these are not integrated with national health services priorities. Consequently, a large percentage of the population travels to the National Hospital for primary health services, experiencing significant barriers to the delivery of timely, coordinated, and geographically accessible care. 38  

    In response to these challenges to accessing to quality care, the Solomon Islands’ developed the Role Delineation Policy and Service Delivery Packages in 2011. The Role Delineation Policy defines the range and services (defined in the Service Delivery Packages) to be delivered at different levels of care.

    The Role Delineation Policy has undergone a series of reforms to address financing, human resource, and governance issues, including the organizational structure reform. 39 This reform focuses on several measures that promote the delivery of quality care across settings of care through standardized measures including defined roles and reporting lines, integration mechanisms for efficiency gains, and improved management at the health zone level. 39 The Service Delivery Packages define the services required for six levels of health facilities -  rural health centers, area and urban health centers, general hospitals, and national referral hospitals. These packages set guidelines for staffing, infrastructure, equipment, essential registers, manuals, guidelines and reforms, and essential medicines. 38 Both the RDP and STP are embedded within the National Development Plan and the National Health Strategic Plan (2016-2020) 39 to help stakeholders at the national, regional, and local level guide resource allocation, what services to deliver, and what services to expect. 38 Taken together, the Role Delineation Policy and Service Delivery Packages work to promote better integration and coordination mechanisms for the provision of high-quality care across levels of the health system.

  • Strong coordination of care including through proactive outreach and informational continuity can facilitate more appropriate treatment across the continuum of care. 567 Costa Rica has made great strides to promote coordination across levels of care with primary care systems as the first point of contact. The Costa Rican EBAIS model (Equipos Basicos de Atencion Integral de Salud) created health networks throughout the country, organized into Health Areas - the major unit of primary care. 4041 Each Health Area has between five and fifteen EBAIS multidisciplinary teams, or Integrated Primary Health Care Teams, providing comprehensive preventive, promotive, and curative care to empaneled populations of 30,000 to 110,000 citizens. 42 The EBAIS has two policies that promote primary care as the main system for service provision, gatekeeping and dual referrals. Small groups of Health Areas generally serve as the gatekeeper to secondary and tertiary clinics through standardized regional referral networks. 41 The dual referral system refers patients back to primary care for management to minimize demand on secondary and tertiary services. These gatekeeping and dual referral systems promote coordination across levels of care with primary care facilities as the primary source of care.

  • China has worked to establish multidisciplinary teams across levels of care as a part of the Joint Management by Three Professionals (JMTP) reform in the city of Xiamen. The JMTP leverages a tiered health service delivery approach to the management of chronic disease with a focus on increasing patients’ use of community resources and strengthening systems for role delineation. 43 The JMTP reform tackled this in two ways, strengthening diagnostic and treatment capacities at the PHC level and implementing standardized care pathways across community centers. Multidisciplinary care teams are the vehicle for care management of complex conditions. These teams consist of a specialist, general practitioner, and health manager to provide preventive, promotive, curative, behavioral and rehabilitative services at the community level. Each team member has a defined role that serves to enhance patients’ equitable access to the diagnosis and treatment of complex conditions. In this hierarchical role structure, the specialist determines the diagnosis and treatment plan, the general practitioner implements the plan and conducts daily monitoring, and the health manager handles health education and behavior-related interventions. To promote community-based care, these teams conduct home visits and encourage the use of community health centers as the usual source of care. 43 When necessary, the general practitioner provides two-way referrals to secondary and tertiary hospitals in accordance with standardized referral pathways, reinforcing gatekeeping structures that promote primary care as the first point of contact and main coordinator of care.

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

The questions below may be a useful starting place for determining whether Coordination is an appropriate area of focus for a given context and how one might begin to plan and enact reforms:

What systems are in place for horizontal and vertical integration?

To promote better coordination of care, health systems can adopt horizontal and vertical integration strategies. Comprehensive integration achieves a balance of both horizontal and vertical integration. Horizontal integration involves collaboration across sectors to promote the delivery of comprehensive primary care. By creating linkages within and beyond the health sector, horizontal integration helps to optimize the use of resources and better meet the comprehensive needs of populations. Vertical integration involves redefining the role and interactions among primary, secondary, and tertiary facilities to promote coordination and service delivery across levels of care. Most initiatives in vertical integration are conceptualized in terms of referral systems. To promote primary care as the first point of contact, referral systems should align with empanelment and gatekeeping structures in place, and promote bidirectional referrals.

In what ways are providers supported to encourage coordination of care? For instance, do they receive adequate remuneration and professional development opportunities and are there information systems in place to streamline communication?

The characteristics of a health system can promote or constrain coordination at the point of care. Characteristics that lead to poor working conditions (temporary and/or part-time contracts, insufficient time, fee-for-service pay) and inadequate opportunities for professional development can damage provider motivation and competence to collaborate and coordinate with each other. In addition, robust information systems must be in place to strengthen the capacity of providers to coordinate across the continuum of care.

What incentives are or are not in place to promote collaboration between key actors (including insurers, providers, and health authorities)?

Competing market incentives among key actors (insurers, providers, and health authorities) can disincentivize collaboration and lead to fragmented coordination networks. To promote coordination at the system-level, policymakers must recognize the potential for interfering political and economic interests and restructure market incentive structures and partnerships to promote collaboration, taking into account conflicting interests, competition for limited resources, and developing a culture of collaboration. To incentivize collaboration, coordination efforts must be of mutual benefit to all involved sectors toward a shared vision for collaboration. To sustain coordination efforts, policies governing the function of primary care systems should be protected from turnovers in political leadership and conflicts of interest.

Is a significant amount of primary care delivered by the private sector? If so, how are they involved in the coordination of care?

In health care systems with a large proportion of primary care delivery in the private sector, it is essential to ensure that coordination mechanisms are also linked with the private sector to promote continuity of care. In order to effectively involve the private sector in the coordination of care, stakeholders should consider the intention and benefit of the partnership, such as whether private services are being provided as complementary or supplementary to public services, the regulatory capacity to oversee private sector development (at local, regional, and national level), and given the for-profit nature of private enterprises, the challenge of attracting private sector expansion in remote and underserved areas.

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

  • Like continuity, coordination relies on information systems with broad capacities to track and manage the health of a patient. It is important to ensure that strong information systems are in place, including civil registration and vital statistics and electronic health records systems, within and across levels of care to ensure a patient’s information is available at the right place and the right time to minimize disruptions in their care experience. 31 Information systems should produce reliable, complete, and timely information that ensures interoperability from a wide range of data sources and continuity of patient information. 31 The effective use of information systems empowers and engages patients and improves communication among team members to promote coordination. 444546 Interoperability of data management systems across facilities and services is an essential function to ensure that information systems can effectively collect, analyze, and share critical information to all relevant providers and care teams.

    Learn more in the Information Systems and Information Systems Use Improvement Strategies modules.

  • To facilitate effective coordination within and across facilities, leaders should have relevant skills related to coordination of operations, external/consumer relations, target setting, and human resources. 47 Strong leaders must have or develop particular competencies and personality traits to effectively manage and engage the workforce to motivate a culture of collaboration. Managers should be properly equipped with the tools, systems, and skills to productively assess the health workforce within a facility and provide supportive supervision. Managers and leaders may represent different individuals or groups of individuals within a facility depending on the size and structure.

    Learn more in the Facility Management Capability and Leadership Improvement Strategies module.

  • Central policy directives that promote coordination across all levels of health care and between health and nonhealth sectors require robust regulatory and supervisory mechanisms and a shared vision for high-quality primary health care. 25 In order to translate policy into action, the implementation of high-level policy recommendations and initiatives must be supported across all levels of governance and networks within the health system and across sectors. 23 More information on adopting a coherent approach to health and well-being across all sectors is found in the WHO Health in All Policies: Framework for Country Action.

    As patients transition across levels and sites of care within and beyond the health sector, it is important for quality management infrastructure to be in place to enable care coordination. To facilitate the coordination of high-quality primary health care across providers, facilities, and sectors a national quality improvement plan that integrates standardized care plans, diagnostic protocols, training programs, and accreditation systems should be in place.

    Learn more in the Quality Management Infrastructure and Primary Health Care Policies Improvement Strategies modules.

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

References:

  1. Doherty J. The Cost-Effectiveness of Primary Care Services in Developing Countries: A.
  2. Rao M, Pilot E. The missing link--the role of primary care in global health. Glob Health Action. 2014 Feb 13;7:23693.
  3. Agency for Healthcare Research and Quality. Care Coordination  [Internet]. [cited 2018 Dec 4]. Available from: https://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html
  4. Thomas-Hemak L. Closing the loop with referral management. Group Health Research Institute; 2013.
  5. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502.
  6. Phillips C. Care coordination for primary care practice. J Am Board Fam Med. 2016 Nov 12;29(6):649–51.
  7. Solberg LI. Care coordination: what is it, what are its effects and can it be sustained? Fam Pract. 2011 Oct;28(5):469–70.
  8. World Health Organization. Continuity and coordination of care: a practice brief to support implementation of the WHO Framework on integrated people-centered health services. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.
  9. Friedberg MW, Hussey PS, Schneider EC. Primary care: a critical review of the evidence on quality and costs of health care. Health Aff (Millwood). 2010 May;29(5):766–72.
  10. Enthoven AC. Integrated delivery systems: the cure for fragmentation. Am J Manag Care. 2009 Dec;15(10 Suppl):S284-90.
  11. Montenegro H, Holder R, Ramagem C, Urrutia S, Fabrega R, Tasca R, et al. Combating health care fragmentation through integrated health service delivery networks in the Americas: lessons learned. Journal of Integrated Care. 2011 Oct 10;19(5):5–16.
  12. Ramagem C, Urrutia S, Griffith T, Cruz M, Fabrega R, Holder R, et al. Combating health care fragmentation through integrated health services delivery networks. Int J Integr Care. 2011;
  13. World Health Organization G. Integrated Health Services - What and Why? World Health Organization; 2008 May.
  14. World Health Organization. Framework on integrated, people-centred health services. World Health Organization; 2016.
  15. Vargas I, Mogollón-Pérez AS, De Paepe P, Ferreira da Silva MR, Unger J-P, Vázquez M-L. Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil. Health Policy Plan. 2016 Jul;31(6):736–48.
  16. Gittell JH. Organizing work to support relational co-ordination. The International Journal of Human Resource Management. 2000 Jan;11(3):517–39.
  17. McDonald KM, Sundaram V, Bravata DM, Lewis R, Lin N, Kraft SA, et al. Closing the quality gap: A critical analysis of quality improvement strategies (vol. 7: care coordination). Rockville (MD): Agency for Healthcare Research and Quality (US); 2007.
  18. World Bank Group. FRONTLINE FIRST ... A FORWARD-LOOKING AGENDA FOR HEALTH SYSTEMS TRANSFORMATION. World Bank Group; 2018 Oct.
  19. Enabulele O, Enabulele JE. A look at the two–way referral system: experience   and perception of its handling by medical consultants/specialists among private medical   practitioners in Nigeria . International Journal of Family & Community Medicine. 2018;
  20. World Health Organization. A practice brief to support implementation of the WHO Framework on integrated people-centred health service. World Health Organization; 2018.
  21. Cash-Gibson L. Integrating Health Services. World Health Organization; 2018.
  22. Wang X, Birch S, Zhu W, Ma H, Embrett M, Meng Q. Coordination of care in the Chinese health care systems: a gap analysis of service delivery from a provider perspective. BMC Health Serv Res. 2016 Oct 12;16(1):571.
  23. World Health Organization G. Multisectoral and intersectoral action for improved health and well-being for all: mapping of the WHO European Region. World Health Organization; 2018.
  24. Thomas P, Meads G, Moustafa A, Nazareth I, Strange K, Donnelly Hess G. Combined horizontal and vertical integration of care: a goal of practice-based commissioning . Quality in Primary Health Care. 2008;16:425–32.
  25. World Bank. Deepening Health Reform in China: Building High-Quality And Value-Based Service Delivery. World Bank Group, World Health Organization; 2016.
  26. Joint Learning Network. Vertical Integration and New Roles for Hospitals | Joint Learning Network [Internet]. [cited 2018 Dec 4]. Available from: http://www.jointlearningnetwork.org/vertical-integration
  27. Thomas C, Makinen M, Blanchet N, Krusell K Eds. Engaging the Private Sector in Primary Health Care to Achieve Universal Health Coverage: Advice from Implementers, to Implementers. Joint Learning Network for Universal Health Coverage Primary Health Care; 2016.
  28. Peek CJ, Baird MA, Coleman E. Primary care for patient complexity, not only disease. Fam Syst Health. 2009 Dec;27(4):287–302.
  29. Aller M-B, Vargas I, Waibel S, Coderch-Lassaletta J, Sánchez-Pérez I, Llopart JR, et al. Factors associated to experienced continuity of care between primary and outpatient secondary care in the Catalan public healthcare system. Gac Sanit. 2013 Jun;27(3):207–13.
  30. Teviu EAA, Aikins M, Abdulai TI, Sackey S, Boni P, Afari E, et al. Improving medical records filing in a municipal hospital in Ghana. Ghana Med J. 2012 Sep;46(3):136–41.
  31. Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R. Continuity of care: a multidisciplinary review. BMJ. 2003 Nov 22;327(7425):1219–21.
  32. HIMSS. What is Interoperability? | HIMSS [Internet]. [cited 2019 Mar 15]. Available from: https://www.himss.org/library/interoperability-standards/what-is-interoperability
  33. Measure Evaluation, PEPFAR, USAID. Referral Systems Assessment and Monitoring Toolkit . Measure Evaluation; 2013.
  34. Esquivel A, Sittig DF, Murphy DR, Singh H. Improving the effectiveness of electronic health record-based referral processes. BMC Med Inform Decis Mak. 2012 Sep 13;12:107.
  35. Institute for Healthcare Improvement. Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era [Internet]. [cited 2019 Feb 4]. Available from: http://www.ihi.org/resources/Pages/Publications/Closing-the-Loop-A-Guide-to-Safer-Ambulatory-Referrals.aspx
  36. Ham C, Smith J. Removing the policy barriers to integrated care in England.
  37. Yau GL, Williams AS, Brown JB. Family physicians’ perspectives on personal health records: qualitative study. Can Fam Physician. 2011 May;57(5):e178-84.
  38. EASP. WHO Collaborating Centre for Integrated Health Services based on Primary Care. Practices :: Strengthening universal health coverage through role ... [Internet]. [cited 2018 Dec 6]. Available from: https://www.integratedcare4people.org/practices/584/strengthening-universal-health-coverage-through-role-delineation-in-the-solomon-islands/
  39. WHO. Universal Health Coverage on the Journey towards  Healthy Islands in the Pacific. Division of Pacific Technical Support of the WHO Regional Office for the Western Pacific; 2017.
  40. Pesec M, Ratcliffe HL, Karlage A, Hirschhorn LR, Gawande A, Bitton A. Primary health care that works: the costa rican experience. Health Aff (Millwood). 2017 Mar 1;36(3):531–8.
  41. Pesec M, Ratcliffe H, Bitton A, Ratcliffe Msc H, Director C. Building a Thriving Primary Health Care System: the Story of Costa Rica. 2017;
  42. Clark MA. Health sector reform in Costa Rica: Reinforcing a public system. Woodrow Wilson Center Workshops on the Politics of Education and Health Reforms, Washington DC. 2002.
  43. WHO. China: Multidisciplinary teams and integrated service delivery across levels of care. World Health Organization; 2018.
  44. Bitton A, Flier LA, Jha AK. Health information technology in the era of care delivery reform: to what end? JAMA. 2012 Jun 27;307(24):2593–4.
  45. Delbanco T, Walker J, Darer JD, Elmore JG, Feldman HJ. Annals of Internal Medicine Perspective Open Notes : Doctors and Patients Signing On AND. 2015;121–6.
  46. Altschuler J, Margolius D, Bodenheimer T, Grumbach K. Estimating a reasonable patient panel size for primary care physicians with team-based task delegation. Ann Fam Med. 2012 Oct;10(5):396–400.
  47. Tsai TC, Jha AK, Gawande AA, Huckman RS, Bloom N, Sadun R. Hospital board and management practices are strongly related to hospital performance on clinical quality metrics. Health Aff (Millwood). 2015 Aug;34(8):1304–11.