Core components of management of services & population health

  • Improving the core components of management of services & population health has many potential benefits, including:

    Short and long-term benefits of population health management: 1 2 3 4 5

    • Universal health coverage:  By bringing services directly to communities, community-based care, and other outreach activities help to ensure that all patients can access essential care when they need it most. 
    • Adjustment and accountability to population health needs:  A population health management approach helps countries actively engage with local communities, to hold providers accountable for the needs of these communities, and to plan targeted outreach activities that adapt to community needs over time. 
    • Improved patient experience and health outcomes:  A population health management approach supports more comprehensive, proactive care. In addition, it enables care teams to better identify and understand the needs of the communities they serve, which can help to build trust and respect between patients and providers and increase patient utilisation of needed services. 
    • Improved service quality:  Population health management approaches, such as empanelment and proactive outreach, help ensure that patients receive care when they need it most and that no one gets left behind. Such approaches also help providers to balance their caseload, important for the delivery of timely, efficient services.

    Short and long-term benefits of resilient facilities & services: 6 7 8

    • Increased preparedness:  Increased preparedness helps vulnerable communities safeguard their health, lives, and assets by being alert to hazards and ready to take appropriate action in the face of an imminent threat or at the onset of a disaster or shock.
    • Risk management:  Risk management helps prevent the development of new risk of disasters, helps reduce existing risk of disasters and contributes to increased resilience and reduced disaster-related loss.
    • Increased resiliency:  Resilient facilities can withstand or quickly recover from shocks while maintaining capacity to continue providing essential care during emergencies—and while helping communities recover more quickly.

    Short and long-term benefits of management of services:

    • Service quality:  Management of services is important for ensuring the PHC facilities use funds to provide safe, high-quality services to the communities they serve. Furthermore, it ensures systems are in place to identify and improve on any identified gaps in service delivery and to proactively plan for future activities and expenditures, ultimately helping to improve the efficiency and cost-effectiveness of services.  
    • Data-driven decision-making:  Management of services helps to ensure that facility-based data are collected and used to make health services more effective, safe, and people-centred.
    • Continuous learning and improvement:  Management of services promotes the use of data to implement needed changes to facility infrastructure, amenities, and service delivery processes, eventually leading to improved facility outputs and outcomes.

    Short and long-term benefits of organisation of services:

    • Comprehensiveness and coordination:  Selection and delivery of a well-defined package of PHC services by different facility types is essential for ensuring that a comprehensive set of high-quality services are available to a population.  
    • Safety and effectiveness:  Establishing pathways of care for defined health services is an essential first step in providing effective, evidence-based care to patients. Pathways for care determine clinical guidelines for dividing tasks according to worker competencies and ensuring that safety mechanisms are in place. 
    • Improved information and technology: Establishing systems for referral and coordination between levels of care can help to define the type of information that must be collected and shared between sites of care. The types of necessary information can help to define what kinds of communication systems must be in place to support coordinated care. 
    • Medicines and supplies: An essential component of well-organised services involves defining what services can and should be provided at each facility level and setting of care. With this knowledge, facilities can determine the appropriate medicines and supplies that should be available to successfully deliver the care they are expected to provide.
  • The following principles should also be prioritised, either at the same time or one after another, to improve the management of services & population health:

    Proactive population health management

    Population health management is an approach to PHC provision that integrates active outreach and engagement with the community in care delivery. This approach shifts PHC service delivery from reactive individual care delivery to proactive management of a segment of the population. 

    Effective population health management typically occurs both in established clinics and in the community. It requires a strong organisational structure, efficient information systems, an appropriate mix, and a sufficient quantity of providers. Inherent in population health management is the provision of a broad range of health activities including curative and preventive care, health promotion activities delivered through broad public health initiatives, and engagement with social determinants of health. 

    The core elements of population health management include:

    • Empanelment:  the active and ongoing assignment of an individual or family to a primary care provider and/or care team for the provision of primary care services.
    • Collaboration between facility- and community-based service providers:  the process of facility- and community-based providers working together to provide person-centred, coordinated care. 
    • Community engagement in service planning and organisation:  the inclusion of local health system users and community resources in all aspects of design, planning, governance, and delivery of health care services. 
    • Proactive population outreach:  the active provision of care in homes or communities rather than exclusively in facilities.
    • Services for self-care and health literacy in primary care:  PHC services and processes that support and empower individuals, families, and communities to manage their health and well-being when not in direct contact with health services.

    Resilient facilities & services 

    All countries are vulnerable to emergencies or shocks. The same health system emergency—such as an earthquake, disease outbreak, conflict, economic shock, climate change, or pandemic—can occur with the same intensity in two countries or two communities. However, the extent of the damage, to individual health, infrastructure, or health services, will vary greatly depending on the communities’ vulnerability, preparedness, and resilience. 9 Resilient health facilities are safe, sustainable, secure, and smart. They will be able to keep functioning in an emergency situation, providing essential health services to those in need. Resilient services are flexible, integrated, equitable, and accessible. They will be able to maintain or quickly resume the provision of essential and routine services in an emergency situation.

    Key actions for improving resilient facilities and services include: 

    • ensuring effective planning and preparedness work takes place; 
    • developing protocols and conducting training, using the training to inform revisions to planning and protocols; 
    • assessing facility and service preparedness, incorporating learnings from exercises and emergencies into ongoing preparedness activities; and 
    • responding to emergencies to maintain or quickly return to providing essential and routine health services and help with recovery.

    Management of services 

    Manage services for quality, leadership, and performance at the facility level, including via: 2 10 11 12 13 14 15

    • Professionalism of management, which means that “conditions are in place nationally and subnationally to ensure professionalised management and leadership in a health care organisation. This is achieved by ensuring adequate numbers, competencies, and deployment of managers throughout the health system, and creating an enabling environment that contributes to managers’ motivation and enables them to perform well.”
    • Systems to support quality improvement, which refers to the use of information systems and quality improvement methods/practices (i.e. plan-do-study-act cycles) to make health services more effective, safe, and people-centred via iterative, measurable changes.  
    • Facility budgets and expenditures, which address the availability and management of funds at health facilities to meet the recurrent and fixed costs associated with delivering health services. This component incorporates a range of public financial management processes, from budget formation to budget execution, that influences facility-level funds availability and management.  
    • Management capability and leadership, which refers to the capabilities of managers and leaders to oversee quality improvement and budgetary processes within a facility.  
    • Supportive supervision, which is a component of performance measurement and management. It is characterised by collaborative problem solving and open dialogue. Supervision routinely includes mentoring to address gaps in performance, knowledge, and skills; setting individual goals; and reviewing progress towards their achievement.

    PHC-focused organisation of services 

    Well-organised services across the health system can help to direct patients to primary health care as the first point of contact and support the other four functions of primary care—comprehensiveness, coordination, continuity, and person-centeredness. Elements that help to create a strong and PHC-focused organisation of services include: 16 17

    • Comprehensive and contextualised essential package of health services.
    • Well-defined roles and functions of service delivery platforms and settings.
    • Systems to promote first-contact accessibility.
    • Protocols for patient referral, counter-referral, and emergency transfer.
    • Existence of care pathways for relevant tracer conditions. 
    • Services provided through multidisciplinary team-based care.

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

References:

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  14. Vallières F, Hyland P, McAuliffe E, Mahmud I, Tulloch O, Walker P, et al. A new tool to measure approaches to supervision from the perspective of community health workers: a prospective, longitudinal, validation study in seven countries. BMC Health Serv Res. 2018 Oct 22;18(1):806.
  15. WHO. Primary health care: transforming vision into action - Operational Framework. Global Conference on Primary Health Care. 2018;
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