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Disclaimer: The views expressed in this paper/presentation are the views of the author

and do no necessarily reflect the views or policies of the Asian Development Bank
(ADB), or its Board of Governors, or the governments they represent. ADB does not
guarantee the accuracy of the data included in this paper/presentation and accepts no
responsibility for any consequence of their use. Terminology used may not necessarily
be consistent with ADB official terms.

Integrated and People Centered Care -


Taking Disability as an Example

Dr Peter Cowley, Coordinator, Health Policy and Financing


WHO Regional Office for the Western Pacific
UHC: Moving towards better health

Universal health coverage


(UHC) means that all people
and communities have
access to quality health
services without suffering
the financial hardship
associated with paying for
care.

2 | Integrated and People Centered Care – Taking Disability as an Example


Overlapping population groups

People with
disabilities

People with
non-
Older people
communicable
disease

3 | Integrated and People Centered Care – Taking Disability as an Example


What services for what capacity?

4 | Integrated and People Centered Care – Taking Disability as an Example


An example of demand – disability
spectrum

‘Difficulties functioning’

No difficulties Some difficulties Significant Cannot do at all

5 | Integrated and People Centered Care – Taking Disability as an Example


Health of people with disabilities

 Primary health condition: This is where the need for


rehabilitation services starts

 Secondary health conditions: e.g.: pressure ulcers and


urinary tract infections. Can often be prevented.

 Co-morbid health conditions: e.g.: diabetes, cancer,


hypertension, depression. Additional and unrelated to
primary condition. Detection and treatment often not well
managed.

6 | Integrated and People Centered Care – Taking Disability as an Example


Health care needs of people with
disabilities
 General health care needs

 Special health care needs

 Physiotheraphy

 Speech Therapy

 Assistive devices

 Special test

7 | Integrated and People Centered Care – Taking Disability as an Example


A framework for people-centered
integrated health services delivery

8 | Integrated and People Centered Care – Taking Disability as an Example


Access, costs and quality of services:
balancing the trade-offs

9 | Integrated and People Centered Care – Taking Disability as an Example


Types of integration / coordination

 Across the care pathway/continuum: promotion,


prevention, management…end-of-life care

 Across multiple morbidities, for the whole person

 Across the life-course

 Across service delivery levels: primary,


secondary, tertiary

 Across care systems and actors: health and


social care; medical specialists, nurses,
community and social workers, family, peers

 Across settings: home, community, institutions

10 | Integrated and People Centered Care – Taking Disability as an Example


Reduce barriers to access

 Geographical, physical barriers to access

 Economic barriers: direct, indirect, opportunity


costs

 Socio-cultural barriers: low knowledge /


awareness, ethnicity, gender

 Health system-related barriers: provider bias


(stigma, discrimination), acceptability (privacy,
quality)

11 | Integrated and People Centered Care – Taking Disability as an Example


An example of barriers related to low
functioning

12 | Integrated and People Centered Care – Taking Disability as an Example