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Digvijay Sandhu
Intern, Asian Development Bank
Background - Fragmentation of Healthcare

Noun Project."
Background - Fragmentation of Healthcare
Lack of service coordination between different levels and settings of care.

Isolation of generalist from specialist medicine

Hospital-based, disease-based and “silo” curative care models

Vertical disease-oriented programmes - HIV/AIDS, malaria, tuberculosis and other infectious diseases,

Lack of chronic care management

Duplication of services and infrastructure (Transport)

Lack of seamless data sharing

Integrated care

World Health Organisation defines Person centered Integrated Care as “Health

services that are managed and delivered in a way that ensures people receive a
continuum of health promotion, disease prevention, diagnosis, treatment, disease
management, rehabilitation, and palliative care services, at the different levels and sites
of care within the health system, and according to their needs throughout their life

Models of Integrated Care
Patients should be able to obtain all types of
outpatient care under one roof.

At its polyclinics in Berlin, patients can consult

primary care physicians, specialists, nutritionists,
and other health professionals; they can also
undergo diagnostic tests and have prescriptions

Polikum executives have estimated that within a

year of adopting this approach, the company’s
hospitalization costs were reduced by about half.

Models of Integrated Care
The Agency for Integrated Care (AIC) is set up by
the Ministry of Health to oversee, coordinate and
facilitate all efforts in care integration.

Mission Statement: To achieve the best health

outcomes for our patients.

● Empower clients and coordinate access to

appropriate care.
● Enable stakeholders to strengthen the
primary and community care sectors.
● Enhance collaboration to create a well-
connected healthcare system
Models of Integrated Care
Veterans Affairs
The Veterans Health Administration is America’s
largest integrated health care system, providing
care at 1,240 health care facilities, including 170
medical centers and 1,061 outpatient sites of care of
varying complexity (VHA outpatient clinics),
serving 9 million enrolled Veterans each year.

Objective and Methodology
● To create a health system assessment framework for Integrated care

Literature Review

Identification of principles

Preparing a master list of indicators - 40

Applying indicator prioritization method1

Consulting health experts at Asian Development Bank and Access Health International.
1 “Good Practice Guidelines for Indicator Development -"
Core Principles of Integrated Care

Comprehensive Ethical Holistic System thinking

Collaborative Empowering Preventive Sustainable

Co-produced Equitable Respectful Shared accountability

Coordinated Evidence-based Rights and


“WHO global strategy on people-centred and integrated health services ...." 9
Strategic Direction
to support
Integrated Care
WHO global strategy on people-centred and integrated health

“WHO global strategy on people-centred and integrated health services ...." 10
Results - Indicator List

Indicator 1.1: Existence of a national health policy that incorporate integrated care in its goals/objectives/principle/strategy

Building Block Leadership/Governance

Strategic Direction - WHO Strengthening governance and accountability

Indicator definition The indicator will measure whether a country’s national health policy incorporates the principles of integrated care

Purpose It reflects the government’s awareness and commitment to move towards an integrated model of care.

Definition of key terms Integrated Care: WHO defines Person centered Integrated Care as “Health services that are managed and delivered in a way that ensures
people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and
palliative care services, at the different levels and sites of care within the health system, and according to their needs throughout their life

Data Source This will include national health policies, administrative records, legal and regulatory documents, national health strategies, budget
documents, and regulations and guidelines that relate to the management, organization and financing of the health sector. These
documents can be obtained from government publications, legal and administrative department web sites.

Country example – India, India – National Health Policy 2017


Measurement Yes/No/Partially (With additional space for comments/clarifications)


Indicator Definition
Comprehensive – Does the health policy incorporate care that is comprehensive and tailored to the evolving
health needs (communicable and non-communicable diseases)? Does the policy commit to universal health

Coordinated – Does the health policy incorporate coordination across different providers (private, public,
NGO) and settings (level of care)?

Continuous – Does the policy include any instrument that enables continuum of care - providing care and
services across the life course?

Holistic – Does the policy focus on physical, socioeconomic, mental and emotional well-being?

Co-produced – Does the policy promote active partnerships of people and communities at an individual,
organizational and policy-level.

Systems thinking – Does the health policy promote interaction with other government bodies to improve
health status of the country? 13
Indicator 1.1: Existence of inter-ministerial partnerships to improve health -

Indicator 1.2: Existence of a public-private partnership model in health care delivery


● Commission on Population has a Board of Commissioners

● Beti Bachao, Beti Padhao. Coordinated & convergent
efforts MoHFW and MoHRD to ensure survival, protection which gathers the DOH along with ten other government
and education of the girl child agencies to discuss the policies and programs of the
● The RSBY (NHPS) empanels 4926 private providers and government for population management.
3771 public providers ● 85.6%of licensed national and local government hospitals,
97.7 percent of licensed private hospitals are under the
DOH and were accredited by PhilHealth

Indicator 1.3: Existence of a health financing strategy that supports and funds integrated care

Indicator 1.4: Existence of single pooling mechanism in the health system


● Health is a state subject, however, the centre promotes ● Decentralized governance. The National Health Insurance
health programs - NHPS and NHM. Program under PhilHealth was instituted as a strategy
● Existence of multiple risk pools - ESIS, CGHS, RSBY, towards a shift to a single payer system, ultimately
State sponsored schemes achieving universal health coverage
● PhilHealth covers the entire population.

Indicator 1.5: Existence of a referral system that is both vertically and horizontally integrated

Indicator 1.6: Existence of an interoperable electronic health record

Indicator 1.7: Existence of patient satisfaction surveys for government owned/empaneled medical facilities


● Patients from PHCs. SCs and CHCs can be referred to ● The referral system encompasses a bi-directional referral
sub-district or district level and then to tertiary health system. The DOH handles tertiary level care while local
facilities. government units (LGUs) handle both secondary and
● My Health Record primary care
● My Hospital - Public and Private (987) ● The Philippines does not have an electronic health record.
● There are select government health facilities that deploy
satisfaction surveys, however, no standard are set by DOH 16
Indicator 1.8: Existence of Standard Treatment Guideline for the treatment of comorbid conditions

Indicator 1.9: Existence of coordinated health programs in contrast to vertical health programs


● Standards and Protocols - National Health Portal ● Clinical practice guidelines are developed and regulated by
● National Health Mission the different associations of medical specialization.
Department of Health, Professional Regulation
Commission, Philippine Medical Association, Private
medical specialty organizations

Indicator 1.10: Existence of continuum of care in service delivery

Indicator 1.11: Existence of home based and community care in service delivery

Indicator 1.12: Existence of integrate promotive, preventive, long-term, and rehabilitative care at the primary level of care


● National Health Policy, ● Maternal continuum of care - Pre-natal, post-natal and

● India’s Reproductive, Maternal, Newborn, Child, and vaccinations
Adolescent Health (RMNCH+A) Strategy ● Financial status of LGUs allow different amount of
investments towards promotive, preventive and curative

Thank you. Questions?