WHO global strategy on integrated

people-centred health services 2016-2026

Executive Summary

Placing people and communities at the centre of health

services

Draft for consultation

24/07/2015 version
WHO/HIS/SDS/2015.20
© World Health Organization 2015

This executive summary is a working draft to facilitate consultation on the WHO global strategy on
integrated and people-centred health services 2016-2026. The content of this document is not final
and the text may be subject to revisions before publication. The document may not be reviewed,
abstracted, quoted, reproduced, transmitted, distributed, translated or adapted, in part or in whole,
in any form or by any means without the permission of the World Health Organization.

This executive summary is based on two documents, one on the strategy itself and the other
on the evidence supporting it. These background documents can be found at:
http://www.who.int/servicedeliverysafety/areas/people-centred-care/en.
 Draft for consultation

Contents
Glossary of key terms ............................................................................................................................ 4

WHO global strategy on integrated people-centred health services: an overview .................................... 7

Introduction .......................................................................................................................................... 9

Strategic goals, objectives, policy-options and interventions.................................................................. 10

Implementation principles .................................................................................................................... 16

The role of key stakeholders ................................................................................................................ 16

Progress monitoring ............................................................................................................................ 17

PLACING PEOPLE AND COMMUNITIES AT THE CENTRE OF HEALTH SERVICES
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Glossary of key terms

Accountability: the obligation to report, or give account of, one’s actions – for example, to a governing authority
through scrutiny, contract, management, regulation and/or to an electorate.
Care coordination: a proactive approach in bringing care professionals and providers together around the needs of
service users to ensure that people receive integrated and person-focused care across various settings.
Case management: a targeted, community-based and proactive approach to care that involves case-finding,
assessment, care planning and care coordination to integrate services around the needs of people with long-term
conditions.
Community health worker: people who provide health and medical care to members of their local community,
often in partnership with health professionals. Alternatively known as a: village health worker; community health
aide/promoter; lay health advisor; expert patient; and/or community volunteer.
Continuity of care: the degree to which a series of discrete health care events is experienced by people as coherent
and interconnected over time, and consistent with their health needs and preferences.
Continuous care: care that is provided to people over time across their life course.
Co-production of health: care that is delivered in an equal and reciprocal relationship between professionals,

WHO GLOBAL STRATEGY ON INTEGRATED PEOPLE-CENTRED HEALTH SERVICES 2016-2026. EXECUTIVE SUMMARY
people using care services, their families and the communities to which they belong. Co-production implies a long-
term relationship between people, providers and health systems where information, decision-making and service
delivery become shared.
E-health: information and communication technologies that support the remote management of people and
communities with a range of health care needs through supporting self-care and enabling electronic
communications between health care professionals and patients.
Empowerment: the process of supporting people and communities to take control of their own health needs
resulting, for example, in the uptake of healthier behaviours or the ability to self-manage illnesses.
Engagement: involving people and communities in the design, planning and delivery of health services that, for
example, enable them to make choices about care and treatment options or to participate in strategic decision-
making on how health resources be spent.
High quality care: care that is safe, effective, people-centred, timely, efficient, equitable and integrated.
Integrated health services: the management and delivery of health services such that people receive a continuum
of health promotion, disease prevention, diagnosis, treatment, disease-management, rehabilitation and palliative
care services, through the different levels and sites of care within the health system, and according to their needs
throughout the life course.
Intersectoral action: the inclusion of several sectors, in addition to health, when designing and implementing
public policies that seek to improve health care and quality of life.

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Mutual accountability: the process by which two (or multiple) partners agree to be held responsible for the
commitments that they have made to each other.
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 respond to their needs and
preferences in humane and holistic ways. People-centred care also requires that people have the education and
support they need to make decisions and participate in their own care. It is organized around the health needs and
expectations of people rather than diseases.
Person-centred care: care approaches and practices that see the person as a whole with many levels of needs and
goals, with these needs coming from their own personal social determinants of health.
Population health: an approach to health care that seeks to improve the health outcomes of a group of
individuals, including the distribution of such outcomes within the group.
Primary care: first-contact, accessible, continued, comprehensive and coordinated care to people and communities.
Primary health care: refers to the concept elaborated in the 1978 Declaration of Alma-Ata, which is based on the
principles of equity, participation, intersectoral action, appropriate technology and a central role played by the
health system.
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WHO global strategy on integrated people-centred health services: an overview

PLACING PEOPLE AND COMMUNITIES AT THE CENTRE OF HEALTH SERVICES

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Introduction
The World Health Organization (WHO) global strategy on integrated people-centred health services (IPCHS)
is a call for a fundamental paradigm shift in the way health services are funded, managed and delivered. These
changes are urgently needed to meet the challenges being faced by health systems around the world. Despite
significant advances in people’s health and life expectancy, relative improvements have been deeply unequal
both between countries and within them. Still more than 1 billion of the world’s citizens remain without any
access to health care whilst satisfaction with health services remains low in many countries. The nature of
health care problems, which were once focused on the management of infectious diseases, has shifted.
Health is increasingly shaped by ageing populations, urbanization and the globalization of unhealthy
lifestyles, resulting in a transition in the burden of health care towards noncommunicable diseases, mental
health and injuries. Many of these conditions are chronic, requiring long-term care, with patients commonly
suffering from multi-morbidities, all of which adds to escalating health care costs.

The fragmented nature of today’s health systems means that they are becoming increasingly unable to
respond to the demands placed upon them. For example, fragile and poorly integrated health systems were
key contributors to the Ebola crisis in West Africa and continued lack of connection between health systems
and strengthening capacities within the International Health Regulations leaves other countries vulnerable.
Poorer countries still face significant problems of unequal geographical access to health services, shortages
of health workers and weak supply chains. The focus on hospital-based, disease-based and self-contained
“silo” curative care models 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 and
preferences 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.
PLACING PEOPLE AND COMMUNITIES AT THE CENTRE OF HEALTH SERVICES

Universal health coverage (UHC) will not be achieved without improvements in service delivery so that all
people are able to access high quality health services that meet their needs and preferences. This strategy
calls for reforms to reorient health services, shifting away from fragmented supply-oriented models, towards
health services that put people and communities at their centre, and surrounds them with responsive services
that are coordinated both within and beyond the health sector, irrespectively of country setting and
development status.

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Figure. Conceptual framework for integrated people-centred health services

Country setting
& development status

le-centred & in
eop
,e p ommunity teg Other
C

rat
bl
Family sectors:

Unive l, equita

ed
Health Service education,

health services
sector: delivery: rsa sanitation,
governance, networks, PERSON social assistance,
financing & facilities & labour, housing,
resources practitioners environment
& others

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,
improved efficiency of services, and reduced overall costs.

The strategy sets forth a compelling vision of “a future in which all people have access to health services that
are provided in a way that responds to their life course needs and preferences, are coordinated across the
continuum of care and are safe, effective, timely, efficient and of acceptable quality”. The strategy is based
on experience gained in different countries over the last few years, as well as on wide-ranging consultation
with experts at the global, regional and national level, informed by a number of related global policy
commitments, regional strategies and initiatives in the area of UHC, primary health care, health systems

WHO GLOBAL STRATEGY ON INTEGRATED PEOPLE-CENTRED HEALTH SERVICES 2016-2026. EXECUTIVE SUMMARY
strengthening and social determinants of health.

For the development of this strategy, four different types of country settings have been analysed: low,
middle and high income countries, as well as countries facing special circumstances such as conflict-affected
and fragile states, small island states and large federal states. Recognizing that health systems are highly
context specific, this strategy does not propose a single model of people-centred and integrated health
services. Instead, it proposes five interdependent strategic goals that need to be adopted in order for health
service delivery to become more integrated and people-centred.

Strategic goals, objectives, policy-options and interventions

To meet the fundamental challenges faced by today’s health systems, this strategy proposes the following
five interdependent strategic goals:
1. Empowering and engaging people
2. Strengthening governance and accountability
3. Reorienting the model of care
4. Coordinating services
5. Creating an enabling environment

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Action on each of these strategic goals 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. Several strategic objectives, as well as potential policy options and
interventions are described further below for the attainment of each strategic goal. Some of these potential
policy options and interventions are cross-cutting for several strategic objectives. This non-exhaustive
reference list has been drafted on the basis of literature reviews, input from technical consultation meetings
and expert opinion and does not constitute a set of evidence-based guidelines for reform as evidence on
many of these policies and interventions is still weak. Moreover, the appropriate mix of policies and
interventions to be used at the country level will need to be designed and developed taking into account the
local context, values and preferences.

Strategic Goal 1: Empowering and engaging people

Empowering and engaging people is about providing the opportunity, skills and resources that people need
to be articulate and empowered users of health services. It is also about reaching the underserved and
marginalized groups of the population in order to guarantee universal access to services. This goal seeks to
unlock community and individual resources for action at all levels. It aims at empowering individuals to make
effective decisions about their own health and at enabling communities to become actively engaged in co-
producing healthy environments, providing care services in partnership with the health sector and other
sectors, and contributing to healthy public policy.

1.1 Empowering and engaging individuals and families: individuals and families need to be harnessed to
achieve better clinical outcomes through co-production of care, particularly for noncommunicable and
chronic diseases. This 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 or care for their dependents. Empowerment is also about care that is delivered in an
equal and reciprocal relationship between clinical and non-clinical professionals and the individuals using care
services, their families, and communities, improving their care experience.

Policy options and interventions:

ñ Health education
ñ Shared clinical decision making between individual, families and providers
ñ Self-management including personal care assessment and treatment plans
ñ Patient satisfaction surveys

1.2 Empowering and engaging communities: enables communities to voice their needs and so influence
PLACING PEOPLE AND COMMUNITIES AT THE CENTRE OF HEALTH SERVICES

the way in which care is funded, planned and provided. It helps build confidence, trust, mutual respect and the
building 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.

Policy options and interventions:

ñ Community delivered care and community health workers
ñ Development of civil society, user and patient groups
ñ Peer support and expert patient groups

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1.3 Reaching the underserved & marginalized: is of paramount importance in order to guarantee universal
access to health services. It is essential for fulfilling broader societal goals such as equity, social justice and
solidarity, and helps social cohesion. It requires actions at all levels of the health sector, as well as concerted
action with other sectors and all segments of society, in order to address the other determinants of health
and health equity.

Policy options and interventions:

ñ Health equity goals integrated into health sector objectives
ñ Outreach services for the underserved including mobile units, transport systems and telemedicine
ñ Contracting out services when warranted
ñ Expanding primary care-based systems

Strategic Goal 2: Strengthening governance and accountability

Strengthening governance and accountability involves improving policy dialogue as well as policy
formulation and evaluation together with citizens, communities and other stakeholders. It is about
promoting transparency in decision-making and generating robust systems for the collective accountability
of policy-makers, managers, providers and users through aligning governance, accountability and incentives.

2.1 Bolstering participatory governance: robust governance mechanisms are required to achieve a
coherent and integrated approach in health care policy and planning. This is 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. Governments need to take
responsibility for protecting and enhancing the welfare of their populations and build trust and legitimacy
with citizens through effective stewardship. The stewardship role is the essence of good governance and
involves the identification and participation of community stakeholders so that voices are heard and
consensus is achieved.

Policy options and interventions:

WHO GLOBAL STRATEGY ON INTEGRATED PEOPLE-CENTRED HEALTH SERVICES 2016-2026. EXECUTIVE SUMMARY
ñ Community participation in policy formulation and evaluation
ñ National health policies, strategies and plans promoting integrated people-centred health services
ñ Harmonization and alignment of donor programmes with national policies, strategies and plans
ñ Decentralization, where appropriate, to local level

2.2 Enhancing mutual accountability: is essentially about answerability, and encompasses both the
“rendering of the account”, that is providing information about performance, and the “holding to account”,
meaning the provision of rewards and sanctions. Strengthening accountability of health systems requires
joint action by health and non-health sectors, public and private sectors, and citizens, towards a common
goal.

Policy options and interventions:

ñ Health rights and entitlements
ñ Provider report cards, patient reported outcomes and balanced scorecards
ñ Performance based financing and contracting
ñ Population registration with accountable care provider(s)

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Strategic Goal 3. Reorienting the model of care

Reorienting the model of care means ensuring that efficient and effective health care services are purchased
and provided through models of care that prioritize primary and community care services and the co-
production of health. This encompasses the shift from inpatient to outpatient and ambulatory care. It
requires investment in holistic and comprehensive care, including health promotion and ill-health prevention
strategies that support people’s health and well-being. It requires both gender and cultural sensitivity.
Reorienting models of care is also about creating new opportunities for intersectoral action at a community-
level to address the social determinants of health and make the best use of scarce resources, including, at
times, partnerships with the private sector.

3.1 Defining service priorities based on life-course needs and preferences: means appraising the
package of health services offered at different levels of the care delivery system, covering the entire life-
course. It uses a blend of methods to understand both the particular needs and preferences of the population
and how decisions fit within a holistic approach to health care. It also includes health technology assessment.

Policy options and interventions:

ñ Local health needs assessment
ñ Comprehensive package of services for all population groups
ñ Gender and cultural sensitive services
ñ Health technology assessment

3.2 Revaluing promotion, prevention and public health: 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 (EPHF) within a defined territory.

Policy options and interventions:

ñ Monitoring health status of the population
ñ Surveillance, research and control of risks and threats to public health
ñ Health promotion and disease prevention
ñ 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. It involves ensuring adequate funding,
appropriate training, and connections to other services and sectors. It promotes coordination and continuous
care over time for people with complex health problems, facilitating intersectoral action in health. It employs
inter-professional teams to ensure the provision of comprehensive services for all. It prioritizes community
and family-oriented models of care as a mainstay of practice.
PLACING PEOPLE AND COMMUNITIES AT THE CENTRE OF HEALTH SERVICES

Policy options and interventions:

ñ Primary care services with a family and community-based approach
ñ Multidisciplinary primary care teams
ñ Gatekeeping to access other specialized services
ñ Greater proportion of health expenditure allocated to primary care

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 objective is to find
the right balance between primary care, other specialized outpatient care and hospital inpatient care,
recognizing that each has an important role in the health care delivery ecosystem.

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Policy options and interventions:

ñ Home care, nursing homes and hospices
ñ Repurposing hospitals for acute complex care only
ñ Outpatient surgery, day hospital and 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 and sharing. When used appropriately, they can assure continuity
of information, track quality, and reach geographically isolated communities.

Policy options and interventions:

ñ E-health and m-health

Strategic Goal 4: Coordinating services

Coordinating services involves coordinating care around the needs and preferences of people at every level
of care, as well as promoting activities to integrate different health care providers and create effective
networks between health and other sectors. 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 of the different services.

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 focal point for improvement is the delivery of care to the
individual, with services coordinated around their needs and those of their families. It is also about improved
information flows and maintaining trustworthy relationships with providers over time.

Policy options and interventions:

ñ Shared electronic medical record

WHO GLOBAL STRATEGY ON INTEGRATED PEOPLE-CENTRED HEALTH SERVICES 2016-2026. EXECUTIVE SUMMARY
ñ Care pathways
ñ Referral and counter-referral systems
ñ Case management

4.2 Coordinating health programmes and providers: includes bridging the administrative, informational
and funding barriers between health care sectors and between 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.

Policy options and interventions:

ñ Regional or district-based health service delivery networks
ñ Integrating vertical programmes into national health systems
ñ Incentives for care coordination

4.3 Coordinating across sectors: successful coordination involves multiple actors, both within and beyond
the health sector. It encompasses sectors such as social services, education, labour, housing, traditional and
complementary medicine, and the private sector, among others. It also entails coordination for early
detection and rapid response to health crises.

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Policy options and interventions:

ñ Intersectoral partnerships
ñ Merging of health sector with social services
ñ Integrating traditional and complementary medicine with modern health systems
ñ Coordinating with preparedness, detection and response to health crises

Strategic Goal 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 the different stakeholders to undertake transformational change.
This is a complex task involving a diverse set of processes to bring about the necessary changes in legislative
frameworks, financial arrangements and incentives, and the reorientation of the workforce and public policy-
making.

5.1 Strengthening leadership and management for change: strong leadership and vision are critical to
successful change management within a health system. 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. Development of an organizational culture that supports monitoring and evaluation,
knowledge sharing and a demand for data in decision-making is also a prerequisite for transformational
change.

Policy options and interventions:

ñ Transformational and distributed leadership
ñ Dedicating resources for reform
ñ Systems research and knowledge sharing

5.2 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.

Policy options and interventions:

ñ Clinical governance
ñ Quality assurance and continuous quality improvement

5.3 Reorienting the health workforce: special attention needs to be given to reorienting the health
workforce to meet the requirements of service delivery reforms. It requires health workers to approach
patients, users and communities differently, be more open to working in teams, use data more effectively and
PLACING PEOPLE AND COMMUNITIES AT THE CENTRE OF HEALTH SERVICES

be willing to innovate in their practice.

Policy options and interventions:

ñ Health workforce training
ñ Multi-professional teams working across organizational boundaries
ñ Improving working conditions and compensation mechanisms

5.4 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.

Policy options and interventions:

ñ Aligning regulatory framework

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5.5 Reforming payment systems: changes in the way care is funded and paid for are also needed to promote
the right mix of financial incentives in a system that supports the integration of care between providers and
settings.

Policy options and interventions:

ñ Mixed payment models based on capitation
ñ Bundled payments

Implementation principles
In moving forward with a strategy of this nature, it is important to acknowledge the lessons of history: the
successful reorientation of health services will most likely be a long journey requiring 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 strategy for achieving these goals. The goals 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 to support change. The implementation principles therefore of this strategy are the following:

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.

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.

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.

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.

WHO GLOBAL STRATEGY ON INTEGRATED PEOPLE-CENTRED HEALTH SERVICES 2016-2026. EXECUTIVE SUMMARY
Iterative learning/action cycles: 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 problems.

Goal-oriented: a key focus of the strategy should be on the ongoing monitoring of progress within a
framework that includes specific and measurable objectives.

The role of key stakeholders

Countries: moves towards people-centred and integrated health services need to be country-led in a process
of co-production between governments, providers and the people that they serve. The role of countries is
therefore essential in overcoming some of the key challenges to implementation. Countries committed to
this path should be sure to develop and communicate a clear vision and strategy for what they wish to
achieve. They also need to secure adequate funding for reform and implementation research.

Development partners: should, except under exceptional circumstances where very 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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Citizens’ groups: various networks 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.

Academics and researchers: have an important role to play in providing analytical, educational and
implementation skills. Understanding of strategies to support people-centred and integrated health services
needs to be enhanced through health systems research and implementation research efforts.

Provider associations: can play important roles in adopting and endorsing new practices, and in providing
support to their members.

WHO: the role of WHO 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 strategic goals identified in this strategy, will therefore require sustained advocacy and technical
cooperation efforts.

Progress monitoring
In order to track overall progress in the implementation of this strategy, and the progress of each one of its
five strategic goals, the below set of six indicators is being proposed. After agreement is reached on their
usefulness to track implementation progress, specific baselines for 2016 and targets for 2026 will be
developed.
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Table. Strategy monitoring indicators

Strategic Indicator Definition Disaggregation Comments/ Primary
Goal limitations data
source
Overall Number of It reports on Member Region, Data Collection of
progress countries States that are either national collection on information
implementing piloting and/or scaling- annual basis with national
integrated up service delivery authorities
services reforms aimed at and WHO
improving the co- Country
production of care; care Offices by
over time; and the Regional
comprehensiveness and Offices and
coordination of care, transmitted
including public-private to
partnerships and/or headquarters
intersectoral
collaboration
1 Proportion It measures the level Gender, age, Perceived SPA, CIHI,
of countries of satisfaction with socioeconomic quality may Balanced
in which the health services status, not reflect Score Card
patient of the population age sub-national true quality Afghanistan,
satisfaction 18 and older, within of services. European
surveys are the past 12 months, Satisfaction Primary Care
carried out every year in some Monitor
on a regular settings has
basis been shown
to be poorly
correlated
to quality and
varies broadly
with setting

WHO GLOBAL STRATEGY ON INTEGRATED PEOPLE-CENTRED HEALTH SERVICES 2016-2026. EXECUTIVE SUMMARY
and timing
of survey
2 Proportion It considers Member Region, Data are not Country
of countries States whose national national, available Planning
whose national health policies, socioeconomic for all Member Cycle
health policies, strategies and plans status States Database
strategies are aligned with [online
and plans are at least two of the database]
aligned with following four strategic
the WHO goals: empowering
global strategy and engaging people,
on IPCHS strengthening
governance and
accountability,
reorienting the model
of care, and
coordinating services

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Strategic Indicator Definition Disaggregation Comments/ Primary

Goal limitations data
source
3 Proportion of It measures Region, Data not Administrative
countries that proportion of financing source currently data (European
allocate at government total institutional collected Primary Care
least 20% of health expenditure unit, main type broadly, Monitor,
government spent in primary of care, main differing PAHO
total health care type of provider, service Strategic Plan
expenditure to disease, delivery 2014-2019,
primary care sub- national models have WHO SHA
level, differing costs 2011)
socioeconomic
status

4 Proportion It considers primary Health facility Does not assess Health Facility
of countries care facilities that type, the completion Assessment,
with formal have a formal sub-national of referrals or HMIS (SARA,
systems system for referring level the proportion SPA)
for referring patients or of referrals
patients and/or accepting referred appropriately
accepting patients initiated.
referred It does not
patients assess the
counter-referral
completion
either
5 Proportion of It measures Age, sex Data are not Hospital
countries that unplanned and available for all registers linked
have decreased unexpected hospital Member States to routine
hospital readmissions for facility
readmission acute myocardial information
rates on acute infarction systems
myocardial
infarction
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to 10% or less

Acronyms:
CIHI - Canadian Institute for Health Information
HMIS - Health Management Information System
SARA - The Service Availability and Readiness Assessment (SARA) is a health facility assessment tool designed
to assess and monitor the service availability and readiness of the health sector and to generate evidence to
support the planning and managing of a health system
SPA - The Service Provision Assessment (SPA) survey is a health facility assessment that provides a comprehensive
overview of a country’s health service delivery
WHO SHA 2011 - WHO’s System of Health Accounts (SHA) 2011

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