Service delivery and safety

WHO Global Strategy on People-centred and Integrated Health Services


The path to universal health coverage (UHC) draws attention to various barriers in access to quality health services linked to significant shortages in resources, fragmentation of health services and lack of people-centeredness. Worldwide, it is estimated that over one billion people lack access to essential health services. In many countries health services can be too far away (accessibility barrier), or poorly staffed with long waiting hours (availability barrier), or do not conform to people’s cultural, ethnic or gender preferences (acceptability barrier). Even when people do access services, those are often of poor quality, and in some cases, even harmful.

Services tend to be fragmented, curative, hospital-based and disease-oriented rather than person-centered, all of which further hampers access to quality health services. Fragmentation of care and lack of people-centredness can lead to significant difficulties in access to needed services, poor quality of care, inefficient use of resources, duplication of infrastructure and services, loss of continuity of care, and low user satisfaction with services. Moreover, rapid population aging; the emergence of chronic diseases and multi-morbidity, the ever increasing demands and expectations of the population, and the need to be more efficient in health care spending, require a more integrated and people-centred approach to service delivery. All of these issues are longstanding yet penetrating in many countries around the world and need a comprehensive and coherent solution.

WHO Response: Global Strategy on People-centred and Integrated Health Services

There is growing consensus worldwide on the areas in which health systems must be transformed. The WHR 2008 and Resolution WHA62.12 on primary health care, including health system strengthening, call for service delivery reforms to make health systems more people-centered and integrated. During 2014 and 2015, WHO will develop a Global Strategy that will assist its MS to achieve universal health coverage1 with more people-centred2 and integrated health services3. It is envisioned that the Strategy will be forward-looking, evidence-informed and action-oriented. The emphasis of the Strategy will be on the how of health care delivery reform, including reforms in both hospital and primary care settings. The Strategy will provide a wide range of policy options and reform strategies that should allow for context-specific tailoring of policy recommendations at the regional and country levels.

The Strategy will address successful models and trends in service delivery reform and how this would potentially apply in various country settings. It will also build on WHO's past work on service delivery across all levels of the Organization as well as on the lessons learnt from Member States and other development agencies. The Strategy will target government and ministries of health, the donor community, development agencies, professional associations, research institutions and the community at large. Within WHO, the Strategy will provide strategic direction for future cooperation on service delivery across disease-specific programmes. The process of developing the Strategy will follow a participatory and consensus-building approach. A more people-centered and integrated approach to service delivery is expected to increase access to needed health services throughout the life-course; improve health and clinical outcomes; enhance continuity of care and satisfaction with services; expand participation of users and communities in their own health care; improve providers’ job satisfaction; reduce system inefficiencies and duplication of services; and facilitate intersectoral collaboration in order to address other wider determinants of health.

Additional documentation

1. “Ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.” Source: WHO.
2. “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.” Source: Adapted from WHO.
3. “An approach to care that consciously adopts individuals’, 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.” Source: Adapted from WHO and USAID as quoted by the National Ageing Research Institute.

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