1.2. Comprehensive and integrated local service design for enhanced and equitable health care
Integrated services minimize redundancies and gaps in care, ensuring that populations in conditions of vulnerability receive continuous and effective support. Addressing the social determinants of health through comprehensive equity models leads to more effective health outcomes and efficient processes. This area focuses on integrating primary health care and social care within the broader health system, emphasizing the social determinants of health to ensure continuity of care, reduce barriers to access, and incorporate equity-focused models into health care delivery. Strategic entry point No. 3 provides further actions on integrating an SDHE approach into primary health care.
Examples from SIMASHE
Leveraging a Citizen Integrated Information System in Chile: An integrated information system is being developed to combine data from the Ministry of Social Development with electronic medical records and sectoral programmes. The system consists of two components: the first, called Gestion Social Local, is aimed at public servants and allows the integration of information from local social and health services, to improve the efficiency and effectiveness of their delivery using a person-centred, rather than a services-centred, approach. The second component, known as the Citizen One-Stop Shop, allows people to access information about the services they are entitled to, regardless of whether these are provided by different institutions. The system improves coordination between health and social care, and has been developed in collaboration with local municipal teams.
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Deployment of Territorial Health Managers for connecting local PHC work in the Brunca region, Costa Rica: The “Enlaces” strategy, a local integration approach, has been developed within the framework of primary health care (PHC). This strategy involves deploying managers from various health areas of the PHC system in the Brunca region, who can connect the work of primary care, the community and local governments. Regular coordination meetings are held to identify the needs and challenges of each stakeholder group, ultimately aiming to improve the effectiveness of the PHC system.
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Health service extension and deployment of out-of-facility health services in Perquenco, Chile: Municipal health centers have extended their operational hours to enhance access, particularly for working populations. Mobile municipal services have also been implemented to tackle access challenges in rural areas.
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Examples from related work and initiatives
Advancing Urban Governance for Health and Well-being in Khulna, Bangladesh: Under the leadership of its mayor, Khulna City has developed a four-year action plan called “Healthy City Khulna”. The plan prioritizes health in all policies, promotes healthy lifestyles, and strengthens governance and primary health care. To support its implementation, a memorandum of understanding was signed by 11 city stakeholders to establish a multisectoral coordination platform. This platform aims to institutionalize regular dialogue and collaboration between communities, local leaders and key sectors, to drive the plan forward effectively.
Key intervention activities
SIMASHE is continuously seeking examples related to this area of work, including activities for:
- multisectoral collaboration for integrated health and social care.
- devising infrastructures (including digital, physical, organizational) and outreach initiatives to address geographic barriers (e.g. deploying territorial health managers for coordinated service delivery, integrating telehealth systems to manage demand and reducing barriers to access).
- alignment of planning and budgeting processes for integration of the social determinants of health equity.
- leveraging specific health priorities (e.g. noncommunicable diseases) as a platform for comprehensive service integration.
- optimization and tracking of social and health services referral pathways.