Agnes Nanyonjo (Malaria Consortium Uganda & EV 2012)
The 2014 Geneva Health Forum attracted a multitude of participants from different sectors to the world health capital. They gathered for three days of debate on integration and interconnectedness of health care, as this year’s theme was ‘Global Health: Interconnected Challenges, Integrated Solutions’. The sessions by and large were designed to encourage interaction among participants and had session formats ranging from freewheeling fish bowls, a world café, … to more traditional ones like Q&A, debate etc.
Integration can mean different things to different people working in different sectors, as has been previously highlighted by Rifat Atun, one of the plenary session speakers at the Forum. He stated in a 2010 Health Policy and Planning paper for example that “systematic analysis of the relative merits of integration in various contexts and for different interventions is complicated as there is no commonly accepted definition of ‘integration’—a term loosely used to describe a variety of organizational arrangements for a range of programmes in different settings.“
As panel discussants burst out into debate, this became all too clear: from integrated disease care over integrated provision of health service packages to multisectoral approaches to health, different views of integration abounded according to people’s perspectives and experience. There was however a general consensus that integrated care happens at different levels: the global, national, local and patient level.
From a patient perspective, integrated care was generally regarded as patient centred care. Participants agreed that integrated care should be hinged around a patient-provider partnership. This patient-provider partnership is so valuable as patients experience illness in varying contexts. Given the multiple causes of ill health that cannot be explained by the traditional biomedical model alone, the identity of hospitals will have to move away from fancy buildings built around doctors to networks built around patients with good and continuing relationships between patients, their carers and health service providers. It was evident that patient centred care will require bottom up approaches with patients as drivers of intervention.
At the local level, the need to recognize the interdependence between the biomedical approach to disease and systems thinking and the implications of this interdependence for policy and practice were echoed throughout the debate. At the national level it was agreed that states particularly need to offer mechanisms for access to financial protection, high performance health delivery and equity.
As we are all citizens of the world, from the global perspective integration is also a desired key feature of future health systems as it encompasses a systems perspective with elements of governance, economic, social, political and commercial determinants of health. Given the rapid gains we have seen in health in the last decade in terms of life expectancy and child mortality, health systems need to equip themselves to address gaps in equity even faster in the coming decades through integrated care. They shall then no longer be seen as health systems but increasingly as systems for health. Since we know all too well that what shapes national health policy shapes global health policy and vice versa, implementation of integrated health systems raises a key governance question: “Who will lead the global health integration agenda while respecting national approaches to health?”
Although no health system can boast about being truly integrated, as it is not possible (and also not necessary) to integrate everything, integration of health systems and services remains a key priority on the global health agenda.