Figure 1
Key health system developments and policy initiatives relevant to the scale-up of integrated care prior to and during the SCUBY project. NCD, Non-Communicable Disease; CVD, Cardiovascular Disease; MHO, Ministry of Health; NGO, Non-governmental Organisation; GP, General Practitioner; H-EQIP, Health Equity and Quality Improvement Project; NIPH, National Institute of Public Health; UA, University of Antwerp; CHCL, Community Health Center Ljubljana. Reference to position paper (Belgium) [21].
Table 1
Key roadmap actions and strategies to scale-up integrated care across the three participating countries.
| CAMBODIA | SLOVENIA | BELGIUM |
|---|---|---|
| Component 1: Health Service Delivery and Governance Strategy 1.1: Increasing coverage of second-version PEN in primary healthcare. Strategy 1.2: Strengthening the workflow of Second-version PEN at the operational district level. Strategy 1.3: Revising/updating the components of ICP. Strategy 1.4: Adding community-based intervention to ICP. Component 2: Medicine Supply Strategy 2.1: Strengthening and updating the essential medicine supply system. Strategy 2.2: Reinforcing the capacity of staff in managing medicine inventories. Component 3: HR Strategy 3.1: Strengthening leadership and management of human resources for health at the operational district and health centre levels. Strategy 3.2: Ensuring appropriate staff/staff capacity/skills-mix through practical training on T2D & HT care (on-site training), including nurses and midwives. Component 4: Health financing Strategy 4.1: Increasing investments in T2D and HT. Strategy 4.2: Increasing service accessibility at public healthcare facilities. Strategy 4.3: Reducing financial burden to T2D and HT patients. Component 5: Health information system Strategy 5.1: Monitoring and evaluation. | 1. An m-health intervention to support and empower patients (telemedicine). 2. A group education programme by patients (patients as educators). 3. Community-based education programme (with healthy lifestyle intervention(s)). 4. An intra-team collaboration project: developing clinical pathways of patients for better team management (with a focus on the education of registered nurses). | 1. Change management at practice (micro) level: 1a: Better care for chronic conditions by GPs through training. 1b: Human resource management: Budget for nurse in primary care team. 2. Data monitoring at organisational/population (meso) level: 2a: Monitoring of chronic care indicators in Primary Care Zones. 2b: Monitoring care organisation at practice level 3. Health financing at political (macro) level: 3a: Budget for chronic care that stimulates quality. 3b: Alternative financing models in primary care. |
[i] HRH, human resources for health; HT, Hypertension; ICP, Integrated Care Package; PEN, Package of Essential Interventions; T2D, Type 2 Diabetes.
Figure 2
Cross-country lessons can be drawn prior to the roadmap development as well as retrospectively.
Figure 3
Conceptual model for scaling-up integrated care across health systems, aligned with the scale-up dimensions reported elsewhere [5], where (i) an enabling and elastic environment is a pre-requisite for sustainable care integration and expanding the package of care, (ii) subsequent dialogue is required to institutionalise integrated care within existing governance structures, to (iii) then adopt diversification strategies that focus on coverage of vulnerable populations to not be left behind.