| Examples of enabling strategies |
Joint governance arrangements Joint funding arrangements Integrated budgets and funding designed to align providers’ objectives, reduce incentives to cost shifting and encourage efficiency Integrated shared patient records Co-production with patients Multi-disciplinary teams of professionals Generic workers (e.g. Buurtzorg model of nurse-led care) Inter-organizational and inter-personal relationship-building is critical to building integrated services |
Leadership (including political will and explicit implementation strategy) and supportive organizational culture Availability and deployment of appropriately trained and incentivised health workers Good staff morale, motivation and support to overcome structural deficiencies Patient-centred delivery taking into account patients’ complex socio-economic and cultural needs Establishment of a workforce trained to provide a wider range of services at community level (e.g. Health Extension Workers); task shifting Integration of prevention and treatment programmes Integrated care to help ‘normalize’ stigmatized conditions (e.g. HIV, TB) |
| Examples of key challenges faced |
Fragmented health care landscape with weak link with prevention Financial barriers between systems thwart efforts to integrate: funding methods are different for health and long-term/social care in many countries (e.g. in England, health is free while social care is means tested) Financial incentives not aligned across types of providers (e.g. acute, primary health care) Competing for resources preventing collaboration (competition rules) Workforce with high degree of professional specialization Lack of IT inter-operability and restrictive information governance rules Lack of ‘hump’ funds to allow providers to transition to different models of care Health care and social care separated by language, conceptions of health, professional cultures and ways of working Primary and community health care sector under-resourced |
Siloed funding and reporting, with donors wanting accountable results for their specific programmes Lack of incentives for well-funded programmes to integrate with poorer ones Lack of negotiating power for under-funded programmes Limited capacity, support for and number of staff Poor and fragmented Health Management Information Systems (HMIS) infrastructure Fragmented, poorly coordinated care across agencies/sectors Primary health care is generally under-resourced |
