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People-centred health systems
Across the world, the mix of health system challenges grows more complex every day. Added to the continuing imperative to address inequities in health and health care access are the demands resulting from the growing importance of chronic and mental illnesses and the need for greater continuity of care. Changing community expectations of health systems, meanwhile, include particular concerns for patient safety.
Universal Health Coverage (UHC) is providing a global rallying call for those concerned with strengthening health systems. However, to address today’s challenges this call must be deepened and extended by a focus on people-centred health systems: health systems that recognize that people are their central focus and resource, and that address responsiveness at population and patient levels as a central goal.
Acknowledging that health systems operate in broader social, political and economic contexts that are of human creation, people-centred health systems seek to respond to all factors that affect health rather than focusing only on biomedically-driven solutions. They also actively work to address social exclusion and inequities as determinants of poor health, reflecting pro-people philosophies of social justice and equity. To this end, they consider the health needs and preferences of individuals, families and communities, and create the channels through which these can be articulated and realized. They recognize and actively progress people's rights to participate in and determine how health systems are organized, resources are allocated and services delivered. And they pay attention to the role of patients as partners in their own health care and to strategies that empower them to make choices about health and health care.
In addition, people-centred health systems encompass the rights and needs of people who work in and for the health system in various roles – as carers, health workers, advocates, administrators, planners and researchers. Such systems recognize that the critical decisions that determine health system performance are made by people across all parts of the system – at all levels and in both public and private sectors. They emphasise the importance of collective duties toward the advancement of health, and to ensuring accountability for health system and patient outcomes. In working towards universal health coverage, people-centred health systems are sustained by progressive financing mechanisms and collective action to strengthen the range and quality of services delivered to all groups of the population.
The theme of people-centred health systems is, therefore, integral to discussions in many different contexts. It embraces a wide range of issues about health, social justice and human rights, as well as about health systems and service delivery. For example, it:
- emphasizes the role of social exclusion and inequities as determinants of poor health and encourages active engagement to address them;
- addresses concern for improving the quality of health care, for example through strategies of service integration, improving access to essential medicines and engaging patients and health workers in collectively ensuring quality and safety;
- encompasses the rights and needs of people who work in and for the health system in various roles – as carers, health workers, activists, health system decision-makers and researchers;
- recognizes that people are at the heart of health system complexity, and influence health system performance and health policy change;
- links to thinking about social empowerment, and how to recognize and actively progress people’s rights to participate in and determine how health systems are organized, resources allocated and services delivered.
The research agenda related to people-centred health systems is as broad as the complex challenges currently facing health systems. Like all health policy and systems research it is addressed by work that is deliberately inter-disciplinary or that draws on particular disciplinary traditions; and it applies a range of methodological approaches. Particular attention is, nonetheless, given to participatory and action research and evaluation approaches that support health system change, as well as to the contribution of implementation and complexity sciences in understanding how to bring about change.
In addition, research for people-centred health systems pays attention to who sets the research agenda, how the research is conducted and how to ensure that research has impact on people’s lives. Recognizing that researchers have roles in all these processes, it also acknowledges that they are one group among many with a legitimate concern for people-centred health systems. They bring their professional expertise to the challenge of health policy and system development, and work alongside others, engaging across experience and disciplinary boundaries to generate insights and ideas, and to support change within health systems. Thus, taking action to strengthen people-centred health systems requires strategies for developing learning communities and knowledge-translation platforms that bring researchers, activists, health system managers and policy-makers together.
Page updated: 13 September 2013