New Year, Renewed Commitment: Making progress toward universal health coverage through person-centered care
January 11th, 2023 | Viewpoint
January 11th, 2023 | Viewpoint
As noted by the World Health Organization (WHO), “universal health coverage requires strong, people-centred primary health care.” As we begin 2023, it is clear that to achieve the fundamental objectives of universal health coverage (UHC) and 2030 Sustainable Development Goal 3.8, we need to include communities in the design, implementation, and monitoring of people-centered health services.
But what is person-centered care?
Person-centered care acknowledges essential human dignity, treats people as individuals, and asks what they want from treatment and care. Person-centered systems, approaches, and services improve:
JSI colleagues around the world identified five principles (see figure and descriptions below) of person-centered care that apply to all our practice areas—HIV, sexual and reproductive health; family planning; infectious diseases; immunization; maternal, newborn, and child health; nutrition; digital health; and health systems strengthening.
Integrating these principles across health and development programs can help the global community make greater progress toward UHC.
Trust & Transparency
Trust is essential to public health. Person-centered operations, workforce development, and services are conducted with transparency and the goal of building and maintaining trust between partners.
Ethiopia’s Health Extension Program deploys health extension workers (HEWs) to provide disease prevention and family health services and share information with communities across the country. HEWs work in the communities in which they grew up and reside, placing them in a better position to maintain trust and deliver respectful care. JSI’s Last Ten Kilometers project trained more than 10,000 HEWs to link communities to services, improving the health status of more than 17 million Ethiopians over 10 years.
Safety & Dignity
People-centered communications, settings (workplace and care), interactions, and experiences provide a sense of safety and dignity—primarily defined by the people being served. Clients’ autonomy, privacy, and values are acknowledged and respected by providers and the system they work in.
Through the Rapid Immunization Skill Enhancement Gavi Health System Strengthening Phase 2 Grant, JSI developed an interactive and adaptable knowledge-building system to support different levels of health personnel to implement guidelines for India’s Universal Immunization Program. The system offers tailored learning based on providers’ needs and increases their capacity to deliver evidence-based, high-quality care to all individuals. Initially piloted in five districts of five states, the platform has scaled to 36 districts and served almost 14,000 learners.
Culture & Identity
Health policies, products, and services designed using a “whole person” approach consider people’s contexts, experiences, culture, identity, and where they are in the life course. Governance and management solutions demonstrate the values that they are expected to uphold.
JSI and inSupply Health are developing sustainable and scalable community-based distribution models to increase equitable access to health commodities in Kenya. The team works in arid and semi-arid lands, where nomadic and semi-nomadic pastoralist people live and have limited access to health services. Community health volunteers use supply data to promote better resupply practices, ensuring that commodities are available where and when people need them and in line with their religious and cultural norms. Changes to cStock, a supply chain strengthening tool, reduced community health volunteers’ barriers to reporting, and its implementation increased access to commodities in these communities.
Voice & Choice
Individuals and communities understand and are able to advocate for and make decisions about their health goals and service options. One of the biggest health governance challenges is ensuring people’s meaningful participation and reflecting their needs in policies and implementation.
Through the Access Collaborative, JSI has helped more than 20 countries introduce and scale up subcutaneous DMPA. This expanded the range of available contraceptive methods and corresponding information so girls and women can select the method that meets their reproductive goals. In Nigeria, people-centered health system leadership, reproductive health policies, and partner engagement gave women seeking family planning services more choice.
Empathy & Collaboration
Staff and providers understand that the individuals they treat are connected to other people, broader communities, and contexts that influence their lives and their health care decisions. Empathy is perceived as a combination of the emotional, cognitive, and practical skills involved when caring for a person. Providers deliver empathetic care in collaboration with a person’s broader care team and social network.
In the Lango Sub-region of northern Uganda, USAID’s Regional Health Integration to Enhance Services-North, Lango project, implemented by JSI, works with and across ministry of health cadres (e.g., district and village health teams, health workers) to ensure routine immunization of every child. The project’s training of community volunteers as vaccinators has increased reach and improved health outcomes. As people who understand the social and environmental context, these volunteers are better able to meet the needs of their community and understand what drives their health care decisions. In Amolatar District, DPT3 vaccination coverage improved from 82 percent in June 2019 to 98.3 percent in July 2021.
No matter how much or how often people and communities are “empowered,” UHC will not be achieved until health systems include them—especially those most often excluded from critical health conversations and who face high levels of inequity— in the design, implementation, and evaluation of health services. If we are to achieve health care for all by 2030, we must put people at the center of our policies, systems, services, and programs, and work by these principles ourselves.
By Jessica Posner and Nicole Castle