Accountability for coordinated/integrated health …

1 By: Esther Suter and Sara Mallinson Accountability for coordinated / integrated health services delivery Working Paper Accountability for coordinated / integrated health services delivery Working Paper Esther Suter and Sara Mallinson health Services Delivery Programme Division of health Systems and Public health ABSTRACT Accountability is an essential governance tool defining relationships, roles and responsibilities pertaining to the actors involved, ensuring that the resources necessary to perform those roles are available and that performance is measured and evaluated. This document explores how Accountability can support coordinated / integrated health services delivery. Keywords DELIVERY OF HEALTHCARE, integrated health SERVICES ADMINISTRATION health CARE SYSTEMS health SERVICES Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen , Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site ( ).

2 World health Organization 2015 All rights reserved. The Regional Office for Europe of the World health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World health Organization in preference to others of a similar nature that are not mentioned.

3 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World health Organization. CONTENTS Page List of Tables .. v Acknowledgements .. vi Abbreviations .. vii Preface .. viii 1. Accountability for CIHSD .. 1 Governance and Accountability .

4 1 Definition of Accountability .. 2 Accountability for CIHSD .. 2 2. Components of Accountability for CIHSD .. 3 Legal Accountability .. 3 Financial Accountability .. 3 Professional Accountability .. 3 Political Accountability .. 4 Public Accountability .. 5 3. Roles and responsibilities in CIHSD Accountability .. 6 4. Actions to strengthening Accountability for CIHSD .. 11 Actions by the stewards .. 11 Actions by service delivery organizations and stewards .. 11 Actions by providers .. 12 Actions by the public .. 13 5. Tools in Accountability for CIHSD .. 14 Tools for legal Accountability .. 14 Tools for financial Accountability .. 15 Tools for professional and organizational standards .. 15 Tools for political Accountability .. 16 Tools for public Accountability .. 16 6. Development and assessment frameworks for CIHSD Accountability .. 22 7. Final Remarks .. 25 References.

5 26 Accountability for the provision of coordinated / integrated health services Page v List of Tables Page Table 1. Accountability for CIHSD stakeholders, their roles and responsibilities .. 7 Table 2. Overview of selected Accountability tools for CIHSD .. 18 Table 3. Examples of accreditation and quality assurance institutions .. 20 Table 4. Summary of Accountability tools for CIHSD .. 21 Table 5. Selected examples of frameworks to support Accountability development and assessment .. 23 Accountability for the provision of coordinated / integrated health services Page vi Acknowledgements This working paper was developed by Esther Suter and Sara Mallinson from the Workforce Research and Evaluation Alberta health Services of Canada and edited by Juan Tello and Viktoria Stein of the health Services Delivery Programme in the Division of health Systems and Public health at the WHO Regional Office for Europe.

6 Erica Barbazza provided inputs during the discussions that shaped the final product. The Division of health Systems and Public health is led by Hans Kluge. Abbreviations CEO Chief executive officer CIHI Canadian Institute for health Information CIHR Canadian Institutes for health Research CIHSD coordinated / integrated health Services Delivery CQC Care Quality Commission GAP Global Accountability Framework GP General Practitioner NHS National health system NICE National Institute for Clinical Excellence OECD Organisation for Economic Co-operation and Development PAM Patient Activation Measure POET Personal outcomes evaluation tool PROMs Patient-reported outcome measures WHO World health Organization Accountability for the provision of coordinated / integrated health services Page viii Preface In 2012, Member States of the WHO European endorsed the European health policy health 2020.

7 Recognizing health system strengthening as one of four priority action areas in setting out a course of action for achieving the Region s greatest health potential by year 20201. The vision put forward by health 2020 calls for people-centred health system. In doing so, it extends the same principles as first set out in the health for all and primary health care agenda, reorienting health systems to give priority to areas including disease prevention, continual quality improvement and integrated services delivery. The importance weighted to health system strengthening is also made explicit globally in WHO s 12th General Programme of Work for the period between 2014 to 2019, with a priority technical cluster specifically concentrated on the organization of integrated services delivery as positioned in the interim global strategy for people-centred and integrated health services2.

8 In line with these priorities, strategic entry points over the 2015-2020 period have been further delineated in two priority areas: (1) transforming health services to meet the health challenges of the 21st century and (2) moving towards universal coverage for a Europe free of catastrophic out-of-pocket payments3. This document contributes to taking the first of these priorities further. It is set in the context of developing an overarching Regional Framework for Action for coordinated / integrated health Services Delivery. Launched in late-20134, the Framework aims to support Member States in transforming health services delivery by adopting a results-focused, action-oriented approach relying on health systems thinking to identify key entry points for taking action. 1 WHO Regional Office for Europe.

9 (2012). health 2020: A European policy framework and strategy for the 21st century. Copenhagen: WHO Regional Office for Europe. 2 WHO. (2015). WHO global strategy on people-centred and integrated health services. Interim report. Geneva: World health Organization. 3 WHO Regional Office for Europe. (2015). Priorities for health system strengthening in the European Region 2015-2020: walking the talk on people centredness. Copenhagen: WHO Regional Office for Europe. 4 WHO Regional Office for Europe. (2013). Strengthening people-centred health systems in the WHO European Region: a roadmap. Copenhagen: WHO Regional Office for Europe. Accountability for the provision of coordinated / integrated health services Page 1 1. Accountability for CIHSD Governance and Accountability The World health Organization (WHO) has recognized the importance of governance for the responsible management of the well-being of the population and has included governance in its framework for strengthening health systems (Barbazza and Tello 2014, WHO 2008).

10 Even though a consistent definition and measurement of governance is lacking, various authors stress the importance of governance as a critical instrument to strengthen public and institutional performance (Van Kersbergen and Van Waarden 2004, Chhotray and Stoker 2009) and Accountability as one of its key levers for successful performance improvement (George 2003, Brinkerhoff 2004, Hammer et al. 2007, Lewis and Pettersson 2009). In the WHO European Region, the adoption of the guiding policy framework, health 2020, has prioritized improving leadership and participatory governance for health as one of two main strategic objectives towards improved health and well-being of populations. In doing so, whole-of-government and whole-of-society approaches have been called upon for equitable improvements in health (Kickbush and Gleicher, 2012) and are considered here as the necessary governance conditions to underpin coordinated / integrated health services delivery.