Countries of the Americas Seek to Ensure Uninterrupted Care by Reducing Fragmentation of Health Systems

Mother with child receiving medical care

Washington, DC, 27 September 2022 (PAHO) – Ministers of Health of the Region of the Americas agreed on a new policy to address the fragmentation of health systems, a problem that affects the organization, management, and delivery of care in almost the entire Region.

The Policy on Integrated Care for Improved Health Outcomes was adopted by the 30th Pan American Sanitary Conference of the Pan American Health Organization (PAHO), which meets this week in Washington, DC.

"When the supply of services is fragmented, people who need them may discontinue care or be discouraged from seeking it," said James Fitzgerald, PAHO's Director of Health Systems and Services. "We hope this new policy will help countries integrate all levels of care, services, and providers to support uninterrupted, coordinated, comprehensive care for everyone who requires continuous care."

The document affirms that the Region urgently needs to move towards more integrated models, with mechanisms for coordinating care and providing health services that take into account the increasing complexity of processes and number of people with chronic conditions who require care throughout their lives.

This issue has become especially relevant in light of the challenges faced and lessons learned during the COVID-19 pandemic, which showed that fragmentation is one of the main institutional barriers to addressing the population's health problems.

Fragmented care, with lack of coordination among providers of different professional disciplines, prevents equitable access to health and can lead to patients missing needed services, as well as to duplication, conflicting treatment regimens, and over- or under-prescribing.

Causes of fragmentation include segmentation of different insurance programs, disease-focused models of care with predominance of acute episodic and hospital-centered care, vertical programs that are not integrated, fragmented health financing practices, and fragile leadership of the national health authorities.

The Policy on Integrated Care for Improved Health Outcomes provides a strategic framework and range of options to help PAHO Member States implement integrated care.

To this end, the policy calls on authorities to promote policies and establish strong, effective regulations focused on primary health care. It also calls for the promotion of integrated, people-centered health systems that provide culturally and linguistically appropriate, accessible health services with quality, equitable, efficient, and effective care.

PAHO will provide technical cooperation to the ministries of health of the Region so that they can lead and manage the transformation of health services towards integrated care, as well as optimizing the management of services so that people have good experiences, improved health, and better quality of care.

PAHO will also help to strengthen first-level capacities in order to provide inclusive and people-centered care, and promote self-care and community participation in decision-making on health.