A health-systems journey towards more people-centred care: lessons from neglected tropical disease programme integration in Liberia

Dean, Laura ORCID: https://orcid.org/0000-0002-4910-9707, Tolhurst, Rachel ORCID: https://orcid.org/0000-0002-3005-6641, Nallo, Gartee, Kollie, Karsor, Bettee, Anthony and Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X (2023) 'A health-systems journey towards more people-centred care: lessons from neglected tropical disease programme integration in Liberia'. Health Research Policy and Systems, Vol 21, Issue 1, e29.

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Abstract

Background:
Neglected tropical diseases (NTDs) are associated with high levels of morbidity and disability as a result of stigma and social exclusion. To date, the management of NTDs has been largely biomedical. Consequently, ongoing policy and programme reform within the NTD community is demanding the development of more holistic disease management, disability and inclusion (DMDI) approaches. Simultaneously, integrated, people-centred health systems are increasingly viewed as essential to ensure the efficient, effective and sustainable attainment of Universal Health Coverage. Currently, there has been minimal consideration of the extent to which the development of holistic DMDI strategies are aligned to and can support the development of people-centred health systems. The Liberian NTD programme is at the forefront of trying to establish a more integrated, person-centred approach to the management of NTDs and provides a unique learning site for health systems decision makers to consider how shifts in vertical programme delivery can support overarching systems strengthening efforts that are designed to promote the attainment of health equity.

Methods:
We use a qualitative case study approach to explore how policy and programme reform of the NTD programme in Liberia supports systems change to enable the development of integrated people-centred services.

Results:
A cumulation of factors, catalysed by the shock to the health system presented by the Ebola epidemic, created a window of opportunity for policy change. However, programmatic change aimed at achieving person-centred practice was more challenging. Deep reliance on donor funding for health service delivery in Liberia limits the availability of flexible funding, and the ongoing funding prioritization towards specific disease conditions limits flexibility in health systems design that can shape more person-centred care.

Conclusion:
Sheikh et al.’s four key aspects of people centred health systems, that is, (1) putting peoples voices and needs first; (2) people centredness in service delivery; (3) relationships matter: health systems as social institutions; and (4) values drive people centred health systems, enable the illumination of varying push and pull factors that can facilitate or hinder the alignment of DMDI interventions with the development of people-centred health systems to support disease programme integration and the attainment of health equity.

Item Type:	Article
Subjects:	W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 85 Patients. Attitude and compliance W General Medicine. Health Professions > Health Services. Patients and Patient Advocacy > W 84 Health services. Delivery of health care WC Communicable Diseases > Tropical and Parasitic Diseases > WC 680 Tropical diseases (General)
Faculty: Department:	Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12961-023-00975-x
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	14 Apr 2023 11:17
Last Modified:	14 Apr 2023 11:17
URI:	https://archive.lstmed.ac.uk/id/eprint/22315

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