Health services fragmentation is one of the main obstacles of effective health care outcomes in Latin America. Equity-LA II aims to evaluate the effectiveness of different care integration strategies in improving coordination and quality of care of IHN in different Latin-American health systems with particular reference to chronic diseases.
Equity-LA II adopts a quasi-experimental design with an innovative participatory action-research approach involving relevant stakeholders in the entire research process.
The project will
Health services fragmentation is one of the main obstacles of effective health care outcomes in Latin America, leading to difficulties in accessing care, poor technical quality, including discontinuity of care and inefficiencies in the use of scarce resources. These weaknesses are most evident in the care of patients with chronic conditions that require the coordination of multiple health professionals in different settings.
In Latin America, as in other regions, demographic and epidemiological transitions are occurring; accentuating the need for care coordination for the elderly and people with pluri-pathologies, but also for those living in urban slums, rural areas and with low socio-economic status. In response to these challenges, many Latin-American countries have issued policies fostering the introduction integrated health care networks to provide more efficient, equitable and higher quality care.
An IHN is defined as a network of organisations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the health status and outcomes of the population served. Evidence on their outcomes, however, is still scarce. Results from the previous project Equity-LA (FP7-Heath-2007-B-223123) identified numerous barriers to access healthcare in the studied IHN in Brazil and Colombia, as well as factors that hinder care coordination between primary and secondary care; thus, suggesting failures in the implementation of IHN policy.
These results highlight the need for further research to increase our understanding of the IHN performance in different health systems in Latin America, as well as the need to developing Equity-LA II will fill this gap – expanding the research to four additional countries (Argentina, Chile, Mexico and Uruguay) – and, more importantly, will provide evidence on best practices of care integration that could be translated into effective policies for varied socioeconomic contexts and different health systems.
To evaluate the effectiveness of different care integration strategies that improve coordination and quality of care of IHN in health care systems in Latin America with particular reference to chronic diseases. In order to achieve this aim, Equity-LA II adopts a quasi-experimental design for the evaluation of complex interventions (before-after study) with an innovative participatory action-research approach in IHN of six Latin-American countries (Argentina, Brazil, Colombia, Chile, Mexico and Uruguay). Evidence will be produced by combining qualitative and quantitative methods and conducting intra- and cross-country comparisons.
Results of Equity-LA will contribute to improving the effectiveness, efficiency and equity of Latin American healthcare systems by providing evidence on best practices of care integration. This addresses the objectives of the FP7 Health Cooperation Work Programme (to support research that improve efficiency and effectiveness of health systems in low and middle income countries); and will be achieved by:
Furthermore, the research supports different Millennium Development Goals by improving access to quality healthcare services; as well as the European Innovation Partnership on Active and Health Ageing by focusing on providing best practices on the management of two conditions highly prevalent among the elderly: type 2 diabetes and chronic obstructive pulmonary disease (COPD).
Finally, the Equity-LA II builds networks that are twofold: between European and Latin American research institutions; and between different interest groups and stakeholders involved in the action research process (policy makers, civil society groups and health providers).
Equity-LA II has developed a knowledge management and dissemination strategies that will impact the development of policies: generated evidence will be translated into policy tools and guidelines conducive to more effective health systems and higher quality services through improving IHN.
Guidelines will comprise strategies on policy advocacy, involvement of stakeholders, use of evidence and scale up of IHN examples. Apart from local, national and international policy makers, potential users of research results include local healthcare providers and researchers, enhancing their understanding on the performance and best practices of IHN and their outcomes.