The CIHEB Approach to Health Service Delivery in Resource Constrained Countries
The CIHEB approach to health service delivery emphasizes the following
- Extensive patient preparation before commencement of chronic therapy
- Resolution of barriers to treatment success with emphasis on clinical and non clinical criteria
- A requirement for home and community based support
- Defined and effective patient-clinic flow systems for different tiers/types of service
- Point-of-care services with minimal referral needs
- Integrated preventive, treatment and rehabilitative services within a facility or well-defined referral network
- Empowerment of information sharing and joint patient management across facility-based inter-professional teams
- Data-driven patient care informed by best practices in data demand and information use
- Continuous Quality Management in healthcare through provider managed evaluations and interventions
- Emphasis on single patient and population level outcomes
Inter-Professional, Integrated Service Delivery
Poor policy and guideline implementation along with disparate funding sources leads to the development of silos in many care settings. High patient burdens, staff attrition and inadequate inter-professional collaboration worsen the effect of such silos. CIHEB directly confronts silos in health service delivery and trains health workers on the benefits and applications of integrated service delivery. Modeled after the multi-disciplinary approach employed at the University of Maryland Medical center, CIHEB facilitates interactions between health workers that enhance patient information distribution and use, and incentivizes collaboration across facility units and between the facility and community. CIHEB equips and empowers local health systems to sustain these approaches by developing location-specific care and treatment plans that consider local diseases of importance and locally available resources and constraints.
Integrated Point of Care Services
Various studies have demonstrated the impact of point-of-care services on patient satisfaction, retention in care and access to essential services.
Despite logistic, human, technological and power constraints, CIHEB in most facilities co-locates all necessary laboratory, pharmaceutical and critical service needs at patients' primary points of care. These efforts limit patient discomfort and referral, and enhance patient tracking and evaluation, which enhances the effectiveness and efficiency of care.
CIHEB selects medical technologies on the basis of their applicability within target environments while maintaining quality. In addition, CIHEB provides the necessary infrastructure and support to ensure the uninterrupted delivery of point-of-care services
Community Engagement and Support
CIHEB believes that community engagement is critical to service delivery. Advocacy and education within communities is important in the design, access and uptake of services, and many chronic conditions require community- and home-based care services for successful prevention, care and treatment outcomes.
All CIHEB service delivery projects incorporate a community component having strong linkages with identified facilities. CIHEB also provides appropriate staff and equipment for community engagement activities that are either clinical or non-clinical in nature. Communities are involved in the development of project care plans and patient flow systems to ensure context-specific effectiveness.
Contextually Relevant Technology and Resources
CIHEB seeks and deploys appropriate technologies to enhance the quality of service delivery. Low cost, efficiency, usability and sustainability are key factors considered for resource constrained settings and all resources necessary for the continued functioning and maintenance of such technologies are provided from the outset of their installation.
Technologies are routinely deployed to enhance clinical, laboratory, pharmacy and patient information. Surveillance activities, facilities, and host national institutions have their capacity built to manage and maintain these technologies.
Center for International Health, Education and Biosecurity
Institute of Human Virology (IHV)
725 West Lombard Steet
Baltimore, MD 21201