PHA-Exchange> Document on: The FRAMEWORK FOR AGE-FRIENDLY COMMUNITY-BASED HEALTH CARE

[Ghassan]

Dear Colleagues,

Greetings from Syria
It pleases me to share with you an important document on FRAMEWORK FOR AGE-FRIENDLY COMMUNITY-BASED HEALTH CARE

Best Regards

Ghassan Shahrour, 
Yarmouk
P O Box 14189 Damascus - Syria
Email 1:  afodafro at scs-net.org
Email 2:  syria at icbl.org

http://www.who.int/hpr/ageing/perth_framework.htm

PERTH FRAMEWORK FOR AGE-FRIENDLY COMMUNITY-BASED HEALTH CARE

Rationale

The Madrid International Plan of Action on Ageing adopted by the Second UN World Assembly on Ageing (2002) emphasizes that health promotion activities, disease prevention throughout the life course and equal access of older persons to health care and services are the cornerstone of healthy ageing. It recommends measures to provide universal and equal access to community-based health care and to establish community health programmers for older persons. The Madrid Plan also calls for the elimination of discrimination in access to health care based on age or any other forms of discrimination. 

The United Nations Principles for Older Persons (1991) reaffirm the principles of independence, participation, care, self-fulfillment, and dignity, whereby older persons should have access to health care and should benefit from family and community care and protection, in accordance with each society's system of cultural values. 

Every human being is entitled to the enjoyment of the highest attainable standard of physical and mental health conducive to living a life in dignity. The human right to health is recognized in numerous international instruments, among them the Universal Declaration of Human Rights, the International Covenant on Economic, Social and Cultural Rights, the International Convention on the Elimination of All Forms of Racial Discrimination, the Convention on the Elimination of All Forms of Discrimination against Women, and the Constitution of the World Health Organization (WHO). 

The process of rapid population ageing poses tremendous challenges to the provision of health care and social services and demands on such services may intensify as the number and proportions of older persons in populations continue to increase. The global disease profile is shifting from infectious to non-communicable and chronic diseases such as heart disease, stroke and cancer, many of which can be prevented or delayed through strategies which include health promotion and disease prevention. While the disease burden is rapidly shifting towards chronic conditions, health systems are still mostly geared to address acute, episodic events. But chronic diseases require ongoing monitoring in order to minimize the development of associated disabilities and negative effects on the quality of life. Chronic care is often more effectively provided in a community-based rather than an acute care or institutional setting. 

While most older persons continue to enjoy relatively good health and are active contributors to their communities and families, many older persons require special attention and support in order to maintain health. Generally, older persons prefer to age in their own homes, within their communities or familiar environments. The proximity, accessibility, cost effectiveness and user-friendliness of community-based health care services are therefore of vital significance to the health and well-being of older persons and their families. 

Community-based health care is generally the first point of contact with formal health services and is often complemented by social care. Health care provided at the community level should also include a range of health promotion and disease prevention activities. However, with a few exceptions, community-based health care services are often fragmented and are not sensitive to the needs of their older users. They may have inadequate resources and little emphasis on health promotion, prevention, systematic screening and referrals -- all of which are essential for maintaining health of ageing populations. 

Objectives

In an effort to promote the responsiveness of community-based health care to the needs of the population at large and in particular to the growing numbers of older persons, a set of General Principles Guiding Age-Friendly Community-based Health Care has been developed. Such General Principles aim at providing guidance and setting standards in the provision of community-based health care to ensure that services are age-sensitive, age-responsive and more accessible to users of all ages and, in particular, older persons. Users of health care services, especially older users, must be empowered and enabled to remain active, productive and independent in their own communities for as long as possible. As an overall objective, the General Principles aim to enable older persons to achieve active ageing, defined by WHO as the process of optimizing opportunities for health, participation and security in order to enhance the quality of life as people age. 

The General Principles target two major groups: (1) policy makers and professional associations, particularly in the health and social services sectors; and (2) health care providers at community levels, which include health professionals such as general practitioners, nurses, community health workers, as well as clerical health center staff, family care-givers and social workers. 

Beneficiaries of the General Principles will be health care users of all ages, in particular older persons. 

It is expected that the General Principles, once put into effect, will result in the promotion of age-friendly attitudes and the provision of age-friendly health care services, especially at the community level. This will be achieved through increased awareness and sensitivity to older persons and their needs, better training for service providers of health care for older persons, as well as better understanding and use of health care services by the users, i.e. older persons and their families.

The General Principles, once tested and implemented, will inform changes in attitude and practices at the community health care level. The implementation of the Principles should be monitored and evaluated regularly at the national and local levels by qualified professionals in collaboration with other stakeholders, to include in particular older persons. The implementation is to be governed by professional and ethical standards.

Overarching Principles

As an overarching principle, health care services must aim to provide the highest attainable standards of health, conducive to promoting active ageing and health over the life course and to maintaining life in dignity. Towards this end, health care services must meet the following essential criteria: Availability; accessibility; comprehensiveness; quality; efficiency; non-discrimination; and age-responsiveness. All medical services and attention should cover both physical and mental health, including the provision of equal and timely access to basic promotive, preventive, curative and rehabilitative health services and health education, regular screening programmes, appropriate treatment of illnesses and disabilities, preferably at the community level, as well as the provision of essential drugs. Further, health care services should be coordinated with the provision of social support services, including, when necessary, the provision of basic essentials such as food, shelter and safety.

Health care users of all ages, of which older persons are a growing target group, should be enabled to make informed choices regarding services available to them. The principle of non-discrimination should be upheld to ensure equal distribution and treatment, as well as the prevention of abuse, taking into account the economic, social, psychological and physical vulnerability of older persons. 

The special health needs of women, particularly older women, must be taken into account in the promotion of age-friendly attitudes and provision of health care services. As older women generally account for the majority of the growing older population, community-based health care must ensure that attitudes, services and relevant policies integrate both age and gender concerns. Further, there is growing evidence that the health needs of ageing men are often neglected and need to be addressed by health care providers through special outreach programmes. 

Age-friendly community-based health care must be responsive to cultural diversity, and sensitive to the concerns of all health care users, including older persons. The integration of cultural concerns and sensitivity into community health care provision will enhance the responsiveness of services and minimize barriers to service accessibility, thus empowering older persons, their families and community networks.

At the macro policy level, age-friendly community-based health care will help promote an integrated approach to public health and health care. The General Principles on Age-Friendly Community-based Health Care must therefore be fully integrated into relevant health and social policies at the national and local levels at all stages of policy making and implementation. For this process to be effective, cooperation and coordination between government departments, other relevant organizations and civil society as well as between the national and local levels must be improved. It is essential that investment in community-based health care, including health care of older persons and age-friendly community-based health care, be recognized as having long-term benefits and be supported by national governments, with adequate budget allocation and training support to professionals and informal caregivers. Ultimately, age-friendly community-based health care should result in attitudinal change, education, training and the whole range of integrated health services and social support to be comprehensive, accessible, responsive and cost-effective.

General Principles Guiding the Practice of Age-Friendly Community-based Health Care:

It is recognized that the organisation and delivery of community-based health care services depend on national health care systems and their individual settings. However, the following General Principles are applicable to any community-based health care setting and provide guidance to all providers of formal community-based health services; such health care services include, among others, general practitioners, local health care centres, and community-based government clinics. 

Age-friendly community-based health care should incorporate the following General Principles:

1. In the areas of information, education, and training:

1.1 All health care centre staff should receive basic training in age, gender, and culturally sensitive practices that address knowledge, attitude and skills

1.2 All clinical staff in the health care centre should receive basic training in core competencies of elder care

1.3 Health care centres should provide age, gender and culturally appropriate education and information on health promotion, disease management and medications for older persons as well as their informal carers in order to promote empowerment for health

1.4 Health care centre staff should review regularly the use of all medications, including complementary therapies such as traditional medicines and practices 

2. In the area of community-based health care management systems:

2.1 Health care centres should make every effort to adapt their administrative procedures to the special needs of older persons, including older persons with low educational levels or with cognitive impairments 

2.2 Health care centre systems should be cost sensitive in order to facilitate access to needed care by low income persons

2.3 Health care centres should adopt systems that support a continuum of care both within the community level and between the community and secondary and tertiary care levels 

2.4 Health care centres should put into place mechanisms that facilitate and coordinate access to social and domiciliary care services 

2.5 All record keeping systems in health care centres should support continuity of care by keeping records on community-based, secondary and tertiary care as well as on the provision of social services for their clients 

2.6 All relevant stakeholders, including older persons, should be part of participatory decision-making mechanisms regarding the organisation of the community-based care services

3. In the area of the physical environment:

3.1 The common principles of Universal Design should be applied to the physical environment of the health care facility whenever practical, affordable and possible 

3.2 Safe and affordable transport to the health care centre should be available for all, including older persons, whenever possible, by using a variety of community-based resources, including volunteers

3.3 Simple and easily readable signage should be posted throughout the health care centre to facilitate orientation and personalise providers and services

3.4 Key health care staff should be easily identifiable using name badges and name boards 

3.5 The health care centre should be equipped with good lighting, non-slip floor surfaces, stable furniture and clear walkways 

3.6 The health care centre facilities, including waiting areas, should be clean and comfortable throughout 

These General Principles can be adapted to each health care centre and provider setting in order to ensure responsiveness and sensitivity to the community served. 
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