Integrated Community Care (ICC) is a new concept that has been launched by the international partnership of philanthropic organisations known as TransForm which came into being in 2018. The TransForm partners are convinced of the value of investing time, resources and imagination to enhance the capacity of local communities to deal with public health issues and the care needs of community members throughout their whole lifetime.
The TransForm initiative is conceived as a learning journey, since this is the only way to move forward while maintaining a longitudinal perspective and creating space for the necessary learning curve. Our hope is that sharing our reasoning and insights will allow interested parties to understand how we can support ICC and embed and express it in practice, find the storylines that form the ‘ICC 4all’ narrative and identify principles that could help in building sustainable and context-sensitive ICC.
ICC has an undeniable relevance to all stakeholders and a high face validity. It brings together three generic concepts: “integrated”, “community” and “care”. In its most rudimentary form, ICC is recognized as a much-needed and valuable expansion of more widespread notions of integrated care, explicitly recognising the value, potential and power of communities, citizens and laypeople. Going even deeper than this, however, ICC deserves its own approach. Strengthening communities will require a fundamental shift in the way we value and understand the role of people and communities as an integral part of the system. It involves a shift from an ego-system awareness with the emphasis on one’s own well-being, to an eco-system awareness that simultaneously emphasises the well-being of all .
Integrated community care is now more firmly on the agenda than ever. Citizens, neighbourhood networks, community-based organizations and informal carers are all being recognized as key players in tackling the Covid-19 crisis as they address the huge needs for psychosocial, practical and food support . Bottom-up initiatives are popping up to respond to the needs of the most vulnerable individuals in our communities. The response to the crisis from the voluntary sector has been spectacular. Their example inspires us to act differently, cooperate better and innovate faster. Cooperation and innovation are necessary if we are to increase the resilience of our health and care systems .
ICC acknowledges that communities are essential partners that contribute invaluable assets: relationships, expertise, contextual knowledge, entrepreneurship, public space and services, and locally supportive ecosystems. ICC seeks to create conditions that will allow people to care for themselves and also for others in their community. It is a whole-of-society approach to health and well-being, centred on the needs and preferences of citizens, families and communities. One key feature of ICC is that it moves away from ‘delivery’ and towards genuine ‘co-development’. Individuals and communities are no longer framed as recipients. This gives it a greater relevance as it aligns with fundamental shifts taking place in society and in health and care systems. ICC is linked to a positive, empowering understanding of health. It encompasses the desire to be a positive force for change amid the multi-faceted transition to a new, sustainable equilibrium for our societies. The main elements of the narrative can be summarised as follows:
There is no single model for operationalizing ICC but a wide range of existing practices express the DNA inherent within the concept in different ways. These include, among others, Community Health Centres, Vibrant Communities and Healthy Place-making .
TransForm, the international coalition for learning in the area of ICC, has identified three storylines to guide us as we seek ways to make ICC the new standard of care:
The principles underpinning effectiveness adhere to the GUIDE criteria: they help with Guidance (priority setting), they have Utility (i.e. they are actionable), they are Inspiring (motivating people to ‘walk the talk’), they are Developmental (i.e. applicable to a range of contexts) and they are Evaluable (i.e. you can document and judge the results).
The seven effectiveness principles for Integrated Community Care are set out below. These are grouped into three categories: the importance of authentic partnerships, the relevance of facilitating and enabling infrastructure and the dynamics of evaluation :
The Covid-19 crisis may be a turning-point. It is giving us a unique opportunity to acknowledge ICC as a systemic approach that blurs boundaries between informal and formal care, between different skills in the workforce and between primary and specialist care. We call on all stakeholders and policymakers to work together to find inclusive and sustainable solutions that can move us towards ‘ICC 4all’:
The ongoing Covid-19 pandemic has revealed the fragilities in key infrastructures and systems. A renewed emphasis on resilience creates opportunities for a more richly textured and locally sensitive health and social care system that plays to the strengths of citizens and communities and addresses social and environmental determinants of health .
The TransForm experience has already generated insights into a new paradigm that may bring fundamental benefits for all people, especially for under-served and marginalised groups. Nevertheless, we must have patience with the slow pace of fast change. We believe in the power of experimentation, in working continuously to build our evidence base and in ongoing enlargement of our learning coalition.
TransForm wishes to thank all participants who attended the Brussels expert workshop (November 2019) for sharing their knowledge and expertise with us. Special thanks also to TransForm’s international community of practice, who are working tirelessly within the ICC movement. Their input has been crucial in bringing us this far.
For more information, visit the website www.transform-integratedcommunitycare.com.
The author has no competing interests to declare.
This editorial is written on behalf of the TransForm Partnership, an international forum intended to foster integrated community care in Europe and beyond: https://transform-integratedcommunitycare.com.
This paper underwent peer review using the Cross-Publisher COVID-19 Rapid Review Initiative.
Boivin A, et al. Covid-19—a pivotal moment in community care. 2020. https://blogs.bmj.com/bmj/2020/04/07/covid-19-a-pivotal-moment-in-community-care.
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TransForm. Integrated Community Care 4all. Strategy Paper to move ICC forward. Edited by Philippe Vandenbroeck and Tom Braes (shiftN) as result of an expert workshop on 28–29 November 2019 in Brussels. 2020.
Scharmer O, Kaufer K. Leading From the Emerging Future: From Ego-system to Eco-system Economies. San Francisco, CA: BerrettKoehler; 2013. DOI: https://doi.org/10.1057/9781137468208_12