Starting the Transition Towards Integrated Community Care 4all

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 [5].

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 [1]. 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 [2].

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:

• ✓ ICC engages and empowers people in local communities;
• ✓ ICC promotes a sense of accountability towards a territorially defined population;
• ✓ ICC fosters inclusiveness and reaching out to underserved and marginalised groups;
• ✓ ICC activates and reinforces the social ties between people;
• ✓ ICC is goal-oriented in nature, supporting people’s priorities and life goals;
• ✓ ICC strengthens communities by tackling social, economic and environmental determinants of health;
• ✓ ICC comes down to a continuous process of whole-system innovation;
• ✓ ICC requires a social movement to make it a reality.

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 [6].

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:

• A systems storyline to fully acknowledge the heterogeneity of ICC and to map and understand the many drivers and strategies behind the various models and practices that exist in integrated community care.
• A participatory storyline to emphasize the importance of a shared vision, a strong narrative and the active involvement of all at the micro, meso and macro levels in communities and in society.
• An implementation storyline to focus on the formulation of meaningful and effective guiding principles that can help ICC to mature and become more robust in diverse contexts, amidst changing views and evolving challenges. The principles are intended to provide direction to those aiming to make ICC a reality.

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 [3]: