Integration

What do we mean?

INTEGRATION

Integrated Locomotion

INTEGRATION

of

WHAT?

1. “[Combining] different kinds of services or operational programs to ensure and maximize collective outcomes. It would include referrals from one service to another, as well as services provided in the same setting or by the same provider.”

2. Ensuring appropriate sequencing and coordination of elements of care; e.g. immediate post-delivery care for the mother and newborn, particularly in settings where the same health worker is responsible for both.

3. Breaking down silos between different types of health workers or departments in a health facility (HF); improving collaboration within a HF or across levels of a HF (including referral linkages).

4. Supermarket/ cafeteria type service delivery model, offering key services whenever the clinic is open rather than only at specific times of the week or month, allowing clients to get, for example, immunization and family planning (FP) services during the same clinic visit.

5. Taking advantage of what was previously a one-intervention outreach contact to deliver additional interventions (‘one-stop’, ‘no-missed opportunities’; e.g. adding vitamin A supplement distribution to polio National Immunization Days (NIDS) or to routine immunization contact around 9 months of age).

6. Piggy-backing (or coat-tail riding), taking advantage of an existing function as a platform to which a new intervention is added; linking an important but less-well-funded intervention to a better-funded program, e.g. pneumonia community case management (CCM) added to malaria CCM (funded under the President’s Malaria Initiative (PMI)).

7. Placing a new technical intervention within an existing program.

8. Using a service delivery contact to promote another service or to facilitate referral linkage, or to promote a particular behavior/ household practice (e.g. determine immunization status during sick child visit, and make referral to immunization service; nutrition or family planning counseling provided at the time infants are immunized).

9. Taking advantage of other programs to elicit information: e.g. immunization contacts could be used to find out whether the infant slept under a bednet the previous night.

10. Merging a function programmatically, e.g. ensuring that antenatal tetanus toxoid or intermittent presumptive treatment (in pregnancy) or HIV screening and PMTCT is fully incorporated into the antenatal program (including at level of provision of service).

11. Using more polyvalent (rather than specialized) health workers.

12. Incorporating content from several interventions/ program areas within a single tool (e.g. a family health card, health education job-aids for service providers, supervisory checklists covering multiple interventions/ program areas)

13. De-verticalizing what has been a more specialized program, e.g. leprosy, STI, TB, PMTCT, …

14. Mainstreaming systems functions previously managed on a vertical basis (e.g. supply chain for TB or HIV commodities, management information system (MIS) previously as a stand-alone for a particular technical area merged into a single comprehensive MIS).

15. Institutionalizing elements of what has been a pilot initiative: e.g. changing Health MIS forms, adding new program commodities to Essential Medicines Lists; modifying routine supervisory checklists; modifying pre-service and in-service training curricula,…

16. Consolidating/merging of management units; e.g. WHO has combined CAH and MPS into a new MCH division; MCHIP can be considered another such example.

17. Harmonizing management/ administrative procedures across multiple programs (or among donors, e.g. under a Sector-Wide Approach arrangement).

18. Improving coordination between units which remain distinct (e.g. expectation of HHS, State Dept, USAID, DoD, etc. with regard to health programming under PEPFAR, PMI, etc.; donors and host government).

19. Linking health with non-health activities, e.g. income-generation, education, agriculture, environment, community development (e.g. as per Alma Ata-style Primary Health Care).

20. Within a particular geographic area, consolidating services and facilities across multiple levels, (e.g. outreach, primary level, hospital level) or across types of service (e.g. social services, acute care, rehabilitory care, etc.) into a single coherent system.

services

management

systems

tools

2 + 2 > 4 ?

↑ commensalism

↑ ↑ mutualism

↓ ↓ competition

↑↓ parasitism

MakeSense

Sense Act

Plan/ decide

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