MSH Co-Hosts Global Health Integration Symposium

Management Sciences for Health (MSH) co-hosted a three-day integration symposium in Washington, D.C., "Delivering Impact in Women and Children's Health: The Challenges and Opportunities of Service Integration" symposium from April 11-13. Other partners included: The Global Health Council, John Snow Inc., Jhpiego, The US Agency for International Development, Maternal and Child Health Integrated Program, PATH, FHI, Guttmacher Institute, and John Hopkins University School of Public Health. 

The Symposium brought together a diverse group of stakeholders to define integration and answer many questions surrounding the feasibility, effectiveness, and appropriateness of integrated programming. 

The term integration has gained increasing prominence in the global health community (implementers, service providers, advocates, and donors) to describe service delivery and systems management strategies that highlight coordination of care and sharing of resources.

In addition, the Symposium served as a platform to share best practices for the development, delivery, management, and measurement of integrated maternal, newborn, and child health (MNCH) and reproductive health programs and systems. 

Throughout the Symposium, examples of integrated approaches supported the global health community's conviction that integration, when appropriate and implemented in a smart way, is a key tool for success in health systems management and seamless health service delivery. Integration encourages creativity and innovation to coordinate already existing systems and resources to save more lives. 

However, several barriers remain, such as: disease-specific, vertical budgeting; disease-specific health worker training; strict reporting requirements; and, restrictions on family planning. 

On Monday, MSH presented a panel discussion called "Build It Better and Stronger: Maternal and Child Health Programs for Maximum Impact" at an event open to the public. MSH invited an expert panel: Diana Silimperi, Vice President, MSH; Rudi Thetard, Chief of Party, BASICS Malawi; Issakha Diallo, Project Director, AWARE II Ghana; and Abdelhadi Eltahir, Senior Advisor for Maternal and Newborn Health, Pathfinder International to present. 

The panel focused on the grim fact that more than one-and-a-half million women every year will die from complications during pregnancy and childbirth. At the same time, an estimated six million children die each year from preventable causes. Reaching the Millennium Development Goals will require more than scientific expertise. Leadership and effective management processes are also needed to bring existing and new interventions to scale throughout countries' service sites and communities. The panel highlighted successful integrated programs in Malawi, Burundi, and Zimbabwe, explaining processes and factors needed for success.

Dr. Silimperi, who moderated the event, opened the panel by presenting the major barrier to greater impact on MNCH, "It is not the lack of evidence-based MNCH interventions, but the lack of resources and the lack of a comprehensive health systems approach," she said.

Dr. Diallo cautioned that program designers must keep the client in mind, "Women are already overburdened, thus combining health services and education must be developed in the context of the health system and given the opportunity to develop creatively without constraints from the donor."  

Dr. Eltahir followed with a highly successful example of two provinces in Burundi with strong relations with the government that coordinated MNCH, nutrition, water and sanitation, and immunization that utilized innovation and community mobilization. These efforts led to training of mothers, improved nutrition for children, increased child immunization rates, and increases in women delivering at facilities. The success was due not only to smart and innovate design, but also due to strong relations with the government, a key stakeholder mentioned in all panelists' presentations. 

Dr. Thetard closed the panel by recognizing the complexity of integration. While there are many ways to integrate systems, there are even more ways to tweak systems for greater impact. He cited an example of integrating MNCH and HIV programming, which has been an important challenge, particularly for malnourished children whose HIV status often go undetected.

To provide a follow-up resource and to help move the conversation on integration forward, a report on the Symposium will be released with recommendations for the global health community on integration. 

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