Integration

It’s common sense that a mother who is on treatment for AIDS, pregnant, has a sick child, and is accompanying a sister debilitated by Tuberculosis should not have to visit four separate service delivery points to receive care. Integrated health services not only make the world a healthier place, but also decrease the burden on health systems.

Integration is a comprehensive approach to service delivery. It is the transition from a vertical or horizontal approach to a diagonal, synergistic approach at all levels of a health system. Smart integration means coordinating disease specific programs (such as HIV and AIDS) with other health programs that have operated independently in the past (for example, family planning) to deliver services at the same time or, more importantly, with the same funding. Integration helps organizations maximize the impact of their health investments while allowing people, information, and funding to flow more easily among collaborating groups and stakeholders. Equally important, integration enables providers to treat the health needs of individuals and families more efficiently---regardless of the initial reason a person seeks care.

This is a guest post from Olive Mtema, Policy Advisor, from the Community Based Family Planning and HIV & AIDS Services project in Malawi. Olive is an employee of the Futures Group.

On March 12, 2011, Muslim Leaders gathered in Lilongwe, Malawi for a conference on Reaffirming Muslims' Positions on Family Planning and HIV & AIDS Issues. The conference was hosted by the USAID-funded Community Based Family Planning and HIV & AIDS Services project (CFPHS) in collaboration with the Malawi Ministry of Health, Reproductive Health Unit (RHU); Muslim Association of Malawi (MAM); and Quadria Muslim Association of Malawi (QMAM). CFPHS is led by MSH, with Futures Group and Population Services International as key implementing partners.

Over the course of the past ten days, I have been fortunate to visit the Central, Eastern, and Western Regions of Uganda.  As part of these visits, I have traveled through and spent time in many of the districts in these regions. It is during these drives through the countryside that I have noticed the campaigns for family planning services over and over again. Though it is possible my eye is fine tuned to notice these signs, as I am here supporting STRIDES for Family Health (a MSH-led, USAID funded family planning, reproductive health, and child and maternal health project), it would be hard for anyone to miss the cheerful rainbows that are posted on signs outside many of the health centers and hospitals indicating that family planning services are provided in that facility.

Signs promoting available family planning services in Uganda, March 2011.

 

The Global Health Initiative (GHI) and its approach of integrating health programs with HIV & AIDS, malaria, tuberculosis, maternal, newborn, and child health, nutrition, and family planning and reproductive health is in line with the current approaches and health priorities of the Government of Malawi.

Malawi, with a population of slightly over 13 million people, has 83% of its people living in the rural hard to reach, underserved areas. The biggest health challenge facing the country is access to basic health services by the rural population. The problem of access to health services is multifaceted. For instance, family planning services are mostly facility-based, contributing to a low Contraceptive Prevalence Rate of 28% and high unmet family planning need of 28% (Malawi Demographic and Health Survey, 2004).

However, there is also a critical shortage of trained health service providers and availability of contraceptives is a logistical nightmare in Malawi. Making a routine mix of all contraceptives accessible to women of reproductive age regularly in rural communities can avert unwanted pregnancies and maternal deaths, and reduce high total fertility rate and infant mortality rate. Rural people walk long distances to seek health services, sometimes only to return without a service due to shortage of health personnel and stock-out of supplies.

At the First Global Symposium on Health Systems Research in Montreux, Switzerland in November, Dr. Yogesh Rajkotia, of USAID Rwanda, moderated a panel discussion noting that Performance-Based Financing (PBF) is an effective health systems strengthening strategy. The presentations were made on behalf of the Rwandan Ministry of Health with the guidance of Dr. Agnes Binagwaho, Permanent Secretary.

In 2000, Rwanda’s health system was perceived as weak: there were human resources shortages, especially in rural areas; poor quality of services; and a high morbidity/mortality rate of women and children. Since 2001, Rwanda has committed itself to better health and to pushing for achievement of the Millennium Development Goals (MDG) by 2015.

PBF is a powerful means for increasing the quantity and quality of health services by providing incentives to health providers to improve performance. A PBF program typically includes performance-based grants or contracts. Health clinics and their staff are rewarded for reaching or exceeding health indicators.

On this World AIDS Day, we reflect yet again on progress made toward global commitments to fight the HIV epidemic. According to UNAIDS, new infections have decreased this past year from 2.7 million to 2.6 million, but, 30 years into the epidemic, only 5.2 million people out of the estimated 15 million who need drugs have access to treatment. Stigma, discrimination and human rights violations against persons living with HIV still exist, even in countries with generalized epidemics.

Integrated HIV programming across the entire health system can minimize many of these barriers to HIV prevention, care and, treatment.

Over 33 million people are currently living with HIV & AIDS throughout the world. Despite great strides in slowing the epidemic, there remains a stunning gap in prevention, care, and treatment efforts. This is especially true for most-at-risk-populations, which include commercial sex workers (CSWs) and their clients, injecting drug users (IDUs), men who have sex with men (MSM), and prisoners. People in these risk groups are so stigmatized and discriminated against in many countries that it becomes extremely difficult – sometimes impossible – to provide them with much-needed HIV prevention, care and treatment services. Even more, MARP behaviors often are illegal, which then compromises needed action and support from government authorities.

Denial of such basic human rights as access to prevention, care, and treatment for the most-at-risk-populations is unacceptable. It leaves those most in need underserved and severely marginalized. As World AIDS Day 2010 approaches with this year’s message of “Universal access and human rights,” I am reflecting on the specialized HIV interventions that MSH helps provide to most-at-risk populations.

Part three of the blog series: Spotlight on Global Health Initiative Plus Countries

Health Financing is Helping Rebuild Rwanda’s Health Sector

It's been over 15 years since the Rwandan genocide; few would know of the tremendous successes in health that the country has experienced. Rwanda has made good progress towards meeting the Millennium Development Goals since they were identified. These impressive achievements are due to an increase in essential health interventions and the implementation of new health financing mechanisms.

 

The Global Health Initiative (GHI), with its plans for integrated programs across the spectrum of infectious diseases, maternal and child health, family planning and health systems, seems like it was designed specifically to meet Guatemala’s challenges.

This article originally appeared on The Huffington Post.

As world leaders gather next week at the U.N. to review progress on the Millennium Development Goals (MDGs) to eradicate poverty, hunger, and disease by 2015, a new integrated approach to funding and delivering health services in developing countries is critical if the UN's global health targets -- especially for women and children -- are to be met. Currently, the health goals are competing with each other for money, people, and other scarce resources. How can we get back on track?

There is much to celebrate next week: over four million people are currently receiving antiretroviral drugs to treat AIDS; eliminating mother to child transmission of HIV is within reach by 2015; malaria deaths have been reduced by over half in some countries; the global burden of TB is falling; and more than 500 million people are now treated for one or more neglected tropical diseases.

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