Back to Basics: Providing Integrated Health Services

Back to Basics: Providing Integrated Health Services

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.

The natural state of health is integrated. The global health community (implementing NGOs, service providers, governments, and donors) are the ones who have dis-integrated care with our service delivery approaches.

Integrated funding is the single most important lever to ensure integrated service delivery. Some people in the global health community fear integration and integrated funding. HIV & AIDS advocates may think that their money will be taken away. Family planning implementers are worried that the little money they do receive will be taken away. And, lastly, there is a fear of over loading the system. However, as we face an increasing amount of chronic diseases---such as cancer, diabetes, and heart and lung diseases---the only sensible solution is to offer patients an integrated services approach. As a family physician, I know that an integrated approach to funding and delivering services is critical for a healthier future. It is the means to saving lives.

In Rwanda an innovative approach to delivering health services was implemented by the Government as it began rebuilding after civil war. The Ministry of Health proposed an ambitious three-pronged program to extend geographic and financial access to care, strengthen institutional capacity, and improve the quality of care and availability of human resources, medicines, and supplies.  MSH assisted Rwanda with this massive reform effort. Rwanda took an integrated approach to care. The funding for health services (from the Government, funders, and individuals) is pooled into one fund. Performance-based financing grants are then used to provide a basic package of services. Service providers are given monetary and non-monetary incentives to meet goals, deliver services, and improve health. Donors cannot only fund disease specific health services; they have to support delivery of all services. Priority is no longer on one indicator or disease. A set of indicators, some of which are disease specific, were developed to monitor results.  As a result of this approach, Rwanda will likely be one of the few countries to reach the Millennium Development Goals.

Malawi has also seen dramatic results when integrating services. In partnership with the Ministry of Health, MSH works with a network of community-based distribution agents trained in both family planning and HIV integration. These agents---men, women, and youth---provide clients with a range of contraceptive methods, link them to facilities, and offer information and education through community events in rural areas. These providers have had a dramatic impact on their own communities. Since 2007, over 1,000 agents have begun dispensing oral contraceptives and condoms to their communities. Nearly 700,000 people have received family planning and HIV information and messages. Total couple years of protection increased by 12,000 in one year, and over 67,000 people now know their HIV status.

Integration is not a magic bullet, but this approach, when done smartly, makes best use of financial, human, and other scarce resources. It will be an important approach to manage the rapidly growing burden of non-communicable diseases.

Jonathan D. Quick, MD, MPH is President and Chief Executive Officer of MSH. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist.