Challenges and Recommendations

CHALLENGES

  • Getting all sectors to a common pursuit of public health [reference below]
  • Insufficient funding and unequal resource allocation as well as a lack of human resources with relevant skills
  • May add an additional strain on existing systems  [i]
  • Longer development phase; more time need for staff to realize value and best ways to integrate activities and maximize opportunities and a need for attention to measurement
  • Lack of coordination between private and public providers  [i]
  • Avoiding criticism regarding the way funding and incentives are set up for integration
  • Barriers created by gender norms and traditional practices that prevent accessing and using integrated services  [i]

RECOMMENDATIONS ON INTEGRATED PROGRAMMING

  • Integration does not necessarily mean that everything must be integrated into one package.  It should instead be viewed as a continuum.  [i]
  • Commit to what works and do not try to use integration for something that simply does not work. 
  • Community involvement is key to success and sustainability.
  • Need to define roles and responsibilities of the various actors, the importance of each partner playing to their skills;  sensitizing staff to the perspectives of new partners; harmonizing working conditions for staff between sectors; developing and implementing monitoring and evaluation systems; ensuring excess capacity exists to fill management gaps in the event of illness or absence.
  • Integration requires close coordination between individuals, departments and sectors.  Resources will need to be pooled, a unity of purpose will need to be established and relationships will need to be based on a give-take foundation.
  • Integration is not a solution for inadequate resources.  Integrating two programs could provide savings, but would not be able to be sustainable without the system as a whole having adequate resources.  [i]
  • Consider embedding the monitoring of important processes and the evaluation of outputs and outcomes into programming for integration.  Adequately supporting this work with the necessary budget and manpower, perhaps by leveraging funds from other partners with similar interests.  [i]

     

    RECOMMENDATIONS ON MOVING INTEGRATION FORWARD

  • More research is needed in order to enhance and deepen our understanding of integration (what contributes to good integration, when and when not to integrate, what are the additional benefits of integration, when do the benefits outweigh the costs, what can we learn about the best way to sequence integrated services or program elements, etc.)
  • More work is needed to develop and share effective tailored tools and methods for integration measurement, monitoring, learning, and evaluation.
  • Donors should provide more resources for integrated, holistic programs and service delivery (less siloed or compartmentalized funding by sector).
  • Policy and decision makers should provide practical guidance to program designers and managers for greater excellence in integrated programming and service delivery.
  • More focus should be placed on funding and understanding the role of cross-cutting issues and strategies such as behavior change, gender, sustainability, local capacity strengthening, innovation, and systems strengthening. 
  • Knowledge and skills development (pre-service and in-service training and education) are needed related to integration (integration being the specialty of focus rather than a particular disease or condition).

Along with the scoping tool, found in the 'Tools to get Started' section, The Global Health Initiative has developed a List of Factors that may Promote and Inhibit Service Integration.  Click on the attached document and scroll to pages 13-14 for the complete lists.

Resources