Deciding What Services and/or Interventions Should be Integrated

“The selection of interventions to be integrated is done based on programmatic factors including   burden of disease, the availability of resources (operational funds, supplies  human resources, etc.), the cost-effectiveness and feasibility of interventions, the presence of partnerships that support the interventions, and the acceptability of interventions by community and political leaders.” – WHO, Regional Office Africa

When examining what services, programs or interventions should be integrated, it is best to keep in mind that ‘context is key’.  Globally, populations and cultures have different need, needs that require different types of resources.  Determining if there is added value to integrating, whether the processes and outcomes will be better as a result of integration is an important factor.  While integrating services has many advantages, it places new demands on service-delivery systems, such as increasing provider workloads or complicating logistics systems.  Similarly, the demand and requirements for providing one service, particularly a curative one, may squeeze out another service, often a preventative one.  [i]

Although there has been notable effort to fund integrated programs, additional integration, linkages and coordination between donors is needed. Most countries have parallel departments in their ministries of health that address the various components of health needs. Linkages between these departments are essential to successfully integrate services, but to maximize effectiveness and comprehensiveness of care, it is necessary to take a rights-based approach, rather than one that is simply health-based. Departments outside of the health sector can have significant implications on the delivery of care.  It may be useful to build and strengthen linkages between health, policy, law enforcement, schools and other sectors to reduce barriers to care and address a wide variety of patient needs. In addition, integrated services will be more effective with diverse and comprehensive support from a variety of departments within government, as well as the private sector. [i]

Three guiding principles can help program designers and managers decide whether to integrate services: [i]

  • All of the interventions and/or services being integrated must be effective in meeting the specific needs of the population.
  • The interventions should address the same type of clientele.
  • Integrating should create synergies that enhance the impact of all the services being provided.