Integration has been defined as “the organization, coordination, and management of multiple activities and resources to ensure the delivery of more efficient and coherent services in relation to cost, output, impact, and use (acceptability).” (WHO HIV, Family Planning/Reproductive Health, Maternal Newborn and Child Health Technical Working Group, March 2011). The integration of health sector activities and the integration of health sector activities with activities in other sectors – such as water and sanitation, education, food security, agriculture, economic growth, microfinance, and democracy and governance – can potentially achieve high-yield gains for health.
Five Factors to Consider about Integration
Recent Empirical Evidence and Further Inquiry about the Value of Integration
Recent empirical evidence about the effects of integrating programs in the health sector has been promising. One such example is the rigorous analysis of the health and economic development effects of a long-term investment in an integrated family planning and maternal, neonatal, and child health program in Bangladesh. Others include the USAID-commissioned Cochrane Review on the integration of family planning, maternal and child health, nutrition, and HIV services. However, further inquiry and more rigorous research designs are needed to guide programs.
Integration Scoping Tool
Decisions about how to integrate or judgments about the adequacy of existing integration efforts can be informed by periodic assessments of what is already occurring. The Integration Scoping Tool is illustrative and exploratory; it can be used in any “scoping exercise” that seeks to understand better the nature and extent of integration efforts in any country. The Tool comprises three elements:
Monitoring and Measuring Integration Progress
U.S. Government country teams should consider embedding the monitoring of important processes and the evaluation of outputs and outcomes into programming for integration, and adequately supporting this work with the necessary budget and manpower, perhaps by leveraging funds from other partners with similar interests.
Antiretroviral Therapy and Antenatal Care Integration in Zambia
Source: Killiam, AIDS 2010;24(1):85-91 and USAID Cochrane 2010 (study rigor was good, step-wedge evaluation design used)