Integrated Services

The Government of Ghana has adopted the WHO focused antenatal care (ANC) package in a move to improve access, quality and continuity of ANC services to pregnant women. As part of these efforts, the Government has exempted fees for ANC clients. The main objective of this study, undertaken by Noguchi Memorial Institute for Medical Research in collaboration with the Ghana Health Service (GHS), FRONTIERS, and with USAID funding, was to examine the extent to which adaptation of the package influenced quality of care received by pregnant women and its acceptability to both providers and clients. The study used a policy analysis and a situation analysis in ten intervention clinics in which the package had been introduced and four comparison clinics.

To promote the health and survival of mothers and babies, Kenya has adapted the WHO goal-oriented Antenatal Care (ANC) package, popularly known as focused ANC (FANC). The Ministry of Health (MOH) has designed new guidelines for ANC services, placing emphasis on refocusing antenatal care, birth planning and emergency preparedness, and the identification, prevention and management of life threatening complications during pregnancy and childbirth. ANC visits are now used as an entry point for a range of other services, thus promoting comprehensive integrated service delivery. A major challenge, however, is whether the Kenyan health care system can cope with the implementation of this package.

This case study describes how five Integrated Management of Childhood Illness (IMCI) trainers and supervisors conducted an assessment of provider knowledge and skill to carry out IMCI at 38 facilities in two districts in Kenya. [author’s description]

The integration of HIV-prevention activities into care has received little attention within or outside formal healthcare settings. The contribution of community home-based care services in facilitating disclosure of HIV status and reducing stigma have also not been described. This study examines the community impact of an integrated community home-based care (ICHC) programme on HIV-prevention efforts and disclosure of status. Quantitative data was collected from 363 people living with HIV (PLHIV) and 1 028 members of their micro-communities. [from abstract]

This study estimates the costs of resources

The Integrated Management of Childhood Illness (IMCI) strategy seeks to reduce [childhood] deaths through three main components: improving the skills of health workers, improving health systems an improving family and community practices. IMCI has been shown to be associated with improved quality of care, which should result in improved health outcomes. However, concern about the costs of implementing IMCI had been given as a reason why some countries have not adopted it on a large scale. It is important, therefore, to assess whether IMCI does, in practice, cost more than routine care for children who are less than 5 years old, and if so, by how much…Here we present results from the cost components of the MCE study in the United Republic of Tanzania.

[This case study evaluates the] Drug Resources Enhancement against AIDS and Malnutrition (DREAM) program, created by the Community of Sant’Egidio to fight AIDS in sub-Saharan Africa. The project takes a holistic approach, combining Highly Active Anti- Retroviral Therapy (HAART) with the treatment of malnutrition, tuberculosis, malaria, and sexually transmitted diseases. It also strongly emphasizes health education at all levels. DREAM aims to achieve its goals in line with the gold standard for HIV treatment and care. [author’s description]

This document focuses on FP integration with HIV services, more specifically with HIV care and treatment services. It encourages supervisors or planners, service providers, and community-based personnel to consider opportunities for operationalizing client-responsive integration of FP and HIV services.

This document summarizes a project to design, implement and compare two models of integrating CT for HIV within FP services in 23 health facilities in Kenya in terms of their feasibility, acceptability, cost and effect on the voluntary use of CT, as well as the quality of FP services. [adapted from summary]

The Global Alliance for Vaccines and Immunization (GAVI) was established in 1999 to finance and speed the delivery of new and improved vaccines for children in the developing world. Through collaborative leadership and international funding, GAVI aims to improve health in developing countries, increase international public health equity, and serve as a model for others in the global health community. However, this paper questions the extent to which GAVI can actually achieve its goals. GAVI has not received unanimous support because it competes for the limited supply of skilled professionals in developing countries and subordinates country-specific health need to its own purposes.

Research on the Integrated Management of Childhood Illness (IMCI) shows that it is a scientifically sound way to treat sick children, but ways to ensure that it is implemented properly are lacking. This 1997-98 study examined and compared three implementation approaches: structured feedback of performance data, structured feedback of performance data where quality improvement (QI) teams were in place, and the formal World Health Organization training in districts with QI teams. The report details the impact of each intervention, noting that sustaining performance is problematical under any intervention. The cost of IIMCI training was four times that of performance feedback. [publisher’s description]

This case study evaluates a project in Kenya that concentrates on HIV and AIDS care and prevention through support and training of community volunteers to provide PLHA with HBC, widespread and diverse efforts to promote behavior change and raise awareness about HIV and AIDS, improving access to VCT, as well as capacity building efforts and direct material assistance for OVC and PLHA. [adapted from introduction]

This issue of the HST Update discusses South Africa’s integrated services. It contains articles such as: an introduction to the integration of services, the national perspective, building district health systems in the Western Cape, what the nurses think, what the managers think, a case study of the Free State’s experience, a case study of the Kalahari District, Northern Cape, and a case study of the East Vaal Region.

This presentation details a program to implement and evaluate the feasibility, acceptability, effectiveness and cost of two models of integration of HIV prevention information, and routine offer of provider initiated counselling and testing for HIV into family planning (FP) services in 18 health facilities in North West Province, South Africa. [adapted from abstract]

This first issue of Focus on… presents information about the benefits and challenges of linking HIV/AIDS services and family planning and related reproductive health care. To highlight the major issues of integration (also called linkages), Focus on… summarizes key points from selected resources—most from the past 3 years—that reflect field successes, lessons learned, and further avenues for research.

Providing contraceptive services at VCT centers is an opportunity to prevent unintended pregnancies among clients whose needs may not be met through traditional family planning services. Operations research in Kenya suggests that integrating family planning into VCT services is feasible and acceptable. An integration intervention improved providers’ discussions about fertility desires and contraceptive methods with clients, without compromising the length of client-provider interaction or client waiting time. Although many VCT clients were considered at risk of unintended pregnancy, the i

As strides are made in the prevention and treatment of HIV, it is important to take advantage of opportunities to expand and integrate reproductive health services. Integration is an approach that uses a client visit as an opportunity to address other health and social needs beyond those that prompted the current health visit.

To maximize program impact with current resources, integration of Family Planning into existing HIV/AIDS programs is a very cost effective and an excellent point of entry. This is a study of an intervention program focused on initiating and also strengthening existing integration of FP into functional VCT, ART and PMTCT sites. The intervention encompassed an orientation on integration benefits to heads of health facilities; identification of challenges of integration and drawing of plan of action on how to overcome the challenges and improve integration. Major challenges identified were related both to health workers, such as high workload, staff burnout and turnover, as well as to efforts in scaling up of facilities operations to adequately incorporate integration activities. [from abstract]

This brief is a best practice model for improving the quality and accessibility of family planning and HIV services in rural communities in Zimbabwe. [from author]

The integration of HIV and family planning services offers a number of benefits. It may not only provide women with greater access to health care, it will also enable women living with HIV to avoid unintended pregnancies. Fortunately, our experience with the integration of family planning and HIV services is growing. As described in this issue, the organizers of an African regional conference on integrated services received more than 100 abstracts explaining their work on the subject. [publisher’s description]

In Mozambique, [Health Alliance International] HAI has been working closely with the MOH for more than fifteen years to support the development and implementation of MOH programs in reproductive health, the response to HIV/AIDS, and malaria control… HAI works with the MOH to implement the nationally designed model of HIV care, and has supported the implementation of voluntary counseling and testing centers, prevention of mother-to-child transmission of HIV (PMTCT) PROGRAMS, and HIV treatment centers integrated into this public sector model of care. [publisher’s description]

This paper is a desk study which looks at experiences of integrating vertical health programmes into national delivery systems where government and donors have adopted a sector wide approach (SWAp) to supporting health sector reform. It was commissioned to facilitate decision making in SDC regarding future possible integration of the Tanzania Tuberculosis and Leprosy Programme into national delivery systems and the SWAp process.[author’s description]

This report documents the assessment of a family planning training program for providers to enable them to offer family planning counseling and methods, and make referrals where needed as part of antiretroviral therapy services in Ghana. [from summary]

This research study was undertaken to test the feasibility, acceptability, and effectiveness of two models of integrating family planning services with postabortion services.

This issue of The Family Planning Manager explores the different faces of integration and examines the key management systems that may ned to be adapted to effectively deliver services in an integrated setting. The issue also provides guidelines for assessing integration at several different organizational levels, and offers some practical advices on how to make integration work better in your program. [author’s description]

This report is designed as a general resource to help family planning program managers strengthen their programs and meet growing family planning needs…It offers a broad overview of key programmatic considerations. Each subsection includes a list of practical specialized resources and hands-on tools that can support program managers desiring to bring about programmatic change… It is hoped that this report will inspire program managers to further investigate ways to strengthen family planning programs so that they may increase contraceptive prevalence and fulfill the reproductive rights of the women and men they serve. [author’s description]

This presentation from the Scaling Up High-Impact FP/MNCH Best Practices in Asia and the Near East Technical Meeting covers the reasons to support integrated services and the challenges to this process.

The report aims to share findings from an assessment to explore how access to critical services for populations at risk of HIV and unintended pregnancy can be strengthened by converging HIV and sexual and reproductive health (SRH) services under the National Rural Health Mission (NRHM) and the National Aids Control Programme (NACP). The report provides information on the demand and opportunities for and the challenges of implementing HIV and SRH convergence in four states—Andhra Pradesh, Bihar, Maharashtra, and Uttar Pradesh. [adapted from executive summary]

Increasing evidence supporting the value of screening women for cervical cancer once in their lifetime, coupled with mounting interest in scaling up successful screening demonstration projects, present challenges to public health decision makers seeking to take full advantage of the single-visit opportunity to provide additional services. We present an analytic framework for packaging multiple interventions during a single point of contact, explicitly taking into account a budget and scarce human resources, constraints acknowledged as significant obstacles for provision of health services in poor countries.

Using Thailand as a case study, this paper aims to explore the potential implications of integrated health system intervention. Within the Thai context, it is argued in this paper that autonomy of a network of public providers, rather than autonomy of individual hospitals, should be encouraged if management of health manpower is to be optimized. [from abstract]