Abstract
BackgroundBecause of the current emphasis and enthusiasm focused on integration of health systems, there is a risk of piling resources into integrated strategies without the necessary systems in place to monitor their progress adequately or to measure impact, and to learn from these efforts. The rush to intervene without adequate monitoring and evaluation will continue to result in a weak evidence base for decision making and resource allocation. Program planning and implementation are inextricability linked to monitoring and evaluation. Country level guidance is needed to identify country-specific integrated strategies, thereby increasing country ownership.DiscussionThis paper focuses on integrated health services but takes into account how health services are influenced by the health system, managed by programs, and made up of interventions. We apply the principles in existing comprehensive monitoring and evaluation (M&E) frameworks in order to outline a systematic approach to the M&E of integration for the country level. The approach is grounded by first defining the country-specific health challenges that integration is intended to affect. Priority points of contact for care can directly influence health, and essential packages of integration for all major client presentations need to be defined. Logic models are necessary to outline the plausible causal pathways and define the inputs, roles and responsibilities, indicators, and data sources across the health system. Finally, we recommend improvements to the health information system and in data use to ensure that data are available to inform decisions, because changes in the M&E function to make it more integrated will also facilitate integration in the service delivery, planning, and governance components.SummaryThis approach described in the paper is the ideal, but its application at the country level can help reveal gaps and guide decisions related to what health services to prioritize for integration, help plan for how to strengthen systems to support health services, and ultimately establish an evidence base to inform investments in health care. More experience is needed to understand if the approach is feasible; similarly, more emphasis is needed on documenting the process of designing and implemented integrated interventions at the national level.
Highlights
Because of the current emphasis and enthusiasm focused on integration of health systems, there is a risk of piling resources into integrated strategies without the necessary systems in place to monitor their progress adequately or to measure impact, and to learn from these efforts
Summary: This approach described in the paper is the ideal, but its application at the country level can help reveal gaps and guide decisions related to what health services to prioritize for integration, help plan for how to strengthen systems to support health services, and establish an evidence base to inform investments in health care
In the U.S President’s Emergency Plan for AIDS Relief (PEPFAR) five-year strategy, there is an important priority for “downstream” integration of family planning and HIV services at the health service and individual levels “so that women living with HIV can access necessary care, and so that all women know how to protect themselves from HIV infection” [5]
Summary
Definitions of health service integration integration is a broad term, many definitions highlight service delivery combinations. While logic models are critically important tools in the evaluation of any health program, they are especially crucial in the evaluation of integrated health interventions because of the complexity of insuring that the key health system building blocks are appropriately leveraged in order to achieve maximum health impacts with maximum efficiency These details are best defined at the national level through a dedicated process that should yield specific recommendations and assign roles and responsibilities to ensure that the inputs and funding are available to carry out planned activities and interventions. Strengthening health information systems in general and ensuring that routine data systems are “interoperable” will result in high costs to donors, governments, and partners; the value of which is hard to communicate to donors and politicians [59] Successful application of this framework requires collaboration and cooperation amongst stakeholders of all types and at all levels of public health policy, programming, and practice from the international, national, sub-national, and service delivery level. Authors’ information HR is Deputy Director of HIV and AIDS and Other Infectious Diseases and ES is senior technical specialist-HIV and AIDS for the MEASURE Evaluation project, a 5-year, USAID funded project supporting the monitoring and evaluation of population, health and nutrition worldwide, based in the Carolina Population Center at The University of North Carolina at Chapel Hill
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
