Combating health care fragmentation through integrated health service delivery networks in the Americas: lessons learned

Abstract

PurposeThis paper aims to: analyze the challenge of health services fragmentation; present the attributes of integrated health service delivery networks (IHSDNs); review lessons learned on integration; examine recent developments in selected countries; and discuss policy implications of implementing IHSDNs.Design/methodology/approachA literature review, expert meetings, and country consultations (national, subregional, and regional) in the Americas resulted in a set of consensus‐based essential attributes for implementing IHSDNs. The analysis of 11 country case studies on integration allowed for the identification of lessons learned.FindingsStudies suggest that IHSDNs could improve health systems performance. Principal findings include: integration processes are difficult, complex, and long term; integration requires extensive systemic changes and a commitment by health workers, health service managers and policymakers; and, multiple modalities and degrees of integration can coexist within a system. The public policy objective is to propose a design that meets each system's specific organizational needs.Research limitations/implicationsThe analysis presented in this paper is qualitative.Practical implicationsSome policy implications for implementing IHSDNs are presented in the paper.Originality/valueThe research and evidence on integration remains limited. The paper expands the knowledge‐base on the topic, presenting lessons learned on integration and recent developments in selected countries, which can support integration efforts in the region.