Abstract
Background:Health systems integration is becoming increasingly important as the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, primarily designed to strengthen public-sector health systems. In many countries across sub-Saharan Africa, including Kenya, prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general maternal child health (MCH) clinics. The objective of this study was to evaluate the benefits and challenges for integration of care within a developing health system, through the lens of an evaluative framework.Methods:A framework adapted from the World Health Organization’s six critical health systems functions was used to evaluate the integration of pMTCT services with general MCH clinics in western Kenya. Perspectives were collected from key stakeholders, including pMTCT and MCH program leadership and local health providers. The benefits and challenges of integration across each of the health system functions were evaluated to better understand this approach.Results: Key informants in leadership positions and MCH staff shared similar perspectives regarding benefits and challenges of integration. Benefits of integration included convenience for families through streamlining of services and reduced HIV stigma. Concerns and challenges included confidentiality issues related to HIV status, particularly in the context of high-volume, crowded clinical spaces.Conclusion and Global Health Implications: The results from this study highlight areas that need to be addressed to maximize the effectiveness and clinical flow of the pMTCT-MCH integration model. The lessons learned from this integration may be applied to other settings in sub-Saharan Africa attempting to integrate HIV care into the broader public-sector health system.
Highlights
As the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, attention has been turned to approaches focused on health systems integration.[1]
Leadership perceived key benefits of integration to include: strengthening of the maternal child health (MCH) health system by increasing national recognition and resources; the ability to qualify for performance-based incentives; convenience for families to have all care under one roof; and reducing stigma for HIV-positive patients receiving antenatal care at the HIV clinics
While additional training was needed for the staff to perform these tasks, it did enable clinical staff to work at the top of their abilities
Summary
As the global health community transitions from acute, disease-specific health programming to models of care built for chronic diseases, attention has been turned to approaches focused on health systems integration.[1] Health system integration has been described as “the extent, pattern, and rate of adoption and eventual assimilation of health interventions into critical health system functions.”[2,3] Historically, vertical health care programming and financing has been the primary focus, with specific health infrastructure developed for specific disease states, such as malaria or HIV/AIDS This approach promotes rapid scale-up of care services, in the face of epidemics, simplifies monitoring and evaluation processes, and streamlines financing mechanisms, especially in low- and middle-income countries where health care programming is so commonly externally funded.[4,5] Those against this approach believe it creates unsustainable, diseasespecific care silos that could decrease access, quality and equity, and render the health system less responsive to the needs of the population.[6] They argue that instead, a horizontal, more integrated, approach should be employed to focus on broader public health goals and health systems strengthening.[7] A novel, diagonal approach has been developed, where separate, vertical programs are integrated into a broader set of primary health care services, despite retaining some specialized staff, resources, and infrastructure to ensure continued effectiveness. In many countries across sub-Saharan Africa, including Kenya,prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general maternal child health (MCH) clinics.The objective of this study was to evaluate the benefits and challenges for integration of care within a developing health system, through the lens of an evaluative framework
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