SUPPORT summaries

Integration - Does integration of primary healthcare services improve healthcare delivery and outcomes?

Primary health care in many low and middle-income countries is organised through a series of vertical programmes for specific health problems such as tuberculosis control or immunisation of children. Vertical programmes can help deliver particular technologies, but may lead to service duplication, inefficiency and service fragmentation. The World Health Organization and other organizations promote integration, where inputs, delivery, management and organization of particular service functions are brought together, as a solution to such problems.

Key messages

- What integration means in practice is not always clear. There are a number of strategies for integrating primary healthcare services at the point of delivery, including simply adding on services, bringing together the delivery of existing services, and implementation of packages of services.
- There is limited evidence of the effects of alternative strategies from comparisons between integrated and vertical approaches to delivering services.
- Integrated Management of Childhood Illness appears promising, but co-interventions, including provision of drugs, may confound this.
- Integration may not, in reality, improve service delivery and outcomes, including evolving strategies for implementing and sustaining Integrated Management of Childhood Illness. If strategies to achieve integration are used, their impact should be evaluated.