Integrating Health Services
Integrating health services, such as family planning with HIV care or with maternal and child health care, can be more convenient for clients and more efficient for programs.
Integrating multiple health care services—for example, family planning; HIV care and prevention; maternal, newborn, and child health care; child immunization services; and postabortion care services—at the same facility or through a community-based program can benefit clients, providers, and programs.
- Clients. A couple visits a clinic for family planning, and the health care provider offers them testing for HIV and other sexually transmitted infections. A mother who brings her baby for immunization learns about her family planning options and obtains services. A woman with HIV comes for antiretroviral treatment and also receives information about contraceptive choices and an offer of supplies and services. Such examples show how offering multiple services at one location can increase access and convenience for
- Providers. Integration of services can enable providers to address the health of their clients more holistically. Some providers report that they like the opportunity to offer clients multiple services. They caution, however, that adequate resources, training, and support are necessary.
- Programs. Integrated services can be more efficient by avoiding duplication of effort and can serve more people at the same or similar cost by saving money that might have been spent maintaining separate facilities. Many services—particularly government services—are already integrated at the primary care level, where one provider, at a rural health post, provides all types of primary care to the community.
Deciding Whether to Integrate Services
While integrating services has many advantages, it places new demands on service-delivery systems, such as increasing provider workloads or complicating logistics systems. Also, the demand and requirements for providing one service, particularly a curative one, may squeeze out another service, particularly a preventive one.
Three guiding principles can help managers decide whether to integrate services:
- All of the interventions being integrated must be effective in meeting their specific health.
- The interventions should address the same clientele.
- Integrating should create synergies that enhance the impact of all the services.
Deciding Which Services to Integrate
Family planning can be added into other existing health care services, or other health care services can be added into existing family planning services. The Population Council has developed The Assessing Integration Methodology (AIM) Handbook to help programs evaluate the capacity of health facilities to offer integrated services. It can also be used to monitor and evaluate currently integrated services.
Some major service integrations with family planning include:
- HIV care and prevention services. Integrating family planning into HIV care and prevention services can increase access to family planning. Preventing unintended pregnancies in women with HIV is an important and cost-effective strategy for preventing new infections through mother-to-child transmission. USAID recommends integrating family planning and HIV services in countries where the HIV epidemic is generalized, and thus the number of people who need both services is likely to be large.
- Maternal, newborn, and child health care. Integrating family planning into these services expands women’s access to important information about postpartum return to fertility, the value of birth spacing, and family planning options at crucial times such as after delivery or during visits for childhood immunizations. Pediatric clinic visits offer another opportunity for mothers to obtain family planning information and services.
- Immunization services. Infant immunization services provide an opportunity to reach postpartum women with family planning messages and services or referrals. Both types of services share a common clientele of postpartum women. Furthermore, many women who might not seek health care services for themselves want to obtain health care services for their children, including routine infant immunizations.
Systematic Screening and Referral Systems—An Integration Alternative
Identified as a best practice in reproductive health by USAID, systematic screening is a simple intervention to address more health care needs during a single clinic visit. Clients fill out a brief questionnaire to help providers identify their reproductive health care needs and desires (see p. 23 of the “Elements of Success in Family Planning Programming” Population Reports issue for a sample screening instrument). Services are then offered at the same facility, if available, or through referral to another facility. Referral systems—standing arrangements between providers or facilities to send and to accept clients for specified services—help family planning and other health care facilities offer clients better and faster access to specialized services and follow-up care.