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A longstanding debate on health systems organization relates to benefits of integrating health programmes that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes. This debate has long been characterized by polarization of views and ideologies, with protagonists for and against integration arguing the relative merits of each approach. However, all too frequently these arguments have not been based on hard evidence. The presence of both integrated and non-integrated programmes in many countries suggests there may be benefits to either approach, but the relative merits of integration in various contexts and for different interventions have not been systematically analysed and documented. In this paper we present findings of a systematic review that explores a broad range of evidence on: i the extent and nature of the integration of targeted health programmes that emphasize specific interventions into critical health systems functions, ii how the integration or non-integration of health programmes into critical health systems functions in different contexts has influenced programme success, iii how contextual factors have affected the extent to which these programmes were integrated into critical health systems functions. Our analysis shows few instances where there is full integration of a health intervention or where an intervention is completely non-integrated. Instead, there exists a highly heterogeneous picture both for the nature and also for the extent of integration. Health systems combine both non-integrated and integrated interventions, but the balance of these interventions varies considerably. Health systems combine both non-integrated and integrated interventions, but the purpose, nature and extent of integration vary enormously. Seldom are interventions wholly unintegrated or fully integrated into health system functions. More evidence is needed in order to fully conclude on the effectiveness of health programme integration, particularly from country case studies with robust designs using a common methodology and replication logic. A longstanding debate on health systems organization relates to benefits of integrating health programmes that emphasize targeted interventions into mainstream health systems to improve health outcomes; a debate long characterized by polarization of views, with protagonists for and against integration arguing the relative merits of each approach Walsh and Warren ; Newell ; Warren ; Wisner ; Cueto ; Magnussen et al. However, all too frequently the debate has not been informed by hard evidence Atun et al. Both integrated and non-integrated programmes widely exist, suggesting benefits to either approach, but the relative merits of integration in various contexts and for different interventions have not been systematically analysed and documented. Further, as the nature and extent of integration varies, there are methodological challenges to comparing various interventions. In this paper we present a systematic review that explores i the extent and nature of integration of targeted health programmes that emphasize specific interventions into critical health systems functions defined in the Methodology section , ii how contextual factors have affected the extent to which these programmes were integrated into critical health systems functions. We use a new conceptual framework, discussed in detail in a complementary paper in this journal Atun et al. Our review evaluates peer-reviewed studies of priority population, health and nutrition interventions introduced at regional or national scale. These interventions for reproductive health, maternal and child health, communicable diseases, immunization and malnutrition are fundamental for achieving the health-related MDGs World Bank This paper is organized in four sections. The Introduction is followed by the Methodology section, which includes a brief description of the conceptual framework used to map the nature and extent of integration into critical health system functions of the programmes presented in the studies analysed. The Results section includes for each programme this mapping and an analysis of how contextual factors influenced integration. The Discussion section provides an overview of the implications of findings for policy makers, practitioners and researchers. We developed a search strategy based on the use of—exploded—MeSH terms, supplemented with a broad search for keywords in the titles or abstracts for which no appropriate MeSH terms exist. A systematic review by Briggs and Garner, which used Cochrane Systematic Review methodology, served as the basis for the development of the search strategy Briggs and Garner The strategy combined two parts: the first designed to identify articles related to organizational arrangements for health care delivery, and the second designed to limit the search to specific areas identified as key health programmes for developing countries. The search strategy is shown in detail in Box 1. The considered studies were primarily programme evaluations and studies at regional or national scale assessing the relative performance of different care models following changes in organizational structure. We included studies that were randomized or cluster randomized trials, before or after evaluation, interrupted time series, and programme evaluations without controls. For inclusion, the study had to present data on outcome measures such as health outcomes, quality of care, access to care and service utilization, patient satisfaction and cost or cost-effectiveness. Papers just describing the development of a care model were excluded. We did not include grey literature as these publications have not undergone peer review and there are no agreed methods on assessing the quality of these studies. Supplementary searches were conducted through reference and citation tracking of the key articles retrieved during the search. The search strategy retrieved potentially relevant articles. This was followed by selection of articles deemed relevant for further analysis by two independent reviewers on the basis of the titles retrieved. In order to establish a common set of inclusion criteria, the first titles were assessed jointly. The criteria for inclusion at the first stage were based on the potential relevance of each article to the research question for the review, independent of study design. Once a common approach and understanding was developed, each reviewer independently assessed one half of the remaining titles i. Each study deemed relevant by either of the reviewers was further considered for inclusion in the second stage of analysis. This yielded a total of titles, which were retained for the second stage of selection. In this stage, the two reviewers independently assessed the abstracts of each of the remaining studies for relevance to the review. The studies selected by each of the reviewers were then compared. Where there was concordance to include or exclude a study they were retained or discarded. Where there was disagreement, the article in question was retained for full text analysis. A total of studies were retained for the third stage of the review at which the full text was analysed. Studies were then evaluated based on study design and relevance. Data extraction was done independently by the two reviewers, each using a common checklist purpose developed for this review and based on the analytical framework outlined in detail below. Extracted data included:. Participants: unit of analysis, number of participants in intervention and comparison groups;. We reviewed potential articles, which yielded 55 papers included in this review Figure 1. Flow chart representing the selection process for studies included in the review. In a companion paper Atun et al. Drawing on relevant empirical evidence and theory Atun et al. The conceptual framework provides a basis for evaluating these five constituents with respect to the purpose , extent and nature of integration of the health intervention s under study into critical health system functions. We consider integration of elements of a health intervention studied with critical health system functions described above and detailed in Table 1. With respect to extent , we identify whether the integration is full, partial or non-existent, and by level we refer to integration of these functions at local provider unit , district, regional or national tiers. Given the broad mix of outcome measures used in different studies, it was not possible to directly compare the relative success of interventions, or generalize from these. Hence, we limit our analysis to integration, but briefly describe in Box 2 for each study the reported changes in the process, output or outcome parameters measured. Here we present all interventions grouped by the disease area. To build a sustainable national programme for dengue control, Cuba integrated community working groups CWGs and primary health care PHC workers into the existing programme, which had limited integration into the mainstream health system Toledo Romani et al. Areas with integration of CWGs reported greater improvements in entomological indices. In certain areas in Colombia strengthened community participation and networks managed by a central coordinating body to improve malaria control led to decreased malaria incidence, but there were no control sites for comparison or trend analysis showing changes in malaria incidence in the periods that preceded programme introduction Rojas et al. Various strategies have been implemented to control schistosomiasis. Brazil, Burundi, Cameroon and Saudi Arabia have integrated some targeted interventions into primary care structures or community centres, while Uganda and China adopted unintegrated delivery structures. In Brazil, integrated strategies helped reduce the incidence and prevalence of schistosomiasis infections at similar rates to those reported without integration Coura Filho et al. In Saudi Arabia, integration of targeted interventions into PHC led to a greater decline in the incidence and prevalence of infections than that achieved by unintegrated interventions Table 1 Ageel and Amin ; Jarallah et al. In Cameroon, programme integration into PHC led to improved population knowledge about schistosomiasis and utilization of health centres Bausch and Cline ; Cline and Hewlett In Burundi, an integrated model achieved lower utilization and treatment levels than an unintegrated model but at much lower cost Engels et al. In Uganda, use of schools and community-directed treatment for mass drug distribution helped reach poor communities in remote areas Kabatereine et al. In Uganda, provision of additional PHC tasks by community health workers, such as family planning, immunization, malaria and tuberculosis TB control, was positively correlated with increased treatment quality for onchocerciasis Katabarwa et al. In many countries, leprosy services have historically been delivered as targeted interventions with no integration. In Tamil Nadu, India, following integration the number of detected cases increased slightly, but as follow-up and treatment completion were no longer monitored, completion rates declined Rao et al. In Andhra Pradesh, India, there were negligible differences in leprosy prevalence and newly detected cases before and after integration. Whereas in Maharashtra, India, a comparison of leprosy programmes in Jamkhed integrated and the neighbouring Osmanabad without integration showed a decline in social stigma experienced by leprosy patients in communities receiving integrated care Arole et al. In Sri Lanka, integration of targeted interventions for leprosy into PHC was associated with higher case detection Kasturiaratchi et al. The nutrition programmes studied included general programmes to address under-nutrition and programmes providing micronutrient supplementation. While mothers in the intervention area reported better care practices than those in the control area, there was no difference in children's malnutrition rates Hossain et al. Multi-country studies on micronutrient supplementation including vitamin A, iodine and iron demonstrate campaign-based interventions e. In Peru, a multi-micronutrient supplementation programme, with an integral communication campaign and community involvement in education and distribution targeting children, women and adolescent girls, improved coverage and led to an increase in the knowledge on the beneficial effects of supplementation Gross et al. The programme had a protective effect on the haemoglobin levels of the three target groups, was more cost-effective and better targeted to the population needs compared with a non-integrated food-distribution programme. Evaluation of mass immunization campaigns targeted interventions with no integration in three different contexts revealed contrasting results. It led to significant increases in immunization coverage for the first dose of polio vaccine, but coverage declined between the first and the third doses. Before and after the PPI campaigns, inequities related to gender, caste, wealth status, religion and geography for polio and other immunization did not change Bonu et al. In Sierra Leone, mass immunization campaigns led to high coverage rates for single-dose vaccines, with lower coverage rates for vaccinations requiring three doses. With each full dose of vaccines, there was a significant decline in infant and child mortality across all the socio-economic groups Amin There were no comparators. Studies comparing the effectiveness of the Integrated Management of Childhood Illness IMCI strategy with routine care comprising a series of non-integrated programmes report improvements in the quality of care delivered. In Bangladesh, the quality of care i. In South Africa, introduction of IMCI in selected districts led to improved process and health outcomes as measured by a quality index based on the quality indicators developed by WHO Chopra et al. In Tanzania, case management, prescribing and under-5 mortality rates rose significantly in districts where IMCI was introduced compared with those where it was not Armstrong Schellenberg et al. Related studies Adam et al. In Uganda, introduction of IMCI led to improved performance of trained health workers and the quality of care delivered to children aged under 5 years Pariyo et al. Similarly, in Brazil Amaral et al. By contrast, in Peru, implementation of IMCI did not positively affect care quality and service utilization in facilities where it was introduced Huicho et al. Evaluation of the Indian Integrated Child Development Services ICDS programme which comprises a package of education services, nutritional support for pregnant and nursing women and children, and links to other PHC-based health services for children demonstrated improvements in the quality and quantity of services offered, expansion in immunization coverage and reductions in malnutrition in children aged under 6 years Lal Uptake of immunization and antenatal care services increased, with significant improvement in feeding practices, nutritional levels and health status of children in districts that adopted the ICDS scheme compared with non-ICDS districts Gupta et al. Addition of therapeutic food supplementation and nutritional support to ICDS led to declines in malnutrition levels in severely malnourished children Kapil et al. ICDS services, when delivered in a coordinated manner with the Expanded Program for Immunization EPI , led to significant increases in overall immunization coverage, with greater improvement in knowledge, attitudes and practices of carers regarding immunization in intervention districts compared with districts where ICDS and EPI were delivered separately Tandon and Sahai ; Tandon et al. While one study demonstrated strong positive correlation between nutritional status and morbidity of children and the degree of utilization of all ICDS services Saiyed and Seshadri , another found no significant impact of ICDS on malnutrition levels in intervention sites, but higher rates of coverage for DPT and measles immunization in non-ICDS districts Trivedi et al. This programme led to statistically significant improvements in all measured outcomes e. When compared with the pre-existing unintegrated government programme, the uptake of contraceptive services did not change DeGraff et al. This programme, commonly known as the Lady Health Worker Programme LHWP , which delivers door-to-door in rural areas a bundle of integrated services related to MCH and FP, achieved significantly higher use of modern contraceptive methods in areas served compared with routine practice providing these services separately Douthwaite and Ward We present below an analysis that describes, for each intervention included in the study, how the intervention elements are integrated into the six critical health system functions, and map the nature and extent of integration of intervention elements into these. Our analysis draws on the data available in the published papers. The mapping of the extent of integration Figure 2 reflects the actual situation as reported in the published paper in the period under concern rather than what was intended. The extent and nature of integration by targeted health intervention and intervention success as reported in the study. This dimension captures aspects related to distribution of governance responsibilities, accountability and performance management for an intervention. For example, in a number of settings interventions for schistosomiasis control adopted a fully integrated governance structure—such as that in Brazil, where the intervention was managed by the municipality Coura Filho et al. In India, the governance structures for interventions aimed at leprosy control were successfully integrated with the PHC services Rao et al. Partial integration occurs where responsibility is shared by the existing general health care system and a specific structure created purposely for the intervention. For instance, in Cuba composite entities comprising PHC level and vector control team workers jointly managed the interventions for dengue control Toledo Romani et al. In Sri Lanka, the responsibility for managing interventions for leprosy control moved between the local health authorities and the Central Leprosy Clinic personnel Kasturiaratchi et al. In India, anganwadi centres, created as part of a self-managed system for child health and development, were also responsible for the organization of a wide range of primary care services Lal ; Gupta et al. This review considers the governance role to be non-integrated when accountability remains exclusively with dedicated specialist entities charged with implementation and management of health interventions, without involvement of the general health care system—for example, interventions directly managed by dedicated units within national or regional governments without integration into main health system functions, as with the interventions for schistosomiasis control in China Sleigh et al. In this review, financing refers to the pooling of financial resources and the provider-payment methods used to allocate these. Revenue generation, a critical financing function, is beyond the scope of the review. We considered an intervention to be fully integrated if it was funded entirely through the national or regional general health care budget. Examples of full integration of financing include interventions for schistosomiasis control in Brazil Coura Filho et al. Under the Integrated Child Development Services ICDS scheme in India resources were provided by the national government directly to the intervention, which comprised a range of essential health services to supplement other general services provided locally and funded by local and national governments Lal ; Gupta et al. When financing was provided directly to an intervention and addressed only a particular disease or problem, the function was considered to be non-integrated. In some instances interventions were directly funded by the government; either at local level, for example dengue control in Cuba Toledo Romani et al. In our framework, the planning function includes activities, processes and systems for needs assessment, priority setting, and resource allocation. Examples of full integration include community leadership in schistosomiasis control in Cameroon Cline and Hewlett , and integration of decision-making for leprosy control with the PHC system in India Rao et al. Planning was considered to be non-integrated when the decision-making focused solely on the intervention without consideration of general health care activities. This may include specific national government units at national level, as in the schistosomiasis control project in China Sleigh et al. Service delivery relates to structural and organizational dimensions of a particular intervention, either at or close to the interface with the customer. In our analysis, services within a health intervention are considered to be fully integrated if their provision is the responsibility of general or multi-purpose health workers, as with schistosomiasis control in Burundi and Cameroon Engels et al. Partial integration refers to instances where there is shared responsibility for the provision of services between general health workers and the health intervention staff; as with interventions for dengue control in Cuba Toledo Romani et al. Partial integration was also achieved in the ICDS intervention in India through collaboration of anganwadi workers and purpose-trained volunteers Tandon and Sahai ; Tandon et al. Partial integration also occurred when service delivery for a number of interventions was linked; for example, family planning and maternal and child health services Tuladhar and Stoeckel ; Phillips et al. In Uganda, National Immunization Days were used as a vehicle to deliver interventions for schistosomiasis control Kabatereine et al. The IMCI strategy is a good example of partial integration where interventions for management of a number of childhood illnesses are bundled Bryce et al. A number of interventions rely solely on single purpose workers and have no integration with other interventions or general health services; such as the interventions for malaria control in Colombia Rojas et al. Demand generation, increasingly recognized as an important health system function, relies on a number of interventions such as the use of appropriate financial incentives and monetary support, insurance, or information, education and communication IEC activities designed to change behaviour. Demand generation was considered to be fully integrated if mechanisms used to create financial incentives or IEC activities were provided jointly with the general services or were delivered by PHC workers. For example, in Burundi, Cameroon and Saudi Arabia, IEC for schistosomiasis control was the responsibility of staff of the public health centres Engels et al. In Colombia, education on the prevention, diagnosis and treatment of malaria was provided by both community volunteers working in malaria control and staff from the general health services Rojas et al. In Peru and Bangladesh, health education for nutrition interventions was provided jointly by the targeted programme staff and regional health workers Hossain et al. In China, IEC related to schistosomiasis control was provided through a partnership between programme staff, general health workers, schoolteachers and community health workers Sleigh et al. Similarly, staff involved in the LHWP in Pakistan and the ICDS in India provided a wide range of IEC activities on general health, women's health, family planning, and maternal and child health in addition to those related to their specific interventions Lal ; Gupta et al. In contrast, in a number of countries, information campaigns related to health interventions tended to be stand-alone activities, focusing solely on a single problem or disease, and delivered by single-purpose health workers or volunteers: for example, for dengue control in Cuba Rojas et al. To better understand which factors have influenced the integration of health interventions, we analysed the context in which these interventions were implemented; in particular, factors pertaining to the adoption system, the health system and those relating to the wider politico-economic and socio-cultural contexts. These factors interact to create opportunities or barriers; influencing the receptivity of a context, and thereby the desirability and sustainability of an intervention. Changing politico-economic and socio-cultural contexts impact on population needs, which in turn influence the sustainability of a particular programme and its design. For example, in Peru, rapid urbanization and the arrival of large numbers of indigent slum-dwellers significantly altered the morbidity profile of the local population, with a substantial rise in micronutrient deficiencies, creating a significant new burden that had to be addressed rapidly by developing targeted interventions Gross et al. In contrast, the rise in living standards in Saudi Arabia led to improvements in general hygiene and sanitation, thereby helping to reduce the schistosomiasis burden Jarallah et al. Understanding the local socio-cultural context is critical to the design of an appropriate intervention, as illustrated by the schistosomiasis control programme in Uganda. This intervention initially targeted schoolchildren, but as one-third of children in certain endemic areas were not enrolled in schools, the intervention failed to reach large population groups Kabatereine et al. The intervention was then modified to facilitate integration with other targeted programmes enabling use of this intervention in a wider range of opportunities, such as National Immunization Days, for deworming activities. While the disease-specific focus of interventions for the control and eradication of leprosy India, Sri Lanka or schistosomiasis e. With low endemicity and reduced prevalence, the more financially sustainable option was to integrate these interventions into mainstream PHC services. In Brazil, integration of the intervention for schistosomiasis control into PHC was possible as municipalities possessed enough absorptive capacity to assume responsibility for planning, financing and delivery of the intervention when external funding for the targeted programme ceased Coura Filho et al. Similarly, the presence of a well-developed PHC infrastructure with high population coverage and utilization rates enabled Saudi Arabia to embed schistosomiasis control into PHC Jarallah et al. The FPHSP in Bangladesh could provide efficient family planning services for many years thanks to its dedicated human and physical resources Simmons et al. However, the LHWP programme in Pakistan struggled to find a place in an already overstretched and fragile health system which experienced significant funding shortfalls Douthwaite and Ward , and was delivered as a targeted intervention. In contrast, the Dular strategy for health education and child health services was able to build at low cost on the infrastructure of the ICDS, thereby ensuring sustained delivery of a programme that could integrate health education and child health services Dubowitz et al. Critical events create windows of opportunity or a necessity for action—mobilizing civil society and other key actors, such as health professionals and policy makers, to introduce new systems for finance, and delivery of health interventions. For example, an outbreak of dengue in a non-endemic area of Cuba motivated the local community to strengthen existing interventions for dengue control Toledo Romani et al. In Cameroon, a number of development projects raised concerns about the possible expansion of snail habitats with concomitant increase in schistosomiasis infection, prompting the government to establish a dedicated intervention for schistosomiasis control with strong community involvement and integration into PHC. This intervention coincided with the government's commitment to strengthen the national PHC system Cline and Hewlett Confronted with unsustainably high population growth rates, the government of Bangladesh introduced the FPHSP to provide family planning education and contraceptive services DeGraff et al. Overcrowding in refugee camps that followed the military conflict in Macedonia increased the risk of rapid transmission of vaccine-preventable diseases, necessitating urgent implementation of EPI for children Koop et al. The Peruvian nutrition supplementation programme was established in response to evidence which showed high prevalence of iron deficiency in the newly urbanized population Gross et al. Synergies between targeted health interventions can create opportunities for integration and positively influence the ultimate success of these interventions. In contrast, poor coordination between related interventions can be detrimental to effectiveness and sustainability. For example, in Morocco multiple and contrasting guidelines for managing child health hindered effective implementation of IMCI Naimoli et al. Similarly, in Peru the presence of a number of child health programmes with overlapping remits led to inefficiencies in delivery and destructive competition for IMCI resources Huicho et al. In Tanzania, successful introduction of IMCI coincided with measures to improve management of the district health systems, creating an enabling environment for implementation of the IMCI strategy Armstrong Schellenberg et al. The extent and nature of integration can be influenced by the commitment of local or national leadership and that of the health workers to a particular programme design. For example, government commitment to a targeted programme was critical to the success of schistosomiasis control in China Sleigh et al. Similarly, in Sri Lanka, government commitment enabled successful integration of leprosy services into PHC Kasturiaratchi et al. In contrast, a lack of government commitment to development of an integrated programme contributed directly to the poor IMCI results in Peru Huicho et al. Similarly, in Cuba, reluctance of health workers to relinquish responsibilities delayed integration of targeted interventions for malaria control into PHC Rojas et al. The debate on health interventions has tended to narrowly focus on vertical or integrated descriptors. However, our analysis shows this to be a false dichotomy. We found no instances where interventions were purely vertical wholly unintegrated or horizontal fully integrated into the health system functions. Instead, there exists a rich mosaic of instances where health interventions are integrated into one or more critical health system functions, producing a highly heterogeneous picture. As the nature of the problems, the interventions to address these and the adoption and assimilation of health interventions in health systems vary greatly in different contexts, as does the purpose, nature, speed and the extent of integration—influenced by the intervention complexity, health system characteristics and contextual factors. In practice, health systems combine both non-integrated and integrated interventions, but the purpose, nature and extent of integration vary enormously between different interventions in countries, creating a diversity of local solutions to address successfully or not emergent problems. Perhaps the modesty of evidence creates the context for strong opinions for or against integration in global health. Given the large amounts of public and private funding invested in targeted programmes and health systems to address global health, nutrition and population problems it is important and incumbent upon donors and implementers alike to develop a context-specific evidence base to guide policies and practice in relation to programme design, rather than rely on dogma. We find that changes in the nature of the problem such as the epidemiology and context such as socio-economic development, and government commitment or health worker inclination to a particular design influences the nature and extent of integration. However, examples of these are few to form a strong view on the magnitude of these influences. It was not clear from the studies analysed that time in itself is an influencing factor on the integration of targeted programmes into health systems, but rather the integration is influenced by a multiplicity of factors as discussed above. This study has a number of limitations. First, programme evaluations reported in the peer-reviewed literature used in this study provide limited but varied detail on the organizational structures surrounding the intervention and the health systems within which these interventions were implemented. However, the framework presented Atun et al. Unlike the Cochrane criteria for appraising the quality of randomized controlled studies, there is no consensus on the criteria that could be used to appraise systematically the quality of programme evaluations as no such rating exists. Hence, we selected studies on the basis of their relevance to our research question and design see Box 1 , but it was not possible to systematically rate their quality. Fourth, we were unable to retrieve the full text of 28 studies details available from authors. However, analysis of abstracts and place of publication suggest these were unlikely to have been included in the final 55 documents included in the study or to change the study result. Fifth, a major limitation of our study is the non-inclusion of grey literature. We did not include grey literature as these publications have not undergone peer review and there are no agreed methods for assessing the quality of these studies. Hence the benefits of a very time-consuming and costly exercise are not clear. Finally, the inherent heterogeneity of the included studies, both in their clinical focus and in the setting, makes it difficult to generalize findings without a better understanding of how contextual factors have shaped the organizational structures of health interventions. We intend to address this issue through a more comprehensive and in-depth approach, using a multi-country case study design. In spite of the study limitations, which we tried to address, the findings provide new synthesis of evidence to further the debate on health systems and targeted interventions; a debate that has ossified in a binary mode. Given the highly varied contexts and adoption systems, different health system capacities and the range of problems being addressed, it is not surprising that in practice a rich mix of solutions exist. These studies should be longitudinal in nature, carried out over a period of a few years so that sustainability and long-term impacts of a horizontal approach could also be evaluated. Such studies will also need to take account of the multiple dimensions of integration, the wider health system context and the political economy in which they are set, as these factors work beyond the interventions to determine the success of the programmes. While the discussion on the relative merits of integrating health interventions will no doubt continue, discussion should move away from the highly reductionist approach that has polarized this debate. Given the paucity of evidence, we suggest that in order to deliver an evidence-based conclusion on the effectiveness of health programme integration, investments should be made in studies with robust designs, comparable control and intervention groups where possible, valid and reliable outcomes, and analysis of costs. But given the varied contexts within which targeted programmes are implemented, there is a need for country case studies which examine such health interventions to better understand the extent and nature of integration and the reasons for the designs that emerge—country case studies that use a common methodology and replication logic, informed by appropriate theoretical frameworks such as the one used in this study. Such an approach to case studies would allow comparisons among countries and programmes, generating evidence that has relevance beyond a country. Future efforts are best spent on generating and learning from evidence rather than on the empty rhetoric which has dominated this field. Google Scholar. Google Preview. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Advertisement intended for healthcare professionals. Sign in through your institution. Advanced Search. Search Menu. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents Abstract. The conceptual framework for analysing integration of targeted health interventions into health systems. Journal Article Editor's Choice. A systematic review of the evidence on integration of targeted health interventions into health systems. E-mail: r. Oxford Academic. Thyra de Jongh. Federica Secci. Kelechi Ohiri. Olusoji Adeyi. Select Format Select format. Permissions Icon Permissions. Abstract A longstanding debate on health systems organization relates to benefits of integrating health programmes that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes. Health systems , targeted programmes , integration , vertical programmes , horizontal programmes. Box 1 Search strategy and methods. Figure 1. Open in new tab Download slide. Table 1 Open in new tab. Critical health systems functions and elements of integration. Critical health system function. Box 2 Summary of the studies analysed. Figure 2. Does the Integrated Management of Childhood Illness cost more than routine care? Results from the United Republic of Tanzania. Google Scholar PubMed. Impact of the integrated child development services ICDS on maternal nutrition and birth weight in rural Varanasi. Integration of schistosomiasis-control activities into the primary-health-care system in the Gizan region, Saudi Arabia. Google Scholar Crossref. Search ADS. Immunization coverage and child mortality in two rural districts of Sierra Leone. Armstrong Schellenberg. Social stigma: a comparative qualitative study of integrated and vertical care approaches to leprosy. Integration of targeted health interventions into health systems: a conceptual framework for analysis. The impact of control measures on urinary schistosomiasis in primary school children in northern Cameroon: A unique opportunity for controlled observations. The impact of the national polio immunization campaign on levels and equity in immunization coverage: evidence from rural North India. Strategies for integrating primary health services in middle- and low-income countries at the point of delivery. Improving quality and efficiency of facility-based child health care through Integrated Management of Childhood Illness in Tanzania. Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness. Coura Filho. Lessons from successful micronutrient programs. Part II: program implementation. Intensifying efforts to reduce child malnutrition in India: An evaluation of the Dular program in Jharkhand, India. How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. El Arifeen. Sustainability of schistosomiasis case detection based on primary health care. Effectiveness of the communication program on compliance in a weekly multimicronutrient supplementation program in Chiclayo, Peru. Effectiveness of distribution of multimicronutrient supplements in children and in women and adolescent girls of childbearing age in Chiclayo, Peru. Scaling up Integrated Management of Childhood Illness to the national level: achievements and challenges in Peru. Implementation of the Integrated Management of Childhood Illness strategy in Peru and its association with health indicators: an ecological analysis. Role of primary health care in the control of schistosomiasis. The experience in Riyadh, Saudi Arabia. Progress towards countrywide control of schistosomiasis and soil-transmitted helminthiasis in Uganda. Nutritional rehabilitation of severely malnourished children at domiciliary level through the integrated child development services ICDS scheme: A perspective study. Processes and challenges: How the Sri Lankan health system managed the integration of Leprosy Services. Community-directed interventions strategy enhances efficient and effective integration of health care delivery and development activities in rural disadvantaged communities of Uganda. Results of the expanded program on immunization in the Macedonian refugee camps. Better primary health care services utilization through integrated child development service scheme in Haryana. Costs of the multimicronutrient supplementation program in Chiclayo, Peru. Lopez de Romana. Protective effect of multimicronutrient supplementation against anemia among children, women, and adolescent girls in lower-income areas of Chiclayo, Peru. Comprehensive versus selective primary health care: lessons for global health policy. Impact of Integrated Management of Childhood Illness on inequalities in child health in rural Tanzania. Improving facility-based care for sick children in Uganda: training is not enough. Study on integration of the National Leprosy Eradication Programme into primary health care services: a pilot project. The feasibility, demand, and effect of integrating primary care services with HIV voluntary counseling and testing — evaluation of a year experience in Haiti, — Elimination of leprosy: the integration of leprosy related activities into the general health services of Tamil Nadu. An integrated malaria control program with community participation on the Pacific Coast of Colombia. Cost-effectiveness analysis of family-planning programs in rural Bangladesh — evidence from Matlab. Eradication of schistosomiasis in Guangxi, China. Part 2: Political economy, management strategy and costs, — Part 1: Setting, strategies, operations, and outcomes, — Part 3. Community diagnosis of the worst-affected areas and maintenance strategies for the future. Immunization in India — contribution of integrated child-development services scheme to Expanded Program of Immunization. Immunization coverage in India for areas served by the integrated child-development services program. Toledo Romani. Towards active community participation in dengue vector control: results from action research in Santiago de Cuba, Cuba. Selective primary health-care — interim strategy for disease control in developing countries. World Bank. Impact of implementation of Integrated Management of Childhood Illness on improvement of health system in China. Issue Section:. Download all slides. 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