Barriers and enablers to integrating maternal and child health services to antenatal care in low and middle income countries

For most women in low and middle income countries (LMIC), antenatal care (ANC) plays a highly important dual role: not only does ANC provide effective interventions to reduce the risks associated with pregnancy and childbirth, it can also serve as a delivery platform for other health services. Particularly in settings where the prevalence of HIV/AIDS, sexually transmitted infections (STIs), tuberculosis (TB) and malaria is high, integrating services for these conditions with ANC can significantly expand their reach. In fact, the World Health Organization (WHO) identified integration of ANC with other health programmes as a key strategy for reducing missed opportunities for patient contact and improving maternal and child health (MCH). Evidence from the countries studied, however, suggests that in practice integrated delivery of ANC with other health services is not systematic or adequate and that opportunities for providing care for women are lost.

Several factors enable or hinder the ...

Report on the Global Knowledge Commons for Innovations in mHealth and eHealth

The International Society for Telemedicine & eHealth publishes (in an electronic form) the Report of the Innovation Working Group (IWG) Task Force on the Global Knowledge Commons for m-eHealth Innovations.

The report addresses the key challenge facing digital health, which is that of converting our collective knowledge into a global public good, accessible to all, thus enabling each actor in the ecosystem to benefit from what others know. The document postulates that a Global Knowledge Commons (GKC) for innovation in health or simply "the Commons", would be composed of three main constituents:

• A database of projects, products and services;
• A "Who is who in eHealth" - individual experts and institutions; and
• Reusable m-eHealth knowledge objects, in various formats, such as articles, presentations, videos, etc.

The Commons would leverage existing repositories of the digital health space, and lead to five significant beneficial outcomes:

• Digital intelligence at-a-glance through dash-boards by geography, application area and ...

Behavioural health consultants in integrated primary care teams: a model for future care

Significant challenges exist within primary care services in the United Kingdom (UK). These include meeting current demand, financial pressures, an aging population and an increase in multi-morbidity. Psychological services also struggle to meet waiting time targets and to ensure increased access to psychological therapies. Innovative ways of delivering effective primary care and psychological services are needed to improve health outcomes.

Perceptions of health managers and professionals about mental health and primary care integration in Rio de Janeiro: a mixed methods study

Community-based primary mental health care is recommended in low and middle-income countries. The Brazilian Health System has been restructuring primary care by expanding its Family Health Strategy. Due to mental health problems, psychosocial vulnerability and accessibility, Matrix Support teams are being set up to broaden the professional scope of primary care. This paper aims to analyse the perceptions of health professionals and managers about the integration of primary care and mental health.

How can health and social care work together effectively?

Let´s consider what an integrated health and social care system might look like. Should the cultural differences between health and social care be preserved within a closer partnership? And what role can technology play in bringing together services that have traditionally worked in parallel? 

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Managing care integration during the implementation of large-scale reforms: the case of the Australian National Disability Insurance Scheme

The National Disability Insurance Scheme (NDIS) is a new program for the provision of support to people with disabilities in Australia. The purpose of this paper is to explore the early implementation experience of this scheme, with a particular focus on the implications of this scheme for issues of care integration. There is little empirical data relating to the implementation of the NDIS to date. This is the first study to explore boundary issues in relation to care integration. 

Integrating safety concepts in health and social care

Keeping individuals safe from harm and exploitation is a clearly articulated goal within both the health and social care sectors. Two key concepts associated with achieving this common aim are safety and safeguarding. The purpose of this paper is to critically appraise the differences in safety terminology used in health and social care, including opportunities and challenges for greater integration of safety systems across health and social care in England. 

Experiencing integration: a qualitative pilot study of consumer and provider experiences of integrated primary health care in Australia

The terms integration and integrated care describe the complex, patient-centred strategies to improve coordination of healthcare services. Frameworks exist to conceptualise these terms, but these have been developed from a professional viewpoint. 

The objetive of this study was to explore consumers and provider´s concepts, expectations and experience of integrated care. A key focus was whether frameworks developed from a professional perspective are effective models to explore people´s experiences. 

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to strengthen African health systems in order to address communicable and non-communicable diseases. The aim of this study was to assess the position of civil society-led community unity home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demands arise. 

How to Integrate HIV and Sexual and Reproductive Health Services in Namibia, the Epako Clinic Case Study

During the past two decades, HIV and Sexual and Reproductive Health services in Namibia have been provided in silos, with high fragmentation. As a consequence of this, quality and efficiency of services in Primary Health Care has been compromised. 

The authors conducted an operational research (observational pre-post study) in a public health facility in Namibia. A health facility assessment was conducted before and after the integration of health services. A person-centred integrated model was implemented to integrate all health services provided at the health facility in addition to HIV and Sexual and Reproductive Health services. Comprehensive services are provided by each health worker to the same patients over time (longitudinality), on a daily basis (accessibility) and with a good external referral system (coordination). Prevalence rates of time flows and productivity were done. 

Results: Integrated services improved accessibility, stigma and quality of antenatal care services by improving the provider-patient communication, reducing ...

Integrated care: learning between high-income, and low- and middle-income country health systems

Integration is a challenging concept to define, in part because of its multiple dimensions and varied scope: from integrated clinical care for individual patients to broader systems integration- or linkage-involving wide range of interconnected services. This commentary compares integrated care in high-and lower- income countries. Although contexts may differ significantly between these settings, there are many common features of how integration has been understood and common challenges in its implementation

Using Complexity and Network Concepts to Inform Healthcare Knowledge Translation

Many representations of the movement of healthcare knowledge through society exist, and multiple models for the translation of evidence into policy and practice have been articulated. Most are linear or cyclical and very few come dose to reflecting the dense and intricate relationships, systems and politicis of organizations and the processes required to enact sustainable improvements. This study illustrates how using complexity and network concepts can better inform knowledge translation (KT) and argue that changing the way we think and talk about KT could enhance the creation and movement of knowledge throughout those systems needing to develop and utilize it. 

Integration of community home based care programmes within national primary health care revitalisation strategies in Ethiopia, Malawi, South-Africa and Zambia: a comparative assessment

In 2008, the WHO facilitated the primary health care (PHC) revitalisation agenda. The purpose was to stregthen African health systems in order to address communicable and non-communicable diseases. The aim of this article was to assess the position of civil society-led community home based care programmes (CHBC), which serve the needs of patients with HIV, within this agenda. It examined how their roles and place in health systems evolved, and the prospects for these programmes in national policies and strategies to revitalise PHC, as new health care demand arise. 

Coordinating Mental and Physical Health Care in Rural Australia: An Integrated Model for Primary Care Settings

The "GP Clinic" providers primary health care to people using community mental health services in a small town in Australia. This article examines the factors that have driven successful integration in this rural location. Integrated physical and mental health service models that focus on building local service provider relationships and are responsive to community needs and outcomes may be more beneficial in rural settings than top down approaches that focus on policies, formal structures, and governance. 

From HIV prevention to non-communicable disease health promotion efforts in sub-Saharan Africa: A Narrative Review

Although HIV/NCD integration can improve effectiveness of preventive services at individual and community levels, potential public health impact of such approaches remain unknown as reach, adoptability, and sustainability of both integrated and nonintegrated NCD BCC approaches published to date have not been well characterized. So the aim of this study was to synthesize published literature on noncommunicable disease (NCD) behavior change communication (BCC) interventions in sub-Saharan Africa (SSA) among persons living with HIV (PLHIV) and in the general population to inform efforts to adopt similar HIV and NCD BCC intervention activities.

New models of home care

Policy-makers have outlined their ambitions to provide joined-up care closer to home and enable people to remain independent and in their own homes. Home care will be a central component of realising these ambitions. However, there are serious concerns about the state of the home care market
and the quality of care service users receive.
In this case, the present report summarises the evidence on innovations and models of home care that demonstrate potential in the following key opportunity areas:
1. Technology and digital
2. Co-ordinated care planning
3. Recruitment and retention
4. Autonomous team working
5. Alternative approaches to commissioning
6. Personalisation
7. Integrated care approaches
8. Community assets and connections
9. Family-based support and communal living
.

Patient–Provider Video Telemedicine Integrated With Clinical Care: Patient Experiences

Real-time patient–provider video visits have the potential to engage patients by allowing them to access a clinical encounter without arranging transportation, taking time off from work, or spending time in a waiting room. Although millions of U.S. patients have used direct-to-consumer telemedicine services without in-person facilities, these services may lack integration with electronic health records and with clinicians from whom patients receive ongoing care. Evidence is limited from large-scale implementation of “house call” video visits integrated with ongoing health care delivery and providers in community primary care.

Development and Testing of the Provider and Staff Perceptions of Integrated Care (PSPIC) Survey

This article discusses development and testing of the Provider and Staff Perceptions of Integrated Care Survey, a 21-item questionnaire, informed by Singer and colleagues’ seven-construct framework. Questionnaires were sent to 2,936 providers and staff at 100 federally qualified health centers and other safety net clinics in 10 Midwestern U.S. states. Item analyses, exploratory factor analysis, and confirmatory factor analysis were undertaken.

Integrated care systems in the English NHS: a critical view

The intriguing evolution of health policy in recent years has implications for all parts of the health system. With the UK falling behind most high-income countries on many measures of child health and growing evidence of a worrying health gap between UK children in deprived and affluent areas, paediatricians and others working in child health will want to remain abreast of the broader policy backdrop even where child health has not been privileged in policymaking. While the 2012 Health and Social Care Act reinforced the fragmentation of the service through multiple providers in competition with one another, subsequent policy promises local collaboration and joint working. This article traces this evolution and asks what it means.

NACIC2021 – 1st North American Conference on Integrated Care, Toronto, Canada

The Generation of Integration: The Early Experience of Implementing Bundled Care in Ontario, Canada

By bundling services and encouraging interprofessional and interorganizational collaboration, integrated health care models counter fragmented health care delivery and rising system costs.
While research has been conducted on the facilitators and challenges of integration, there is less known about how integration is generated. This article explores the generation of integration through the dynamic interplay of contexts and mechanisms and of structures and subjects.

Impact of integrated healthcare: Taiwan’s Family Doctor Plan

Integration of health services has been pursued worldwide. Diversity in integration approaches and in the contexts in which integrated programmes operate, however, hinders comparative analysis of care integration in both high-income countries (HICs) and low- and middle-income countries (LMICs). This study evaluates an HIC programme implemented in a delivery system resembling those of LMICs, especially its weak primary care system. 

Can Organisational Culture of Teams Be a Lever for Integrating Care? An Exploratory Study

Organisational culture is believed to be an important facilitator for better integrated care, yet how organisational culture impacts integrated care remains underspecified. In an exploratory study, we assessed the relationship between organisational culture in primary care centres as perceived by primary care teams and patient-perceived levels of integrated care

COVID-19 care in India: the course to self-reliance

Many times we think of the integration of health systems as an urgent need. However, there are cases (and realities) where it is necessary to centralize to homogenize the action in the face of a crisis such as the SARS-CoV2 pandemic. The public health response to COVID-19 in India has been highly centralised, resulting in a homogenous strategy applied across a sixth of the world’s population.

Integrated and patient-centred management of Parkinson’s disease: a network model for reshaping chronic neurological care

Chronic neurological diseases are the leading cause of disability globally. Yet, our health-care systems are not designed to meet the needs of many patients with chronic neurological conditions. Care is fragmented with poor interdisciplinary collaboration and lack of timely access to services and therapies. Furthermore, care is typically reactive, and complex problems are managed inadequately because of a scarcity of disease-specific expertise and insufficient use of nonpharmacological interventions. Treatment plans tend to focus on the disease rather than the individual living with it, and patients are often not involved in clinical decision making. By use of Parkinson’s disease as a model condition, this article show an integrated care concept with a patient-centred perspective that includes evidence-based solutions to improve healthcare delivery for people with chronic neurological conditions.

Approaches to integrating palliative care into African health systems: a qualitative systematic review

Africa is characterized by a high burden of disease and health system deficits, with an overwhelming and increasing demand for palliative care (PC). Yet only one African country is currently considered to have advanced integration of palliative care into medical services and generalized PC is said to be available in only a handful of others. The integration of PC into all levels of a health system has been called for to increase access to PC and to strengthen health systems. Contextually appropriate evidence to guide integration is vital yet limited. This qualitative systematic review analyses interventions to integrate PC into African health systems to provide insight into the ‘how’ of PC integration. Forty articles were identified, describing 51 different interventions. This study found that a variety of integration models are being applied, with limited best practices being evaluated and repeated in other contexts. Interventions typically focused on integrating specialized PC ...

Effective implementation approaches for healthy ageing interventions for older people: A rapid review

Given the advanced demographic transition in the world, seeking healthy aging is an imperative task. In this review, strategies that favor a better quality of life for the elderly are shown, including the interaction of different levels of care (intra and extra system). All of this results in better global health indicators for the elderly population, which in turn translates into less need for care by the system.

A reflection on the development of Integrated Health Services Networks in the Americas

In October 2009, the 49^th Directing Council of the Pan American Health Organization (PAHO) approved the resolution “Integrated Networks of Health Services based on Primary Health Care” (IHSDN). The approval of this resolution formalized the commitment of the countries of the Americas to advance in the creation, development, and strengthening of IHSDNs in the Region, and constitutes until today a cooperation mandate for PAHO.

The resolution was accompanied by an important position paper called “Integrated Health Services Networks. Concepts, policy options and roadmap” published in May 2010. This document provided an action guide to implement the IHSDN, including a new definition of fourteen attributes grouped into four categories (care model, governance and strategy, organization and management, and allocation and incentives) to be met by integrated service networks. The importance of this is that the attributes offered leaders, managers, researchers, and those interested in general in this matter, a clear ...

Health workforce planning under conditions of uncertainty: identifying supportive integrated care policies using scenario analysis

Integrated care presents health workforce planners with significant uncertainty. This results from:

• (1) these workforces are likely in the future to be different from the present.
• (2) integrated care's variable definitions.
• (3) workforce policy and planning is not familiar with addressing such challenges.

One means to deal with uncertainty is scenario analysis. In this study shows some aspects of integration-supportive workforce governance and planning policies that were derived from the application of scenario analysis.Through a mixed methods design that applies content analysis, scenario construction and the policy Delphi method, it's analized a set of New Zealand's older persons health sector workforce scenarios. Developed from data gathered from workforce documents and studies, the scenarios were evaluated by a suitably qualified panel, and derived policy statements were assessed for desirability and feasibility.

Adaptation and piloting of an integrated intervention model for alcohol use disorders in primary healthcare in rural Tanzania: a study protocol

According to Africa WHO, the African Region is faced with a growing burden of harmful alcohol consumption and its disastrous effects. There is no other consumer product as widely available as alcohol that accounts for as much premature death and disability. There are two main characteristics that describe alcohol consumption patterns in the Region: a high level of alcohol abstention in some countries and high volume consumption with severe health and social consequences in others. Alcohol use has immediate and long-term effects that increase the risks associated with numerous health conditions. Alcohol is a leading cause of risky sexual behaviours such as unprotected sex, sex with multiple partners, and produces an increased risk of sexual assault. These behaviours can result in unintended pregnancies and sexually transmitted infections (STIs) such as human papillomavirus (HPV) and HIV.

Integration of evidence-based interventions for alcohol use disorders (AUDs) into primary healthcare has potential to ...

How well are non-communicable disease services being integrated into primary health care in Africa: A review of progress against World Health Organization’s African regional targets

In Africa, mortality due to NCDs is projected to overtake the combined mortality from communicable, maternal, neonatal, and nutritional diseases by 2030. To address this growing NCD burden, PHC systems will require substantial re-orientation. In this tudy published, researchers reviewed progress of African countries towards integrating essential NCD services into PHC. The study found that no country met all the recommended indicators to integrate NCD services into PHC, and seven countries met none of the indicators.

Learning from the Pandemic to Improve Care for Vulnerable Communities: The Perspectives and Recommendations from the Rare Disease Community

The COVID-19 pandemic has brought about health and social care disruptions for millions of people with complex health needs and disabilities, who are amongst the most vulnerable populations. More than ever before, the need for integrated care is pressing, as fragmented health and care systems struggle to face the pandemic and vulnerable individuals are exposed to aggravated health, social and economic hurdles. The implementation of effective integrated care pathways is long due and must build upon the key guidelines being published by experts worldwide. Furthermore, the pandemic is opening the doors for more remote healthcare and care coordination, with both services and care receivers being increasingly more receptive to virtual and digital solutions, so long as they are fit for purpose and do improve care.

In this article we will go over the impact that the pandemic has had so far for the community of people living with a rare ...

Applying Complexity Theory to a Hospital Complex Patient Care Program

Increasingly, complexity science concepts are informing health care design and practice. The present paper describes the implementation of early complexity science principles in a Complex Care Program with the aim of strengthening the provision of integrated care. Grounded in cybernetic network theory, Stafford Beer’s Viable Systems Model provided the guiding principles for the program’s redesign. The Viable Systems Model with its broadly applicable principles, is now the conceptual model of information management in the program. Beer’s framework has enabled a relatively small number of clinicians to coordinate care for a large cohort of patients with significant clinical complexity, and a multitude of providers, in the community setting.

Navigate Your Health: A Case Study of Organisational Learnings from an Integrated Care Pilot for Children and Young People in Care

Three peak organisations in Queensland, Australia partnered with consumers and other health and social sector partners to co-design and pilot the first known integrated, health navigation model to improve outcomes for children and young people in care in Australia. Findings highlighted the agency partners’ drive to foster a more integrated and person-centred approach to care. The pilot’s aim of improving health outcomes for a vulnerable population were achieved through a co-designed process which provided additional insights regarding partnerships, improvement, scalability and sustainability.

Integrating diabetes, hypertension and HIV care in sub-Saharan Africa: a Delphi consensus study on international best practice

Although HIV continues to have a high prevalence among adults in sub-Saharan Africa (SSA), the burden of noncommunicable diseases (NCD) such as diabetes and hypertension is increasing rapidly. There is an urgent need to expand the capacity of healthcare systems in SSA to provide NCD services and scale up existing chronic care management pathways. This study highlights the outcomes which may form key components of future complex interventions to define a model of integrated healthcare delivery for diabetes, hypertension and HIV in sub-Saharan Africa.

What does Success Look Like for Leaders of Integrated Health and Social Care Systems? a Realist Review

Health and social care services in England are moving towards greater integration, yet little is known about how leadership of integrated care teams and systems can be supported and improved. This realist review explores what works about the leadership of integrated care teams and systems, for whom, in what circumstances and why. This review has generated new perspectives on the leadership of integrated care teams and systems that can be built upon, developed, and tested further.

The Effect of Integration of Family Planning Into HIV Services on Contraceptive Use Among Women Accessing HIV Services in Low and Middle-Income Countries: A Systematic Review

There is substantial unmet need for family planning (FP) among women living with HIV (WLHIV), leading to unintended pregnancies and may contribute indirectly to increasing the risk of transmission of HIV. This review aims to determine whether integration of FP into HIV testing and care results in increased use of contraception, a reduction in unmet need for FP, improved use of safer conception methods and a reduction in unintended pregnancies in low and middle-income countries. The primary outcome of the review was contraceptive uptake and secondary outcomes included unmet need for FP, safer conception and unintended pregnancy.

Facilitating integration through team-based primary healthcare: A cross-case policy analysis of four Canadian provinces

Team-based care can improve integrated health services by increasing comprehensiveness and continuity of care in primary healthcare (PHC) settings. Collaborative models involving providers from different professions can help to achieve coordinated, high-quality person-centred care.

In Canada, five key components were found that influenced IPHC and integrated health services: patient-centred care; team structures; information systems; financial management; and performance measurement. 

Designing and Governing Responsive Local Care Systems – Insights from a Scoping Review of Paramedics in Integrated Models of Care

Programs that fill gaps in fractured health and social services in response to local needs can provide insight on enacting integrated care. Grassroots programs and the changing roles of paramedics within them were analyzed to explore how the health workforce, organizations and governance could support integrated care. In this study, five concepts were identified for fostering integrated care in local systems: single point-of-entry care pathways; flexible and mobile workforce; geographically-based cross-cutting organizations; permissive regulation; and assessing system-level value.

Values Underpinning Integrated, People-Centred Health Services: Similarities and Differences among Actor Groups Across Europe

In addition to the functional aspects of healthcare integration, an understanding of its normative aspects is needed. This study explores the importance of values underpinning integrated, people-centred health services, and examines similarities and differences among the values prioritised by actors across Europe.

Dimensions of Proximity: An Actionable Framework to Better Understand Integrated Practices in Cancer Networks

This study empirically explores how dimensions of proximity that support integrated care emerge from deliberate actions within a cancer network in Quebec (Canada).

Barriers and challenges to integrated care

Integrated care is critical to the successful delivery of modern day health and social care services, however the implementation into practice poses many barriers and challenges. This article seeks to identify these barriers and present methods through which to aim to address and overcome these.

Integrated Care: Reflections on Change in Health Services

This book critically examines integrated care, looking at integration from an unconventional angle to reveal the tacit assumptions we make when we manage and change health services. Kaehne questions our premises on health services management, the motivations for change and the shortcomings of health policy in complex environments.

Developing an integrated model of care for vulnerable populations living with non-communicable diseases in Lebanon: an online theory of change workshop

The Syrian crisis, followed by a financial crisis, port explosion, and COVID-19, have put enormous strain on Lebanon’s health system. Syrian refugees and the vulnerable host population have a high burden of Non-communicable Diseases (NCD) morbidity and unmet mental health, psychosocial and rehabilitation needs. The International Committee of the Red Cross (ICRC) recently introduced integrated NCD services within its package of primary care in Lebanon, which includes NCD primary health care, rehabilitation, and mental health and psychosocial support services. We aimed to identify relevant outcomes for people living with NCDs from refugee and host communities in northern Lebanon, as well as to define the processes needed to achieve them through an integrated model of care. Given the complexity of the health system in which the interventions are delivered, and the limited practical guidance on integration, we considered systems thinking to be the most appropriate methodological approach.

Collaborative Leadership in Integrated Care Systems; Creating Leadership for the Common Good

The COVID-19 pandemic has become a catalyst for change, but such change can only happen through collaborative leadership which maintains a focus on relationships and purpose rather than solely on outputs or outcomes. This conceptual article explores how health and social care integration has been offered as one potential solution to the challenge of health and social care transformation. Specifically, Integrated Care Systems in England are intended to provide regional governance, to provide public services in a coherent and robust way. We explore this development in relation to three key aspects: the macro-level global policy context; the meso-level organizational behaviour and culture; and the micro-level practice of individual leaders and managers. It is found that, whilst the organizational structure of Integrated Care Systems offers great promise, collaborative leadership is critical to realize truly resilient and sustainable collaborative relationships.