scholarly journals Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration

PLoS ONE ◽  
2016 ◽  
Vol 11 (1) ◽  
pp. e0146694 ◽  
Author(s):  
Susannah H. Mayhew ◽  
George B. Ploubidis ◽  
Andy Sloggett ◽  
Kathryn Church ◽  
Carol D. Obure ◽  
...  
Keyword(s):  
Reproductive Health ◽  
Service Delivery ◽  
Integrated Service Delivery ◽  
The Impact ◽  
Integrated Service

scholarly journals Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

2020 ◽  
Author(s):  
Kate Sheahan ◽  
Jennifer Orgill-Meyer ◽  
Ilene Speizer ◽  
Sian Curtis ◽  
John Paul ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Urban Areas ◽  
Health Facilities ◽  
Index Score ◽  
Child Immunization ◽  
Integrated Service Delivery ◽  
Immunization Services ◽  
The Impact ◽  
Integrated Service

Abstract Background: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. Since most studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum, it is difficult to understand the determinants and effects of integration. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services, and applies them to analyze the extent of integration across 400 health facilities. Methods: This study utilizes cross-sectional health facility (N= 400; 49% hospitals, 51% primary healthcare centers) and healthcare provider (N= 1,479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Components Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that measuring integration as a binary variable does not (a) reflect the true variation in integration within and across health facilities, (b) enable nuanced measurement of the determinants or effects of integration, or (c) provide tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

scholarly journals Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

2020 ◽  
Author(s):  
Kate L. Sheahan ◽  
Jennifer Orgill-Meyer ◽  
Ilene Speizer ◽  
Sian Curtis ◽  
John Paul ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Urban Areas ◽  
Health Facilities ◽  
Index Score ◽  
Child Immunization ◽  
Integrated Service Delivery ◽  
Immunization Services ◽  
The Impact ◽  
Integrated Service

Abstract Background: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods: This study utilizes cross-sectional health facility (N= 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N= 1,479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Components Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that measuring integration as a binary variable does not (a) reflect the true variation in integration within and across health facilities, (b) enable nuanced measurement of the determinants or effects of integration, or (c) provide tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

scholarly journals Development of integration indexes to determine the extent of family planning and child immunization services integration in health facilities in urban areas of Nigeria

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Kate L. Sheahan ◽  
Jennifer Orgill-Meyer ◽  
Ilene S. Speizer ◽  
Siân Curtis ◽  
John Paul ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Urban Areas ◽  
Health Facilities ◽  
Index Score ◽  
Child Immunization ◽  
Integrated Service Delivery ◽  
Immunization Services ◽  
The Impact ◽  
Integrated Service

Abstract Background Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

scholarly journals Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

2021 ◽  
Author(s):  
Kate L. Sheahan ◽  
Jennifer Orgill-Meyer ◽  
Ilene Speizer ◽  
Siân Curtis ◽  
John Paul ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Delivery ◽  
Urban Areas ◽  
Health Facilities ◽  
Index Score ◽  
Child Immunization ◽  
Integrated Service Delivery ◽  
Immunization Services ◽  
The Impact ◽  
Integrated Service

Abstract Background Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods This study utilizes cross-sectional health facility (N= 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N= 1,479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

Towards Integrated Service Delivery for Primary Health Care: Can Programs Meet People's Lives?

2000 ◽  
Vol 6 (4) ◽  
pp. 43
Author(s):  
Vivian Lin
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Service Delivery ◽  
Health Care Policy ◽  
Unit Cost ◽  
Policy Research ◽  
Evidence Base ◽  
Integrated Service Delivery ◽  
Primary Health ◽  
Integrated Service

The primary health care sector faces a number of challenges. Some of these are in the form of persistent problems which include, inter alia, health disparities in resources and outcomes, a fragmented health system, issues of power with respect to priority setting and resource allocation, and a poor information and evidence base with which to allocate resources and evaluate outcomes. These problems are perennially accompanied by a gap between the rhetoric of policy and the reality of implementation. Neo-liberal reforms present a series of challenges to primary health, with the introduction of unit-cost funding, competitive tendering and increased user pays. Changing epidemiological patterns, the rise of evidence-based medicine, and new information and communication technology all question accepted methods of practice. Eroding community confidence in government and professionals, and the growing polarisation of society are also cause for concern. Three areas for development in primary health care policy and practice may provide the keys for dealing with these challenges. These are, first, the development of integrated service delivery models, which move away from narrowly defined single purpose programs delivered by one provider. Second, the development of innovative policy and managerial tools that support the objectives of primary health care while addressing the concerns of policy makers. Finally, the development of a strategic research and development agenda that effectively links policy, research and practice.

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