An Exploration of Integration: The next post in our GHI blog series

A Guest Post by Janie Hayes, Communications Officer, Rotavirus Vaccine Program, PATH

In Washington, DC, integration is in the air. It is a centerpiece of the President’s Global Health Initiative (GHI) and a common theme in congressional deliberations on foreign assistance reform.  Integration is receiving so much attention for simple reasons: the need to find efficiencies and increase impact.

But what does integration mean?  The answer can vary by context.  For global health it means looking at the critical underlying factors that contribute to good health, such as improved nutrition and access to safe water.  It can also refer to the continuum of care across a lifetime, or multiple services at a single location. For mothers and their newborns, for example, integrated services can include family planning; voluntary counseling and testing for HIV; the prevention of mother-to-child transmission of HIV; safe delivery; emergency obstetric care; postnatal care; immunizations and other newborn care; and attention to nutrition, including exclusive breastfeeding for the first six months. Integration may also refer to multiple levels of service, from the large district hospital to the hard-to-reach village clinic.

All of these options will require innovative approaches.  New metrics to monitor the outcomes of integrated services, for example.  Increased training for healthcare workers with new responsibilities. Donor coordination to harmonize reporting requirements.

All will also require the engagement of local communities to identify the best ways to ensure the initiatives succeed in local contexts.

One example comes from the small, dusty market town of Bungoma in Western Province, Kenya.  Bungoma might not seem the likeliest incubator for global health integration.  But there in the Webuye District clinic, community workers and the handful of maxed-out staff that run the clinic have been forced to think creatively about how to help the lines of mothers who appear each morning with sick children, filling the yards and forming a snaking line that spills beyond the premises.

Many of the children who come to Webuye have common ailments, like diarrhea – which can be treated simply if caught in time but can turn into a deadly danger if not. Years ago, Webuye had a dedicated ORT (oral rehydration therapy) corner – a small space with table and chairs where mothers would triage from the line to feed their children a simple sugar-and-salt-and-water mixture until they were well enough to go home.

According to hospital staff, when a large increase of outside funding for specific diseases made its way into Kenya and eventually to Webuye, the furniture from the ORT corner was transferred to a new Voluntary Counseling and Testing center — and children with diarrhea once again had to wait for hours to get help.  In the past few months, though, the ORT corner has returned, and is now located in the clinic near the VCT center. The program that has supported the ORT corner revival, implemented by PATH, has paired with a USAID-funded HIV/AIDS program in Western Province called the AIDS, Population and Health Integrated Assistance (APHIA II) Project. APHIA II is one of the great examples of how the U.S. government has learned how to expand its support for integrated approaches.  The project promotes healthier behaviors, including increased use of services for HIV/AIDS and tuberculosis and expanded use of services for family planning, maternal and child health, and malaria prevention. The diarrheal disease initiative has leveraged expertise and infrastructure support from APHIA II to help expand its focus on child survival.

Even more important than program structure, the ORT corners provide a forum for integrated education at the point of contact directly for mothers. Because mothers usually spend several hours in an ORT corner, the nurses are able to share education not only about ORT, but about other treatment and prevention methods for diarrhea. They provide information on water purification and sanitation, hygiene, nutrition, zinc, and vaccines. It sounds simple; yet strangely, this prevention and treatment education on the most common child ailments is rarely provided to mothers in a comprehensive way. It may be one reason why diarrhea remains the top killers of children in the world.  Integrated education, as well as integrated delivery of services, may be one solution for saving more lives by doing things just a little bit differently.

Many excellent examples of successful integrated programs abound within global health today.  Like the hospital staff in Webuye, there are experts in cities, towns and villages around the world who can help us find them. And we must. Millions of lives depend on it.

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