Integration: An Effective and Efficient Global Health Approach

| April 2, 2012 | 0 Comments

Imagine addressing HIV/AIDS, malaria, and diarrhea in a single intervention.  Policymakers would be pleased at having integrated services in health plans and, more importantly, patients would receive well-rounded health care provisions.  In fact, a recent study in Kenya has done just this, proving to the global health community that this is a better approach to health interventions within a country.

The study, conducted in various locations across Kenya, looked at the cost-effectiveness of various organizations and governmental agencies simultaneously confronting HIV/AIDS, malaria, and diarrhea caused by waterborne pathogens. The distribution was quick and efficient through the use of “CarePacks,” which consisted of bed nets to reduce malaria, water filters to prevent diarrheal diseases, and condoms to reduce the spread of HIV/AIDS. The results of the study were encouraging: for every 1,000 people involved in the study, approximately $16,015 were avoided in health care costs and 16 more lives were saved. [1]

With these results in mind, these researchers revealed an innovative way to approach future global health policy issues: integration. Currently, the interdisciplinary nature of the global health field is its greatest strength, yet also a significant challenge.  Many interventions have a variety of stakeholders at work, but sometimes very little coordination with each other. And often, when coordination does occur, there is miscommunication between the policy makers and the people on the ground. For example, in Haiti recently, policy makers decided to scale back on diphtheria vaccinations without confirming with the medical responders that there was still a need for them, resulting in a severe lack of vaccinations. [2]

In 2007, the Measles Initiative reported that Measles deaths in Africa fell by 91% from 2000 to 2006.

In contrast to the separate actions that often occur, a more economical approach would be to combine the various efforts and money to tackle a wide range of problems at once.  An example of the ideal collaboration would be to have the World Health Organization (WHO) survey and determine the issues that need to be addressed, the Center for Disease Control and Prevention (CDC) evaluating the methods to distribute resources and improve the health issue, the World Bank leading the investments in the projects, and UNICEF distributing immunization. However, in order for this collaboration to be successful, the organizations must hold each other accountable.

Having representatives from each group stay in frequent contact, scheduling semi-annual conversations, and hosting inter-agency meetings can help achieve effective collaboration. The point of these meetings would not only enhance collaboration, but would encourage transparency amongst high-level policy actors by updating others on health systems strengthening efforts and health care improvements.  Such a collaborative approach is not simply idealistic thinking. The Measles Initiative, which was launched in February 2001, involved the combined effect of the United Nations Foundation channeling funds from solicited donors into the on-ground efforts of UNICEF immunizations, resulting in the vaccination of 200 million children and prevention of 1.2 million deaths. [3]

Examining integrated and cost-effective policies also raises concerns on its effects on the quality of care. Often times, programs can be spread thin to save money with little benefit to the persons the program intended to help. The policy-makers implementing the program often gain more out of a cost-effective approach than the patients receiving the care.

In broad-base policy reform, there also remains the problem of not having enough country-specific policies. In certain regions, it might be difficult to completely address the specific problems present when there are a multitude of actors at hand. In addition, factors such as the area’s accessibility, the government’s willingness to help its citizens, and even the local culture may present difficulties when trying to approach vaccination or preventative care generally.  Although these issues should be recognized, they should not be a reason for dismissing integrative care in a wide variety of settings.  The fact that policymakers and on-the-ground implementers are able to provide some type of managed care should be upheld and supported, not reprimanded. That said, for collaboration to be most effective, there needs to be a general strategy in tackling the wide and diverse range of issues. In order to provide comprehensive care, the efficacy and specific targeting of health interventions within a country cannot be compromised.


[1] University of California, San Francisco. “Combined Approach to Global Health Can Save Lives at Lower Cost”. 2/3/2012.

[2] “Continued Miscommunication Between Public Health and Medical Responders”. 4/1/2012.

[3] Centers for Disease Control and Prevention. “Global Health—Partnerships”. 1/26/2010.

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