The integration of the Primary Health Care Services: a systematic literature review

The international debate has been shaped by the legacy in many countries of strong donor-driven vertical programmes that aim to target one or a few selected health problems, leaving other problems that are perhaps seen as more intractable, unaddressed. Thus much of the debate has focused on whether or not it is a good idea to extend the range of services offered by pre-existing vertical programmes such as contraceptive services/family planning (FP). In recent years, considerable donor and political support has been targeted at stemming the HIV/AIDS epidemic.

Correspondingly the focus of the integration debate has shifted to consider the expansion of FP and MCH services to include services of relevance to the prevention of HIV, such as treatment of STDs, education campaigns and condom provision.

Proponents of integration promise that integrated programmes reach more people in ways that are easier for the users than vertical or specialised services,save money because of less wastage and duplication and are more ethical.Those who do not favour integration claim that specialised programmes offer better quality of care and have a greater public health impact than integrated programmes which can be too unfocussed and are harder to implement properly. Integration is also seen as a continuum,where a purely vertical programme and a multi-purpose service are at opposite ends, but between them is a range of options for partial integration, such as programmes which offer a core package of priority services rather than the full range of PHC, perhaps including interventions by sectors other than health.

Unlike other countries in the developing world, South Africa does not have strong donor driven vertical programmes. Nonetheless, the legacy of fragmentation and duplication of services mean that the promises of integration are attractive. As in the 1990s in South Africa, considerable effort is being expended on restructuring health services, with the political will to restructure in ways that promote equity, integration has perhaps been seen as something of a panacea. The purpose of this review is to provide a summary of the lessons learned from other countries about integration, how it can be achieved, and what are the different forms and models of integrated services.

Previous reviews have focused on integration as it applies to one or two services only, or have been general discussion articles without clear inclusion criteria for the studies under review. As there is no comprehensive review of integration of services, we conducted a systematic review of the published literature.