How to assess and prepare health systems in low- and middle-income countries for integration of services-a systematic review
Open accessAbstract
Despite growing support for integration of frontline services, a lack of information about the pre-conditions necessary to integrate such services hampers the ability of policy makers and implementers to assess how feasible or worthwhile integration may be, especially in low- and middle-income countries (LMICs). We adopted a modified systematic review with aspects of realist review, including quantitative and qualitative studies that incorporated assessment of health system preparedness for and capacity to implement integrated services. We searched Medline via Ovid, Web of Science and the Cochrane library using terms adapted from Dudley and Garner's systematic review on integration in LMICs. From an initial list of 10 550 articles, 206 were selected for full-text review by two reviewers who independently reviewed articles and inductively extracted and synthesized themes related to health system preparedness. We identified five 'context' related categories and four health system 'capability' themes. The contextual enabling and constraining factors for frontline service integration were: (1) the organizational framework of frontline services, (2) health care worker preparedness, (3) community and client preparedness, (4) upstream logistics and (5) policy and governance issues. The intersecting health system capabilities identified were the need for: (1) sufficiently functional frontline health services, (2) sufficiently trained and motivated health care workers, (3) availability of technical tools and equipment suitable to facilitate integrated frontline services and (4) appropriately devolved authority and decision-making processes to enable frontline managers and staff to adapt integration to local circumstances. Moving beyond claims that integration is defined differently by different programs and thus unsuitable for comparison, this review demonstrates that synthesis is possible. It presents a common set of contextual factors and health system capabilities necessary for successful service integration which may be considered indicators of preparedness and could form the basis for an 'integration preparedness tool'.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
At present, health systems worldwide are poorly organized to respond to the needs of people with NCDs and other long-term conditions, as they were mainly developed to respond to people in need of urgent or episodic care, usually with single health conditions.
“At present, health systems worldwide are poorly organized to respond to the needs of people with NCDs and other long-term conditions, as they were mainly developed to respond to people in need of urgent or episodic care, usually with single health conditions 17 .”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [17]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Realist review - a new method of systematic review designed for complex policy interventions
Pawson, R., Greenhalgh, T., Harvey, G., & Walshe, K. (2005) · Journal of Health Services Research & Policy · doi:10.1258/1355819054308530 · Cited by 3,190 · see citing works
RAMESES publication standards: realist syntheses
Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013) · BMC Medicine · doi:10.1186/1741-7015-11-21 · Cited by 1,374 · see citing works
Walsh, J. A., & Warren, K. S. (1979) · New England Journal of Medicine · doi:10.1056/nejm197911013011804 · Cited by 1,037 · see citing works
Jacobs, B., Ir, P., Bigdeli, M., Annear, P. L., & Damme, W. V. (2011) · Health Policy and Planning · doi:10.1093/heapol/czr038 · Cited by 553 · see citing works
RAMESES publication standards: realist syntheses
Wong, G., Greenhalgh, T., Westhorp, G., Buckingham, J., & Pawson, R. (2013) · Journal of Advanced Nursing · doi:10.1111/jan.12095 · Cited by 385 · see citing works
Grand challenges: integrating mental health services into priority health care platforms
Patel, V., Belkin, G. S., Chockalingam, A., Cooper, J., Saxena, S., & Unützer, J. (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001448 · Cited by 356 · see citing works
Hanlon, C., Luitel, N. P., Kathree, T., Murhar, V., Shrivasta, S., Medhin, G., Ssebunnya, J., Fekadu, A., Shidhaye, R., Petersen, I., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0088437 · Cited by 339 · cited 20× · see citing works
“…et al. 2012 Liambila et al. 2009 Chaudhary et al. 2005 Shelley et al. 2014 Kouam et al. 2014 Green et al. 2010 Sarnquist et al. 2014 Wright et al. 2014 Hanlon et al. 2014 Li et al. 2012 Kalyango et al. 2012 Smit et al. 2012 Schaan et al. 2012 Awadhi et al. 2012 Winestone et al. 2012…”
BackgroundInfluentialRedefining global health-care delivery
Kim, J. Y., Farmer, P., & Porter, M. E. (2013) · The Lancet · doi:10.1016/s0140-6736(13)61047-8 · Cited by 323 · see citing works
Health systems, systems thinking and innovation
Atun, R. A. (2012) · Health Policy and Planning · doi:10.1093/heapol/czs088 · Cited by 253 · see citing works
Atun, R. A., de Jongh, T. E., Secci, F., Ohiri, K., & Adeyi, O. (2009) · Health Policy and Planning · doi:10.1093/heapol/czp053 · Cited by 227 · see citing works
Grand challenges in global mental health: integration in research, policy, and practice
Collins, P. Y., Insel, T. R., Chockalingam, A., Daar, A., & Maddox, Y. T. (2013) · PLoS Medicine · doi:10.1371/journal.pmed.1001434 · Cited by 220 · see citing works
Dudley, L., & Garner, P. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003318.pub3 · Cited by 165 · see citing works
Integrating tuberculosis and HIV services in low‐ and middle‐income countries: a systematic review
Legido‐Quigley, H., Montgomery, C. M., Khan, P. Y., Atun, R. A., Fakoya, A. O., Getahun, H., & Grant, A. D. (2012) · Tropical Medicine & International Health · doi:10.1111/tmi.12029 · Cited by 140 · see citing works
Screening of patients with tuberculosis for diabetes mellitus in China
Li, L., Lin, Y., Mi, F., Tan, S., Liang, B., Guo, C., Shi, L., Liu, L., Gong, F., Li, Y., et al. (2012) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2012.03068.x · Cited by 139 · see citing works
Unger, J., Paepe, P. D., & Green, A. (2003) · The International Journal of Health Planning and Management · doi:10.1002/hpm.723 · Cited by 124 · see citing works
Health systems, communicable diseases and integration
Shigayeva, A., Atun, R. A., McKee, M., & Coker, R. (2010) · Health Policy and Planning · doi:10.1093/heapol/czq060 · Cited by 119 · see citing works
Strengthening primary care: addressing the disparity between vertical and horizontal investment
Maeseneer, J. D., van Weel, C., Egilman, D. S., Mfenyana, K., Kaufman, A., & Sewankambo, N. K. (2007) · British Journal of General Practice · doi:10.3399/bjgp08x263721 · Cited by 113 · see citing works
Watt, N. F., Sigfrid, L., Legido‐Quigley, H., Hogarth, S., Maimaris, W., Otero‐García, L., Perel, P., Buse, K., McKee, M., Piot, P. K., et al. (2016) · Health Policy and Planning · doi:10.1093/heapol/czw149 · Cited by 107 · see citing works
Chan, A. K., Mateyu, G., Jahn, A., Schouten, E. J., Arora, P., Mlotha, W., Kambanji, M., & van Lettow, M. (2010) · Tropical Medicine & International Health · doi:10.1111/j.1365-3156.2010.02503.x · Cited by 102 · see citing works
Hermans, S., Castelnuovo, B., Katabira, C., et al. (2012) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e318251aeb4 · Cited by 92 · see citing works
Health care reforms and developing countries—a critical overview
Sen, K., & Koivusalo, M. T. (1998) · The International Journal of Health Planning and Management · doi:10.1002/(sici)1099-1751(1998070)13:3 · Cited by 84 · see citing works
Scaling Up Integrated Community Case Management of Childhood Illness: Update from Malawi
Nsona, H., Mtimuni, A., Daelmans, B. M. E. G., et al. (2012) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2012.11-0759 · Cited by 83 · see citing works
Abera, M., Tesfaye, M., Belachew, T., & Hanlon, C. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-113 · Cited by 81 · see citing works
Bagonza, J., Kibira, S. P. S., & Rutebemberwa, E. (2014) · Malaria Journal · doi:10.1186/1475-2875-13-367 · Cited by 76 · see citing works
Reporting guidelines for implementation and operational research
Hales, S., Lesher-Treviño, A., Ford, N. P., Maher, D., Ramsay, A., & Tran, N. T. (2015) · Bulletin of the World Health Organization · doi:10.2471/blt.15.167585 · Cited by 76 · see citing works
Kerschberger, B., Hilderbrand, K., Boulle, A., et al. (2012) · PLoS ONE · doi:10.1371/journal.pone.0046988 · Cited by 62 · see citing works
Cost, cost-efficiency and cost-effectiveness of integrated family planning and HIV services
Shade, S. B., Kevany, S., Onono, M. A., et al. (2013) · AIDS · doi:10.1097/qad.0000000000000038 · Cited by 62 · see citing works
Integration of STI services into FP/MCH Services: Health service and social contexts in rural Ghana
Mayhew, S. (2000) · Reproductive Health Matters · doi:10.1016/s0968-8080(00)90193-9 · Cited by 56 · see citing works
Sodhi, S. K., Banda, H., Kathyola, D., Joshua, M., Richardson, F., Mah, E., MacGregor, H., Kanike, E., Thompson, S., Fairall, L. R., et al. (2014) · BMC Health Services Research · doi:10.1186/1472-6963-14-s1-s8 · Cited by 56 · see citing works
Topp, S. M., Chipukuma, J. M., Chiko, M. M., Matongo, E. M., Bolton‐Moore, C., & Reid, S. E. (2012) · Health Policy and Planning · doi:10.1093/heapol/czs065 · Cited by 54 · see citing works
Self-citationGrépin, K. A., & Reich, M. R. (2008) · PLoS neglected tropical diseases · doi:10.1371/journal.pntd.0000174 · Cited by 51 · see citing works
Reporting guidelines for implementation and operational research
Maher, D. (2016) · Public Health Action · doi:10.5588/pha.16.0018 · Cited by 49 · see citing works
Harrington, E. K., Newmann, S. J., Onono, M. A., et al. (2012) · Infectious Diseases in Obstetrics and Gynecology · doi:10.1155/2012/809682 · Cited by 44 · see citing works
Kouam, C. E., Delisle, H. F., Ebbing, H. J., Israël, A., Salpéteur, C., Aïssa, M. A., & Ridde, V. (2014) · Nutrition Journal · doi:10.1186/1475-2891-13-22 · Cited by 44 · see citing works
Munkhuu, B., Liabsuetrakul, T., Chongsuvivatwong, V., McNeil, E. B., & Janchiv, R. (2009) · Sexually Transmitted Diseases · doi:10.1097/olq.0b013e3181bc0960 · Cited by 41 · see citing works
Benchmarks to measure readiness to integrate and scale up newborn survival interventions
Moran, A. C., Kerber, K. J., Pfitzer, A., Morrissey, C. S., Marsh, D. R., Oot, D., Sitrin, D., Guenther, T., Gamache, N., Lawn, J. E., et al. (2012) · Health Policy and Planning · doi:10.1093/heapol/czs046 · Cited by 41 · see citing works
Horizontal and vertical delivery of health services : what are the trade offs
Msuya, J. (2003) · Cited by 40 · see citing works
Sweeney, S., Obure, C. D., Terris‐Prestholt, F., et al. (2014) · Human Resources for Health · doi:10.1186/1478-4491-12-42 · Cited by 36 · see citing works
Evaluation of health care delivery integration: The case of the Russian Federation
Sheiman, I., & Shevski, V. (2014) · Health Policy · doi:10.1016/j.healthpol.2013.12.011 · Cited by 33 · see citing works
Mitashi, P., Hasker, E. C., Mbo, F., Geertruyden, J. V., Kaswa, M. K., Lumbala, C., Boelaert, M., & Lutumba, P. T. (2014) · Tropical Medicine & International Health · doi:10.1111/tmi.12404 · Cited by 33 · see citing works
Using mobile clinics to deliver HIV testing and other basic health services in rural Malawi
Lindgren, T. G., Deutsch, K., Schell, E. S., et al. (2011) · Rural and Remote Health · doi:10.22605/rrh1682 · Cited by 33 · see citing works
Introduction of Newborn Care within Integrated Community Case Management in Uganda
Nalwadda, C. K., Sengendo, H. N., Ssekitooleko, J., et al. (2012) · American Journal of Tropical Medicine and Hygiene · doi:10.4269/ajtmh.2012.12-0133 · Cited by 32 · see citing works
Shayo, E. H., Mboera, L. E. G., & Blystad, A. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-273 · Cited by 31 · see citing works
Integrated management of childhood illness (IMCI) follow-up of basic health workers
Chaudhary, N., Mohanty, P. N., & Sharma, M. (2005) · The Indian Journal of Pediatrics · doi:10.1007/bf02734143 · Cited by 30 · see citing works
Thompson, M. E., & Harutyunyan, T. L. (2009) · Health Policy and Planning · doi:10.1093/heapol/czn048 · Cited by 30 · see citing works
Nansera, D., Bajunirwe, F., Kabakyenga, J. K., et al. (2010) · African Health Sciences · Cited by 29 · see citing works
Uwimana, J. B., & Jackson, D. J. (2013) · The International Journal of Tuberculosis and Lung Disease · doi:10.5588/ijtld.12.0068 · Cited by 26 · see citing works
Njozing, B. N., Edin, K. E., Sebastiån, M. S., et al. (2011) · BMC Health Services Research · doi:10.1186/1472-6963-11-328 · Cited by 24 · see citing works
Vijayaraghavan, M., Wallace, A. S., Mirza, I. R., et al. (2012) · The Journal of Infectious Diseases · doi:10.1093/infdis/jir772 · Cited by 22 · see citing works
Birdthistle, I. J., Mayhew, S., Kikuvi, J., et al. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-003715 · Cited by 22 · see citing works
Ku, G. M., & Kegels, G. (2014) · Global Health Action · doi:10.3402/gha.v7.25286 · Cited by 22 · see citing works
Shelley, D., Nguyen, L., Pham, H. M., VanDevanter, N., & Nguyen, N. T. (2014) · BMC Health Services Research · doi:10.1186/s12913-014-0606-1 · Cited by 21 · see citing works
Mugala, N., Mutale, W., Kalesha, P., et al. (2010) · BMC Pediatrics · doi:10.1186/1471-2431-10-93 · Cited by 19 · see citing works
Sibiya, M., & Grainger, L. (2007) · Curationis · doi:10.4102/curationis.v30i1.1050 · Cited by 18 · see citing works
Wallace, A. S., Kimambo, S., Lyimo, D., et al. (2013) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000000078 · Cited by 15 · see citing works
Byamungu, D. C., & Ogbeiwi, O. I. (2003) · Leprosy Review · doi:10.47276/lr.74.1.68 · Cited by 12 · see citing works
Primary health care or selective health strategies
Barker, C., & Turshen, M. (1986) · Review of African Political Economy · doi:10.1080/03056248608703689 · Cited by 12 · see citing works
Integrated response toward HIV: a health promotion case study from China
Jiang, Z., Wang, D., Yang, S., et al. (2010) · Health Promotion International · doi:10.1093/heapro/daq044 · Cited by 11 · see citing works
Onozaki, I., & Shakya, T. M. (1995) · Tubercle and Lung Disease · doi:10.1016/0962-8479(95)90582-0 · Cited by 7 · see citing works
Lafort, Y., Sawadogo, Y., Delvaux, T., Vuylsteke, B., & Laga, M. (2003) · Tropical Medicine & International Health · doi:10.1046/j.1365-3156.2003.01065.x · Cited by 6 · see citing works
Health care reforms in developing countries
MILLS, A. J. (1998) · Cited by 3 · see citing works
Hausner, D. S., Kulsharova, M., Seledtsov, V., et al. (2007) · Global Public Health · doi:10.1080/17441690601044265 · Cited by 2 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Thornicroft, G., Ahuja, S., Barber, S., Chisholm, D., Collins, P. Y., Docrat, S., Fairall, L., Lempp, H., Niaz, U., Ngo, V., et al. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30298-0 · Cited by 138 · see citing works
- Authors
- Topp, S. M., Abimbola, S., Joshi, R., & Negin, J.
- Affiliations
- The University of Melbourne (AU)
- Sydney School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
- The University of Sydney (AU)
- Corresponding author
- Topp, Stephanie M
- Venue
- Health Policy and Planning
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-12-18
- Volume
- 33
- Issue
- 2
- Pages
- 298-312
- ISSN
- 0268-1080 (ISSN-L)
- 1460-2237
- PMC
- PMC5886169
- OpenAlex
- W2776121737
- Cited by
- 60
- References
- 62
- Citations by year
- 2026: 5 · 2024: 7 · 2023: 4 · 2022: 9 · 2021: 16 · 2020: 11 · 2019: 5 · 2018: 3
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Health Policy and Planning (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- ResearchOnline at James Cook University (James Cook University) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
- Keywords
- integrated care, health system preparedness, low- and middle-income countries, healthcare logistics, devolution of decision-making
- MeSH terms
- Administrative Personnel, Community Health Workers, Delivery of Health Care, Developing Countries, Government Programs, Humans, Poverty, Capacity Building
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
