Making Health Systems Work through Integration
February 9th, 2016 | Viewpoint
February 9th, 2016 | Viewpoint
In Kenya, through their local community health workers (CHWs), community members have access to integrated health care without having to leave their village. These CHWs, the main source of health care for rural people in Kenya, are trained to provide outreach, general family care, disease prevention, and hygiene and environmental sanitation. The CHWs enable the community to make greater use of their services because they are easy to access. Integration like this across sectors is an approach that better meets the needs of individuals, communities, and health systems around the globe. There are many possible benefits to integration in health programs, including cost-effectiveness, increased access to information and services, and more efficient and streamlined care for patients.
Integration within communities and across sectors is one way Advancing Partners & Communities (APC) is working to advance community health through two projects implemented by HealthRight Kenya in Marakwet County and World Vision Kenya in Isiolo County. These two projects are working to strengthen the integrated messages focused on maternal child health (MCH) and family planning (FP) provided by CHWs. By providing family planning information, counseling, and methods at the same time as maternal and child health services, women who have recently delivered, and are in need of FP services to improve spacing of pregnancies, are more likely to engage in FP. Additionally, when FP is integrated with child health services, women and men are able to see the connection between spacing of pregnancies and healthier children. While there is limited evidence on FP integration, the current data shows that, effective integration can lead to increased uptake of contraceptives and better health of mothers and their children. 
In Markawet, HealthRight is equipping CHWs and facility-based providers to deliver integrated MCH messages to women receiving ante- and postnatal care, and to community members through outreach events focused on child health. HealthRight’s messages focus on the health of the mother. In Isiolo, World Vision has trained CHWs, the local sub-county health team, and religious leaders in the importance of integrated FP and child health, while focusing on male engagement. Male CHWs have trained other influential male figures in the community, including chiefs and elders, to discuss the taboo subject of contraceptives and pregnancy with high school students and the community at large. Men are encouraged to participate in antenatal and FP counseling, in which they receive positive advice on the use of contraceptives and FP. Through these conversations, men are better able to understand the positive impact that World Vision’s integrated messages of healthy timing and spacing of pregnancies has on their communities. While HealthRight and World Vision deliver slightly different integrated messages, they both have seen an increased use of FP services, more services at the facility level, and a higher engagement of men in family health care.
APC seeks to strengthen health services by supporting strategies and policies that create an integrated and effective system of CHWs. Through our partners, APC is working to strengthen the capacity of CHWs, the community health system, and the links between the community and an effective health care system. With strengthened community-level human resources, effective integrated messaging, and national-level coordination, communities will be able to access the health services they need.
Written by Hannah Foehringer Merchant
 Ringheim, K., Gribble, J., Foreman, M. 2011. Integrating family planning and maternal and child health care: saving lives money and time. PRB Policy Brief.
 FHI 360/PROGRESS Project. Integrating Family Planning into Other Development Sectors. Durham, NC: FHI 360,2013.
 Sebert Kuhlmann, A, Gavin, L., Galavotti, C. 2010. The integration of family planning with other health services: A literature review. International Perspectives on Sexual and Reproductive Health, Volume 36,Number 4.