How to assess and prepare health systems in low- and middle-income countries for integration of services: a systematic review

Topp, Stephanie M., Abimbola, Seye, Joshi, Rohina, and Negin, Joel (2018) How to assess and prepare health systems in low- and middle-income countries for integration of services: a systematic review. Health Policy and Planning, 33 (2). pp. 298-312.

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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’.

Item ID: 52611
Item Type: Article (Research - C1)
ISSN: 1460-2237
Keywords: integration, health systems, health services,
Additional Information:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Funders: Australian National Heart Foundation (ANHF)
Projects and Grants: ANHF future leader fellowship APP100484
Date Deposited: 23 Feb 2018 04:32
FoR Codes: 42 HEALTH SCIENCES > 4206 Public health > 420699 Public health not elsewhere classified @ 60%
44 HUMAN SOCIETY > 4407 Policy and administration > 440706 Health policy @ 40%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920207 Health Policy Evaluation @ 50%
92 HEALTH > 9202 Health and Support Services > 920299 Health and Support Services not elsewhere classified @ 50%
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