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More than 13.5 billion COVID-19 vaccine doses were delivered between 2021 and 2023 through a mix of delivery platforms, with mass vaccination campaigns being the main approach. In 2022, with the continued circulation of SARS-CoV2 and the need for periodic boosters being most likely, countries were required to plan for more sustainable approaches to provide COVID-19 vaccinations. In this context of uncertainty, a global tool for integrating COVID-19 vaccines into immunization programs and as part of broader health systems was published jointly by the WHO and UNICEF to respond to country needs. This paper summarizes the approach to, and lessons learned during, the development of a global guidance document and describes some examples of its early use in low- and middle-income countries (LMICs). The guidance leveraged existing health system frameworks, proposed four steps for planning and implementing the COVID-19 vaccination integration journey, and identified investment areas. The development process maximized robust global stakeholder and country engagement, and the timeframe was aligned with donor funding windows to support countries with the integration of COVID-19 vaccination. The rapid dissemination of the guidance document allowed countries to ascertain their readiness for integrating COVID-19 vaccination and inform the development of national plans and funding applications. While progress has been made in specific areas (e.g., optimizing cold chain and logistics leveraging COVID-19 vaccination), in the context of decreasing demand for COVID-19 vaccines, reaching adult COVID-19 vaccine high-priority-use groups and engaging and coordinating with other health programs (beyond immunization) remain challenges, particularly in LMICs. We share the learning that despite the uncertainties of a pandemic, guidance documents can be developed and used within a short timeframe. Working in partnership with stakeholders within and beyond immunization towards a common objective is powerful and can allow progress to be made in terms of integrating health services and better preparing for future pandemics. [ABSTRACT FROM AUTHOR]

Background: Integrated health service, called Posyandu, is one of the efforts by the Indonesian Government to improve the health quality of older people. However, its utilization is not optimal. Thus, factors related to it warrant investigation. Objective: This study aimed to identify factors related to the utilization of integrated health services for older people. Methods: This study employed a cross-sectional design among 173 older people aged ≥ 60 registered as members of integrated health services in two areas in Kendari City, Southeast Sulawesi, Indonesia. Convenience sampling was applied, and data were collected from January to March 2022. Result: There was a significant relationship between the older people’s perception (AOR = 2.40; CI = 1.14-5.03; p = 0.018), family support (AOR = 2.73; CI = 1.23-6.02; p = 0.028), and cadres’ role (AOR = 3.62; CI = 1.59-8.21; p = 0.011) with the use of integrated health services. Otherwise, treatment-seeking showed no relation with the utilization of integrated health services (AOR = 1.68; CI = 0.74-3.82; p = 0.094). Conclusion: The significant factors revealed in this study can be used to improve the utilization of integrated health services for older people in the community. Education to change the perception of older people is needed, and family support and cadres’ roles should be advanced to improve healthcare visits in order to increase health quality.

Female genital schistosomiasis (FGS) is a chronic manifestation of schistosomiasis, usually caused by Schistosoma haematobium infection, which can be responsible for infertility, ectopic pregnancy, and abortion, and is associated with an increased prevalence of HIV infection. No screening programs are currently recommended for FGS. Colposcopy, the conventionally suggested diagnostic tool for FGS, is also considered a crucial screening tool for cervical cancer (CC). We performed an experimental screening via colposcopy for FGS at primary healthcare centers (PHCCs) in the Boeny region of Madagascar, allowing for the detection of patients with both FGS signs and HPV-related dysplasia (HPV-dy). All suspected FGS cases were treated with praziquantel on the day of colposcopy, and all images of suspected CC or HPV-dy were re-assessed by a gynecologist and, if needed, patients were then provided with additional colposcopy for histologic diagnosis and treatment. We describe three cases of FGS and HPV-related precancerous lesions detected during the project, discussing the state of art of the relationship between CC, FGS and HPV and the real-life challenges encountered in terms of both patient compliance and the diagnostic and treatment cascade. Despite the current diagnostic limitations, a screening for FGS via colposcopy may contribute to the early identification of CC or precancerous lesions. The addition of visual inspection with acetic acid (VIA) during colposcopy for FGS screening could improve its impact on CC screening. In addition, although there is limited evidence of the effectiveness of praziquantel in FGS, treatment should in any case be proposed for suspicious lesions, given its safety and ease of administration. The benefit of combined screening could be maximised by increasing the availability of good quality services and improve awareness of both diseases among women

More than 13.5 billion COVID-19 vaccine doses were delivered between 2021 and 2023 through a mix of delivery platforms, with mass vaccination campaigns being the main approach. In 2022, with the continued circulation of SARS-CoV2 and the need for periodic boosters being most likely, countries were required to plan for more sustainable approaches to provide COVID-19 vaccinations. In this context of uncertainty, a global tool for integrating COVID-19 vaccines into immunization programs and as part of broader health systems was published jointly by the WHO and UNICEF to respond to country needs. This paper summarizes the approach to, and lessons learned during, the development of a global guidance document and describes some examples of its early use in low- and middle-income countries (LMICs). The guidance leveraged existing health system frameworks, proposed four steps for planning and implementing the COVID-19 vaccination integration journey, and identified investment areas. The development process maximized robust global stakeholder and country engagement, and the timeframe was aligned with donor funding windows to support countries with the integration of COVID-19 vaccination. The rapid dissemination of the guidance document allowed countries to ascertain their readiness for integrating COVID-19 vaccination and inform the development of national plans and funding applications. While progress has been made in specific areas (e.g., optimizing cold chain and logistics leveraging COVID-19 vaccination), in the context of decreasing demand for COVID-19 vaccines, reaching adult COVID-19 vaccine high-priority-use groups and engaging and coordinating with other health programs (beyond immunization) remain challenges, particularly in LMICs. We share the learning that despite the uncertainties of a pandemic, guidance documents can be developed and used within a short timeframe. Working in partnership with stakeholders within and beyond immunization towards a common objective is powerful and can allow progress to be made in terms of integrating health services and better preparing for future pandemics.

Integrating nutrition interventions into antenatal care (ANC) requires adapting global recommendations to fit existing health systems and local contexts, but the evidence is limited on the process of tailoring nutrition interventions for health programmes. We developed and integrated maternal nutrition interventions into ANC programmes in Bangladesh, Burkina Faso, Ethiopia and India by conducting studies and assessments, developing new tools and processes and field testing integrated programme models. This paper elucidates how we used information and data to contextualize a package of globally recommended maternal nutrition interventions (micronutrient supplementation, weight gain monitoring, dietary counselling and counselling on breastfeeding) and describes four country‐specific health service delivery models. We developed a Theory of Change to illustrate common barriers and strategies for strengthening nutrition interventions during ANC. We used multiple information sources including situational assessments, formative research, piloting and pretesting results, supply assessments, stakeholder meetings, household and service provider surveys and monitoring data to design models of maternal nutrition interventions. We developed detailed protocols for implementing maternal nutrition interventions; reinforced staff capacity, nutrition counselling, monitoring systems and community engagement processes; and addressed micronutrient supplement supply bottlenecks. Community‐level activities were essential for complementing facility‐based services. Routine monitoring data, rapid assessments and information from intensified supervision were important during the early stages of implementation to improve the feasibility and scalability of models. The lessons from addressing maternal nutrition in ANC may serve as a guide for tackling missed opportunities for nutrition within health services in other contexts. Key messages: Integrating evidence‐based nutrition interventions into ANC to reach PW at scale is urgently needed for improving maternal and newborn health and nutrition.The Theory of Change and steps for strengthening nutrition interventions based on four‐country experiences provide practical guidance on addressing missed opportunities for nutrition in ANC.Strategic use of data can contextualize global maternal nutrition guidelines, protocols, capacity building and supervision approaches, and improve micronutrient supply chains and record‐keeping as part of health services strengthening.Engaging family and community members to support PW and improving the knowledge and self‐confidence of PW are important elements of all country programme models. [ABSTRACT FROM AUTHOR]

Background: The uptake of modern contraceptive methods (MCMs) remains low, with 25% of women reporting their use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitate the integration of family planning (FP) with maternal, newborn, and child health (MNCH) services. Objective: The main aim of this study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCMs in rural Pakistan. Moreover, we aim to measure the level of effectiveness of interventions regarding the uptake of MCMs. Methods: A quasi-experimental, sequential, mixed methods study design with pre- and postevaluation will be adopted to evaluate the impact of integration of FP with MNCH services. The interventions include the following: (1) capacity strengthening of health care providers, including technical trainings; training in counseling of women who attend immunization centers, antenatal care (ANC) clinics, and postnatal care (PNC) clinics; and provision of job aids; (2) counseling of women and girls attending ANC, PNC, and pediatric clinics; (3) ensuring sustained provision of supplies and commodities; (4) community engagement, including establishing adolescent-friendly spaces; and (5) use of District Health Information System data in decision-making. Descriptive statistics will be used to estimate prevalence (ie, proportions) and frequencies of outcome indicators. A univariate difference-in-difference analytical approach will be used to estimate the effect of the interventions. In addition, a Blinder-Oaxaca decomposition analysis will be conducted to identify and quantify determinants of the modern contraceptive prevalence rate. Results: The intervention phase began in July 2021 and will run until June 2022. The impact assessment will be conducted from July to September 2022. Conclusions: This project will evaluate the impact of integrating FP with MNCH services. Furthermore, this study will identify the drivers and barriers in uptake of MCMs and will simultaneously help in modifying the interventional strategies that can be scaled up through existing service delivery platforms within the public and private sectors, according to the local sociocultural and health system context. [ABSTRACT FROM AUTHOR]

Introduction: Team-based care can improve integrated health services by increasing comprehensiveness and continuity of care in primary healthcare (PHC) settings. Collaborative models involving providers from different professions can help to achieve coordinated, high-quality person-centred care. In Canada, there has been variation in both the timing/pace of adoption and approach to interprofessional PHC (IPHC) policy. Provinces are at different stages in the development, implementation, and evaluation of team-based PHC models. This paper describes how different policies, contexts, and innovations across four Canadian provinces (British Columbia, Alberta, Ontario, Quebec) facilitate or limit integrated health services through IPHC teams. Methods: Systematic searches identified 100 policy documents across the four provinces. Analysis was informed by Walt and Gilson’s Policy Triangle (2008) and Suter et al.’s (2009) health system integration principles. Provincial policy case studies were constructed and used to complete a cross-case comparison. Results: Each province implemented variations of an IPHC based model. Five key components were found that influenced IPHC and integrated health services: patient-centred care; team structures; information systems; financial management; and performance measurement. Conclusion: Heterogeneity of the implementation of PHC teams across Canadian provinces provides an opportunity to learn and improve interprofessional care and integrated health services across jurisdictions.

Introduction: Team-based care can improve integrated health services by increasing comprehensiveness and continuity of care in primary healthcare (PHC) settings. Collaborative models involving providers from different professions can help to achieve coordinated, high-quality person-centred care. In Canada, there has been variation in both the timing/pace of adoption and approach to interprofessional PHC (IPHC) policy. Provinces are at different stages in the development, implementation, and evaluation of team-based PHC models. This paper describes how different policies, contexts, and innovations across four Canadian provinces (British Columbia, Alberta, Ontario, Quebec) facilitate or limit integrated health services through IPHC teams. Methods: Systematic searches identified 100 policy documents across the four provinces. Analysis was informed by Walt and Gilson's Policy Triangle (2008) and Suter et al.'s (2009) health system integration principles. Provincial policy case studies were constructed and used to complete a cross-case comparison. Results: Each province implemented variations of an IPHC based model. Five key components were found that influenced IPHC and integrated health services: patientcentred care; team structures; information systems; financial management; and performance measurement. Conclusion: Heterogeneity of the implementation of PHC teams across Canadian provinces provides an opportunity to learn and improve interprofessional care and integrated health services across jurisdictions. [ABSTRACT FROM AUTHOR]

Background: Providing at-risk communities with uninterrupted access to early diagnosis and treatment is a key component in reducing malaria transmission and achieving elimination. As programmes approach malaria elimination targets it is critical that each case is tested and treated early, which may present a challenge when the burden of malaria is reduced. In this paper we investigate whether malaria testing rates decline over time and assess the impacts of integrating malaria and non-malaria services on testing rates in the malaria elimination task force (METF) programme in the Kayin state of Myanmar.Methods: A retrospective analysis was conducted using weekly collected data on testing rates from a network of more than 1200 malaria posts during the period from 2014 to 2020. To determine whether monthly testing rates changed over the years of programme operations, and whether integrating malaria and non-malaria services impacted these testing rates, we fitted negative binomial mixed-effects regression models to aggregate monthly data, accounting for malaria seasonal variation.Results: In the first year of malaria post operation, testing rates declined, correlating with a decline in attendance by people from outside the malaria post catchment area, but then remained fairly constant (the Rate Ratio (RR) for 2nd versus 1st year open ranged from 0.68 to 0.84 across the four townships included in the analysis, the RR for 3rd to 6th year versus 1st year open were similar, ranging from 0.59-0.78). The implementation of a training programme, which was intended to expand the role of the malaria post workers, had minimal impact on testing rates up to 24 months after training was delivered (RR for integrated versus malaria-only services ranged from 1.00 to 1.07 across METF townships).Conclusion: Despite the decline in malaria incidence from 2014 to 2020, there has been no decline in the malaria testing rate in the METF programme after the establishment of the complete malaria post network in 2016. While the integration of malaria posts with other health services provides benefits to the population, our evaluation questions the necessity of integrated services in maintaining malaria testing rates in areas approaching elimination of malaria. [ABSTRACT FROM AUTHOR]

Abstract Background The need for specific services for young people is being widely recognized to address their unique and complex health needs. Growing evidence in integrated health services shows promise in improving the efficiency of health systems. Although there is a broad agreement on the need for integrated care in young people, there has been no systematic effort to evaluate the provision of integrated out-of-hospital health services for this group. The proposed systematic review aims to assess the effectiveness, feasibility, and acceptability of young people-specific integrated out-of-hospital services. Methods We will search the following databases using a systematic search strategy: MEDLINE, EMBASE, CINAHL Plus, and CENTRAL for articles published in the English language without applying date filters. The search will be supplemented with article search from systematic reviews of relevant topics, reference lists, and citations of included studies. Eligible studies will include peer-reviewed publications reporting on the evaluation of integrated out-of-hospital health services for young people (10–24 years) regarding effectiveness, feasibility, and acceptability. Two reviewers (AP and AA) will independently carry out study selection, data extraction, and quality assessment. Study findings will be summarized in a narrative review. Wherever possible, evidence synthesis of quantitative data will be done using forest plots and pooled estimates. Discussion This review aims to provide comprehensive evidence regarding young people-specific integrated out-of-hospital health services. Such rigorously evaluated evidence will be useful for policy makers and health professionals to design and select health services for this group. This review will also identify any evidence gaps in young people-specific integrated health services evaluation. Systematic review registration PROSPERO CRD42017068836

Abstract Background HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes in sub-Saharan Africa yet testing coverage for conditions other than HIV is low. Availing point-of-care tests (POCTs) at rural antenatal health facilities (dispensaries) has the potential to improve access and timely treatment. Fundamental to the adoption of and adherence to new diagnostic approaches are healthcare workers’ and pregnant women’s (end-users) buy-in. A qualitative approach was used to capture end-users’ experiences of using POCTs for HIV, syphilis, malaria and anaemia to assess the appropriateness, acceptability and feasibility of integrated testing for ANC. Methods Seven dispensaries were purposively selected to implement integrated point-of-care testing for eight months in western Kenya. Semi-structured interviews were conducted with 18 healthcare workers (14 nurses, one clinical officer, two HIV testing counsellors, and one laboratory technician) who were trained, had experience doing integrated point-of-care testing, and were still working at the facilities 8–12 months after the intervention began. The interviews explored acceptability and relevance of POCTs to ANC, challenges with testing, training and supervision, and healthcare workers’ perspectives of client experiences. Twelve focus group discussions with 118 pregnant women who had attended a first ANC visit at the study facilities during the intervention were conducted to explore their knowledge of HIV, syphilis, malaria, and anaemia, experience of ANC point-of-care testing services, treatments received, relationships with healthcare workers, and experience of talking to partners about HIV and syphilis results. Results Healthcare workers reported that they enjoyed gaining new skills, were enthusiastic about using POCTs, and found them easy to use and appropriate to their practice. Initial concerns that performing additional testing would increase their workload in an already strained environment were resolved with experience and proficiency with the testing procedures. However, despite having the diagnostic tools, general health system challenges such as high client to healthcare worker volume ratio, stock-outs and poor working conditions challenged the delivery of adequate counselling and management of the four conditions. Pregnant women appreciated POCTs, but reported poor healthcare worker attitudes, drug stock-outs, and fear of HIV disclosure to their partners as shortcomings to their ANC experience in general. Conclusion This study provides insights on the acceptability, appropriateness, and feasibility of integrating POCTs into ANC services among end-users. While the innovation was desired and perceived as beneficial, future scale-up efforts would need to address health system weaknesses if integrated testing and subsequent effective management of the four conditions are to be achieved.

Abstract Background The lack of primary healthcare integration has been identified as one of the main limits to programs’ efficacy in low- and middle-income countries. This is especially relevant to the Millennium Development Goals, whose health objectives were not attained in many countries at their term in 2015. While global health scholars and decision-makers are unanimous in calling for integration, the objective here is to go further and contribute to its promotion by presenting two of the most important challenges to be met for its achievement: 1) developing a “crosswise approach” to implementation that is operational and effective; and 2) creating synergy between national programs and interventions driven by non-State actors. Main body The argument for urgently addressing this double challenge is illustrated by drawing on observations made and lessons learned during a four-year research project (2011–2014) evaluating the effects of interventions against malaria in Burkina Faso. The way interventions were framed was mostly vertical, leaving little room for local adaptation. In addition, many non-governmental organizations intervened and contributed to a fragmented and heteronomous health governance system. Important ethical issues stem from how interventions against malaria were shaped and implemented in Burkina Faso. To further explore this issue, a scoping literature review was conducted in August 2016 on the theme of integrated primary healthcare. It revealed that no clear definition of the concept has been advanced or endorsed thus far. We call for caution in conceptualizing it as a simple juxtaposition of different tasks or missions at the primary care level. It is time to go beyond the debate around selective versus comprehensive approaches or fragmentation versus cohesion. Integration should be thought of as a process to reconcile these tensions. Conclusions In the context that characterizes many low- and middle-income countries today, better aid coordination and public health systems strengthening, as promoted by multisectoral approaches, might be among the best options to sustainably and ethically integrate primary healthcare interventions.

Background: HIV, syphilis, malaria and anaemia are leading preventable causes of adverse pregnancy outcomes in sub-Saharan Africa yet testing coverage for conditions other than HIV is low. Availing point-of-care tests (POCTs) at rural antenatal health facilities (dispensaries) has the potential to improve access and timely treatment. Fundamental to the adoption of and adherence to new diagnostic approaches are healthcare workers' and pregnant women's (end-users) buy-in. A qualitative approach was used to capture end-users' experiences of using POCTs for HIV, syphilis, malaria and anaemia to assess the appropriateness, acceptability and feasibility of integrated testing for ANC.Methods: Seven dispensaries were purposively selected to implement integrated point-of-care testing for eight months in western Kenya. Semi-structured interviews were conducted with 18 healthcare workers (14 nurses, one clinical officer, two HIV testing counsellors, and one laboratory technician) who were trained, had experience doing integrated point-of-care testing, and were still working at the facilities 8-12 months after the intervention began. The interviews explored acceptability and relevance of POCTs to ANC, challenges with testing, training and supervision, and healthcare workers' perspectives of client experiences. Twelve focus group discussions with 118 pregnant women who had attended a first ANC visit at the study facilities during the intervention were conducted to explore their knowledge of HIV, syphilis, malaria, and anaemia, experience of ANC point-of-care testing services, treatments received, relationships with healthcare workers, and experience of talking to partners about HIV and syphilis results.Results: Healthcare workers reported that they enjoyed gaining new skills, were enthusiastic about using POCTs, and found them easy to use and appropriate to their practice. Initial concerns that performing additional testing would increase their workload in an already strained environment were resolved with experience and proficiency with the testing procedures. However, despite having the diagnostic tools, general health system challenges such as high client to healthcare worker volume ratio, stock-outs and poor working conditions challenged the delivery of adequate counselling and management of the four conditions. Pregnant women appreciated POCTs, but reported poor healthcare worker attitudes, drug stock-outs, and fear of HIV disclosure to their partners as shortcomings to their ANC experience in general.Conclusion: This study provides insights on the acceptability, appropriateness, and feasibility of integrating POCTs into ANC services among end-users. While the innovation was desired and perceived as beneficial, future scale-up efforts would need to address health system weaknesses if integrated testing and subsequent effective management of the four conditions are to be achieved. [ABSTRACT FROM AUTHOR]

Weight management is a game of chance for most children and young people, and is dependent on service availability and the expertise of the provider. Many localities are without established weight-management services, and the effectiveness of those provided is often not well-known. SHINE (Self Help, Independence, Nutrition and Exercise) is the only documented tier 3 community-based service provider in the UK. It offers a plethora of interventions tailored to each child or young person using a stepped-care approach (SCA) to treat severe obesity: as the severity of obesity increases, so does the intensity of intervention. This article describes an SCA and uses this model to demonstrate a range of appropriate, available interventions. A SCA can provide a holistic and integrative care pathway for children and young people with severe obesity when implemented at tier 3. [ABSTRACT FROM AUTHOR]

Integrated health services are characterized by a high degree of collaboration and communication among health professionals, as well as a merge of political, administrative, and technical actions, which can allow the sharing of information among healthcare team members (physicians, nurses, managers, and other stakeholders) related to patient care, and access to hospital infrastructure and technology, within a patient-centered approach. In this paper, we propose a technological solution based on software agents, which allows supporting the management of collaborative processes in environments of dynamic collaborative networks. We present a methodology for coordinating healthcare services through collaborative processes to enable organizations providing integrated care services and continuous process improvements. This methodology includes methods based on Model-Driven Development, which enable the generation of executable process models and the code of the process-oriented agents, derived from conceptual models of collaborative processes. The methodology and methods are implemented and automated by software agents that enable the generation of the technological solution, at run-time on the platform. Furthermore, we propose an agent-based platform that enables organizations to negotiate collaboration agreements in electronic format to establish collaborative networks, as well as a definition of the collaborative processes to be executed. In this way, the proposed agent-based platform allows collaborations among heterogeneous and autonomous healthcare organizations focusing on the process-oriented integration, enabling us to provide integrated healthcare services. [ABSTRACT FROM PUBLISHER]

The aim of the study was to explore the nature and utilisation of voluntary counselling and testing (VCT) service delivery to the Kasenyi fish landing site in the Wakiso district, Uganda, A qualitative, descriptive and explorative study was conducted and data were collected by conducting semi-structured interviews with seven purposively selected VCT counsellors from two hospitals serving the study area. VCT counsellors, mostly trained in medical sciences and in counselling, also provided other services at their hospitals within an integrated service delivery model. VCT services were offered at the hospitals or through mobile outreaches within target communities, including home-based VCT services. Different forms of counselling included individual, group, family and couples counselling. Although counsellors were well trained and qualified to offer VCT and related services, they faced challenges such as staff shortages and limited institutional support, which affected VCT service delivery and utilisation. Recommendations include increasing VCT staff, recruiting community volunteer counsellors, strengthening institutional support to VCT counsellors and sensitising communities about VCT services. [ABSTRACT FROM AUTHOR]

Concurrent increases in evidence about social determinants of health and the use of value-based health care incentives are driving new efforts to integrate health care and human services. Despite expectations that the integration of these complementary services could improve health, reduce health inequities, and reduce potentially avoidable health care use and costs, current evidence on the effectiveness, implementation, and sustainability of such cross-sectoral partnerships is sparse and mixed. To realize the potential of health care and human services integration, knowledge gaps in these key areas must be filled. In doing so, particular attention needs to be paid to understanding how power and resource differentials between organizations in the two sectors influence integration approaches and their impacts. Furthermore, increased societal investments in resources to address social needs are likely necessary for integrative initiatives to yield desired individual- and population-level impacts.

The value of using administrative records for operational and evaluation purposes has been well established in health and human services. However, these records typically reflect the reach of a single government agency or program and fail to capture the experiences of individuals as they engage with different agencies or programs over time. Thus, the potential for these data to improve everyday operations, coordinate services, develop targeted interventions, and advance the science behind broader social policies has yet to be fully realized. A first step toward realizing that potential is to transition from an agency-centered to a client- or person-centered organization of data. We systematically linked tens of millions of records across California's largest health and human services programs. Our results underscore how the integration of records can help shift discussions from the programs that administer services to the people who are served.

As high-income countries face the challenge of providing better and more efficient integrated health and social care to high-needs and high-cost populations, they may require innovative policy supports at both the national and local levels. We categorized policy supports into four areas: governance and partnerships; workforce and staffing; financing and payment; and data sharing and use. Our structured survey of thirty integrated health and social care programs in high-income countries in 2018 found that the majority of programs had policy supports in two or more areas, with supports for governance and partnerships and for workforce and staffing being the most common. Financing and payment and data sharing and use were less common. Local partnerships empowered integration across sectors, and new staff roles that spanned health and social care embedded this integration in care delivery. National policies-including bundled financing and investment in data-enabled integration and cross-sector accountability.

Area Agencies on Aging are increasingly partnering with health care organizations to address the health-related social needs of older adults and contribute to multisector coalitions that promote community health. Using survey data for the period 2008-13, we examined the potential health impacts of establishing such partnerships. Partnerships with hospitals located in an agency's service county were associated with a reduction of $136 in average annual Medicare spending per beneficiary, while partnerships with mental health organizations in an agency's service county saw potentially avoidable nursing home use fall by 0.5 percentage points. When agencies were funded participants in livable community initiatives-multisector coalitions to promote the well-being and health of older adults-potentially avoidable nursing home use fell by nearly 1 percentage point. Our results suggest that investments in health and human services partnerships through Area Agencies on Aging can yield health returns among older adults, in the form of reduced health care use and spending.

Health care organizations are increasingly implementing programs to address patients' social conditions. To support these efforts, new technology platforms have emerged to facilitate referrals to community social services organizations. To understand the functionalities of these platforms and identify the lessons learned by their early adopters in health care, we reviewed nine platforms that were on the market in 2018 and interviewed representatives from thirty-five early-adopter health care organizations. We identified key informants through solicited expert recommendations and web searches. With minor variations, all platforms in the sample provided similar core functionalities: screening for social risks, a resource directory, referral management, care coordination, privacy protection, systems integration, and reporting and analytics. Early adopters reported three key implementation challenges: engaging community partners, managing internal change processes, and ensuring compliance with privacy regulations. We conclude that early engagement with social services partners, funding models that support both direct and indirect costs, and stronger evidence of effectiveness together could help advance platform adoption.

Background: The need for specific services for young people is being widely recognized to address their unique and complex health needs. Growing evidence in integrated health services shows promise in improving the efficiency of health systems. Although there is a broad agreement on the need for integrated care in young people, there has been no systematic effort to evaluate the provision of integrated out-of-hospital health services for this group. The proposed systematic review aims to assess the effectiveness, feasibility, and acceptability of young people-specific integrated out-of-hospital services. Methods: We will search the following databases using a systematic search strategy: MEDLINE, EMBASE, CINAHL Plus, and CENTRAL for articles published in the English language without applying date filters. The search will be supplemented with article search from systematic reviews of relevant topics, reference lists, and citations of included studies. Eligible studies will include peer-reviewed publications reporting on the evaluation of integrated out-of-hospital health services for young people (10–24 years) regarding effectiveness, feasibility, and acceptability. Two reviewers (AP and AA) will independently carry out study selection, data extraction, and quality assessment. Study findings will be summarized in a narrative review. Wherever possible, evidence synthesis of quantitative data will be done using forest plots and pooled estimates. Discussion: This review aims to provide comprehensive evidence regarding young people-specific integrated out-of-hospital health services. Such rigorously evaluated evidence will be useful for policy makers and health professionals to design and select health services for this group. This review will also identify any evidence gaps in young people-specific integrated health services evaluation. Systematic review registration: PROSPERO CRD42017068836 [ABSTRACT FROM AUTHOR]

Frequent emergency department (ED) users often have complex behavioral health and social needs. However, policy makers often focus on this population's medical system use without examining its use of behavioral health and social services systems. To illuminate the wide-ranging needs of frequent ED users, we compared medical, mental health, substance use, and social services use among nonelderly nonfrequent, frequent, and superfrequent ED users in San Francisco County, California. We linked administrative data for fiscal years 2013-15 for beneficiaries of the county's Medicaid managed care plan to a county-level integrated data system. Compared to nonfrequent users, frequent users were disproportionately female, white or African American/black, and homeless. They had more comorbidities and annual outpatient mental health visits (11.93 versus 4.16), psychiatric admissions (0.73 versus 0.07), and sobering center visits (0.17 versus <0.01), as well as disproportionate use of housing and jail health services. Our findings point to the need for shared knowledge across domains, at the patient and population levels. Integrated data can serve as a systems improvement tool and help identify patients who might benefit from coordinated care management. To deliver whole-person care, policy makers should prioritize improvements in data sharing and the development of integrated medical, behavioral, and social care systems.

Background: The lack of primary healthcare integration has been identified as one of the main limits to programs' efficacy in low- and middle-income countries. This is especially relevant to the Millennium Development Goals, whose health objectives were not attained in many countries at their term in 2015. While global health scholars and decision-makers are unanimous in calling for integration, the objective here is to go further and contribute to its promotion by presenting two of the most important challenges to be met for its achievement: 1) developing a "crosswise approach" to implementation that is operational and effective; and 2) creating synergy between national programs and interventions driven by non-State actors.Main Body: The argument for urgently addressing this double challenge is illustrated by drawing on observations made and lessons learned during a four-year research project (2011-2014) evaluating the effects of interventions against malaria in Burkina Faso. The way interventions were framed was mostly vertical, leaving little room for local adaptation. In addition, many non-governmental organizations intervened and contributed to a fragmented and heteronomous health governance system. Important ethical issues stem from how interventions against malaria were shaped and implemented in Burkina Faso. To further explore this issue, a scoping literature review was conducted in August 2016 on the theme of integrated primary healthcare. It revealed that no clear definition of the concept has been advanced or endorsed thus far. We call for caution in conceptualizing it as a simple juxtaposition of different tasks or missions at the primary care level. It is time to go beyond the debate around selective versus comprehensive approaches or fragmentation versus cohesion. Integration should be thought of as a process to reconcile these tensions.Conclusions: In the context that characterizes many low- and middle-income countries today, better aid coordination and public health systems strengthening, as promoted by multisectoral approaches, might be among the best options to sustainably and ethically integrate primary healthcare interventions. [ABSTRACT FROM AUTHOR]