Integrating Health Care Systems to Save Lives

Benta and Ezekiel Awino have brought their 9-month-old baby, Ronny, to Rongo District Hospital in Western Kenya for an HIV test. Here, Benta, who is living with HIV, has received quality care throughout her pregnancy. Now, both she and her baby return to the same center for follow up appointments to receive services to address the gamut of health concerns common to the region, including malaria, TB, HIV and malnutrition.

This kind of integrated health care model is only now becoming the norm in the district. Up until recently, families like the Awinos, who are living with HIV, went to one facility for HIV care and treatment, another facility for prenatal care, another clinic for their baby's routine health and yet another clinic for any illnesses.

As a result, a child who was not thriving because of underlying HIV and was presented at the sick baby clinic was unlikely to be tested because the facility was not an "HIV" clinic. Keep in mind, the journey to the clinics is almost always arduous, and the likelihood that women return, or come at all, cannot be taken for granted.

Healthy women and healthy babies build healthy communities. We all know this. But we also know that many of the systems in place to keep women and children healthy are fragmented and don't adequately address the needs of those they are built to serve.

These are the glaring inefficiencies/gaps we are considering throughout the forum of the Partnership on Maternal, Newborn and Child Health in Johannesburg at the end of this month.

Simple solutions to align what we are calling "service delivery entry points" within larger systems could make a huge difference to mothers, to the health of children around the world, and, in turn, to a more productive society.

Integrated packages of care save lives by strengthening systems to identify and address potential problems and intervene early. Combining focused interventions for women and their children in the same place, through reproductive, maternal, newborn and child health services as well as infant feeding/nutrition and early childhood services for example, can address critical gaps and create synergies in service delivery. Such interventions include those that relate to HIV, TB, malaria, syphilis, pneumonia, diarrhea and malnutrition.

The Double Dividend is one example of an initiative designed to improve maternal and child survival by aligning reproductive, maternal, newborn and child health services, as well as nutrition and HIV-related services. Infants born to untreated HIV positive mothers, whether HIV infected or not, can have a higher risk of dying than infants who are not exposed to HIV, just as untreated HIV positive pregnant adolescents and women have an increased risk of dying in pregnancy or child birth.

Women when pregnant are much more likely to visit a clinic for ANC, just as infants do for immunization and sick visits. We need to seize these precious opportunities to care for the children and their mothers holistically. There are multiple opportunities to improve linkages between maternal, newborn and child health services to address key diseases and conditions including by:

  • linking staff training for various services to integrate service delivery and management;
  • interconnecting public information about services;
  • using many different types of services as opportunities to reach families; and
  • promoting community outreach and support systems.

This not only will save lives like those of Benta and Ronny, it will also save money. The goal is to yield benefits in terms of the health of both mothers and their children through high quality and efficient interconnected systems which promote human rights and accountability.

No matter how you look at it, this way ahead is a win win.