When my sister-in-law Angelina was six months pregnant, she went to a health facility for a routine antenatal care visit. This was not an easy thing to do, however. She lives in rural Kenya and in order to reach the facility situated 15 kilometres away, she sold her pig. With this money she was able to pay her way to and from the facility.
At the facility, due to the long queues and the low number of health providers, she and the other pregnant women were given group counselling about the importance of delivering their babies in a health facility and, without much attention to the individual needs and questions of the women, the staff quickly cleared the queue.
Angelina felt discouraged and feared that she would take up too much of the health provider's time if she tried to discuss the terrible pain she had in her stomach over the last few days. So she went back home, willing herself to keep going through the pain. The pain made it difficult to perform her household chores, including fetching water from the well and getting firewood to prepare meals for her family.
The next day, these pains persisted but she did not have any money to go back to the health facility. By evening, the situation had deteriorated and she died that night. Later, it was discovered that the foetus had died intra uterine and this was the cause of her pain and eventual death.
Had the health provider taken time to examine Angelina individually and ask about any complaints, they likely could have managed this complication and Angelina would still be alive. Not only did she lose her life, but she left behind six children who are now orphaned and are living in deplorable conditions.
For 15 years, I have been working on global health issues in Kenya, including initiatives focused on improving the health of women and families in the urban slums. I know that Angelina's story is far from unusual.
I believe that integrating health services can be an effective strategy for helping them. Integration of health services is an approach whereby health care providers use opportunities to engage the client in addressing clients/patients' multiple health needs. This approach has not been practiced at its optimum. Health services are organized in silos, which makes integration difficult in many settings.
Indeed, due to lack of integration, many people end up having health complications which would have otherwise been addressed. A holistic approach in addressing the barriers to integration as well as building the capacity of service providers to provide quality health care services would be one way of ensuring that integration takes place in our health facilities. In addition, programs should pursue holistic approaches that address the attitude of the service providers as well as strengthen the human resource systems that create a supportive working environment, improve performance, and build the sustainability of the health care workforce.
With integrated services, women like Angelina would have access to multiple health services each time they are in contact with a health facility. For example, those coming with children for immunization could also get information about family planning, be screened for gender-based violence, gain advice about nutrition, and have cervical cancer screenings in one sitting. This would ensure that women get the full benefit of selling the pig -- or whatever else they have to sell -- for their health care. On the other hand, it would reduce the queues in health facilities since the women would not have to make repeat visits for each health concern.
Health providers would also need to be well-trained and equipped to be able to offer multiple health services to clients and be motivated to do the same. While these are challenges that have been cited as possible barriers to integrating health care services, the benefits to women and children thereof far outweigh these challenges.
Overall, integrating health services is a strategy that is effective in reducing missed opportunities for providing various health services while at the same time reducing operation costs on the facility. As we look forward to the Mexico Conference where Sustainable Development Goals will be discussed, it is important to appreciate that integration of health services is key to meeting international and national development goals and targets.