Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration.


Mayhew, SH; Ploubidis, GB; Sloggett, A; Church, K; Obure, CD; Birdthistle, I; Sweeney, S; Warren, CE; Watts, C; Vassall, A; Integra Initiative, ; (2016) Innovation in Evaluating the Impact of Integrated Service-Delivery: The Integra Indexes of HIV and Reproductive Health Integration. PLoS One, 11 (1). e0146694. ISSN 1932-6203 DOI: https://doi.org/10.1371/journal.pone.0146694

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Abstract

The body of knowledge on evaluating complex interventions for integrated healthcare lacks both common definitions of 'integrated service delivery' and standard measures of impact. Using multiple data sources in combination with statistical modelling the aim of this study is to develop a measure of HIV-reproductive health (HIV-RH) service integration that can be used to assess the degree of service integration, and the degree to which integration may have health benefits to clients, or reduce service costs. Data were drawn from the Integra Initiative's client flow (8,263 clients in Swaziland and 25,539 in Kenya) and costing tools implemented between 2008-2012 in 40 clinics providing RH services in Kenya and Swaziland. We used latent variable measurement models to derive dimensions of HIV-RH integration using these data, which quantified the extent and type of integration between HIV and RH services in Kenya and Swaziland. The modelling produced two clear and uncorrelated dimensions of integration at facility level leading to the development of two sub-indexes: a Structural Integration Index (integrated physical and human resource infrastructure) and a Functional Integration Index (integrated delivery of services to clients). The findings highlight the importance of multi-dimensional assessments of integration, suggesting that structural integration is not sufficient to achieve the integrated delivery of care to clients-i.e. "functional integration". These Indexes are an important methodological contribution for evaluating complex multi-service interventions. They help address the need to broaden traditional evaluations of integrated HIV-RH care through the incorporation of a functional integration measure, to avoid misleading conclusions on its 'impact' on health outcomes. This is particularly important for decision-makers seeking to promote integration in resource constrained environments.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Population Studies (1974-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Research Centre: Gender Violence and Health Centre
Anthropology, Politics and Policy Group (APPG)
Population Studies Group
Centre for Statistical Methodology
PubMed ID: 26800517
Web of Science ID: 368655300030
URI: http://researchonline.lshtm.ac.uk/id/eprint/2534214

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