Integrated health service delivery networks: concepts, policy options and road map for implementation in the Americas

Pan American Health Organization (PAHO)/World Health Organisation introduce its book as a key step to support their member states' commitment towards the development of Integrated Health Service Delivery Networks, as a preferred modality for health service delivery and especially as a main operational strategy of the Primary Health Care approach. The book is proposed as a guiding tool to analyse problems related to health services fragmentation. It seeks to support the analysis of the state of a country's Integrated Health Service Delivery Networks in terms of a list of attributes. Policy instruments and institutional mechanisms that can be used to support the strengthening of the network per attribute are then presented. The prioritisation of certain attributes and the choice of instruments and mechanisms should become the backbone of national plans. The book is organised into five brief chapters. Chapter one guides the understanding of the benefits of Integrated Health Service Delivery Networks for the current health challenges. They expose fragmentation as a main challenge in Latin America, due to a historical development of subsystems that were 'targeted to specific strata of the populations' (for example, type of employment, income, urban or rural residence), and to vertical programmes sponsored by international health initiatives. Chapter two presents the concept of 'comprehensive, integrated and continuous health services " and of Integrated Health Service Delivery Networks, its different modalities and benefits. Health Organizations, are defined as 'a network of organizations that provides, or makes arrangements to provide, equitable, comprehensive, integrated, and continuous health services to a defined population and is willing to be held accountable for its clinical and economic outcomes and the health status of the population served'. Fourteen essential attributes of Integrated Health Service Delivery Networks grouped in four principal domains are proposed as a flexible template to assess a country's situation, propose priority interventions and assess progress in chapter three. They are distributed in four domains: governance, organization and management, model of care and financial incentives (Figure 1). In chapter four, public instruments and institutional mechanisms that support the development of Integrated Health Service Delivery Networks are proposed. Their relevance in 4 different settings was analysed. Those settings were (1) highly segmented health systems; (2) systems without universal coverage and access; (3) systems with decentralisation that fragments service delivery; and (4) systems with separation of functions and multiple service providers. The final chapter briefly presents lessons learned from the past successful …