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![Page 1: Integrated Service Delivery Case Study: Kenya Erin E. Sullivan, Ph.D. Global Health Delivery Project Harvard School of Public Health July 16, 2010.](https://reader035.fdocuments.in/reader035/viewer/2022062801/56649e585503460f94b522af/html5/thumbnails/1.jpg)
Integrated Service Delivery Case Study:
Kenya
Erin E. Sullivan, Ph.D.Global Health Delivery Project
Harvard School of Public HealthJuly 16, 2010
![Page 2: Integrated Service Delivery Case Study: Kenya Erin E. Sullivan, Ph.D. Global Health Delivery Project Harvard School of Public Health July 16, 2010.](https://reader035.fdocuments.in/reader035/viewer/2022062801/56649e585503460f94b522af/html5/thumbnails/2.jpg)
Kileken ole-MoiYoi, Erin Sullivan, Nayana Dhavan, George Kimathi, Joseph Rhatigan, Ephantus Kabiru,
Rebecca Weintraub
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Data Collection
• 50 key informants – Well-defined roles in the country’s health
system – Represented:
• Government of Kenya• Kenya-based NGOs• Internationally-based NGOs• Multilateral organizations • Private sector
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Kenya: Country Context
Population: 38.5 million
Life expectancy: 56 for females 53 for males
UN Human Development Index: 147 out of 182
GDP per capita: US$ 1,590 (in PPP)
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Kenya: Health System
![Page 6: Integrated Service Delivery Case Study: Kenya Erin E. Sullivan, Ph.D. Global Health Delivery Project Harvard School of Public Health July 16, 2010.](https://reader035.fdocuments.in/reader035/viewer/2022062801/56649e585503460f94b522af/html5/thumbnails/6.jpg)
Integration of HIV Program with Health System
Health System Function Integration with Health System
Stewardship and Governance None
Financing None
Planning None
Service Delivery
•Human Resources
None
•Infrastructure Moderate
•Procurement & Supply Chain
Moderate
Monitoring and Evaluation Limited
Demand Generation None
![Page 7: Integrated Service Delivery Case Study: Kenya Erin E. Sullivan, Ph.D. Global Health Delivery Project Harvard School of Public Health July 16, 2010.](https://reader035.fdocuments.in/reader035/viewer/2022062801/56649e585503460f94b522af/html5/thumbnails/7.jpg)
HIV Program Financing
GoK
Ministry of Medical Services
Ministry of Public Health &
Sanitation
Office of the President
NACC
![Page 8: Integrated Service Delivery Case Study: Kenya Erin E. Sullivan, Ph.D. Global Health Delivery Project Harvard School of Public Health July 16, 2010.](https://reader035.fdocuments.in/reader035/viewer/2022062801/56649e585503460f94b522af/html5/thumbnails/8.jpg)
Integration of HIV Program with Health System
Health System Function Integration with Health System
Stewardship and Governance None
Financing None
Planning None
Service Delivery
•Human Resources
None
•Infrastructure Moderate
•Procurement & Supply Chain
Moderate
Monitoring and Evaluation Limited
Demand Generation None
![Page 9: Integrated Service Delivery Case Study: Kenya Erin E. Sullivan, Ph.D. Global Health Delivery Project Harvard School of Public Health July 16, 2010.](https://reader035.fdocuments.in/reader035/viewer/2022062801/56649e585503460f94b522af/html5/thumbnails/9.jpg)
Integration of HIV Program with Health System
Health System Function Integration with Health System
Stewardship and Governance None
Financing None
Planning None
Service Delivery
•Human Resources
None
•Infrastructure Moderate
•Procurement & Supply Chain
Moderate
Monitoring and Evaluation Limited
Demand Generation None
![Page 10: Integrated Service Delivery Case Study: Kenya Erin E. Sullivan, Ph.D. Global Health Delivery Project Harvard School of Public Health July 16, 2010.](https://reader035.fdocuments.in/reader035/viewer/2022062801/56649e585503460f94b522af/html5/thumbnails/10.jpg)
Integration Challenges
• Global Fund model
• Limited infrastructure to support programs
• Poor M&E structures
• Conflicts of interest within the CCM
• Delays in funding
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System-wide Effects
• Concerns about long-term sustainability
• Neglect of non-target diseases
• Parallel systems
• Human resource challenges
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Conclusions
• Disease programs should improve integration
with public health system• A relatively strong health system maximizes
Global Fund resources• Investments in workforce, infrastructure and
government capacity ensure sustainability• Coordination and alignment between health
system stakeholders is needed
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Further Research
• Sustainability and governmental capacity
• Donor alignment and management
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Integration
• ‘integration’—a term loosely used to describe a variety of organizational arrangements for a range of programmes in different settings.
• we define integration as the extent, pattern, and rate of adoption and eventual assimilation of health interventions into each of the critical functions of a health system which include, (i) governance, (ii) financing, (iii) planning, (iv) service delivery, (v) monitoring and evaluation (M&E), and (vi) demand generation.