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Combating health care fragmentation through integrated health service delivery networks in the Americas: lessons learned

Hernán Montenegro (Pan American Health Organization/World Health Organization, Washington, DC, USA)
Reynaldo Holder (Pan American Health Organization/World Health Organization, Washington, DC, USA)
Caroline Ramagem (Pan American Health Organization/World Health Organization, Washington, DC, USA)
Soledad Urrutia (Pan American Health Organization/World Health Organization, Washington, DC, USA)
Ricardo Fabrega (Pan American Health Organization/World Health Organization, Washington, DC, USA)
Renato Tasca (Pan American Health Organization/World Health Organization, Brazil)
Gerardo Alfaro (Pan American Health Organization/World Health Organization, El Salvador)
Osvaldo Salgado (Pan American Health Organization/World Health Organization, Colombia)
Maria Angelica Gomes (Pan American Health Organization/World Health Organization, Paraguay)

Journal of Integrated Care

ISSN: 1476-9018

Publication date: 10 October 2011

Abstract

Purpose

This paper aims to: analyze the challenge of health services fragmentation; present the attributes of integrated health service delivery networks (IHSDNs); review lessons learned on integration; examine recent developments in selected countries; and discuss policy implications of implementing IHSDNs.

Design/methodology/approach

A literature review, expert meetings, and country consultations (national, subregional, and regional) in the Americas resulted in a set of consensus‐based essential attributes for implementing IHSDNs. The analysis of 11 country case studies on integration allowed for the identification of lessons learned.

Findings

Studies suggest that IHSDNs could improve health systems performance. Principal findings include: integration processes are difficult, complex, and long term; integration requires extensive systemic changes and a commitment by health workers, health service managers and policymakers; and, multiple modalities and degrees of integration can coexist within a system. The public policy objective is to propose a design that meets each system's specific organizational needs.

Research limitations/implications

The analysis presented in this paper is qualitative.

Practical implications

Some policy implications for implementing IHSDNs are presented in the paper.

Originality/value

The research and evidence on integration remains limited. The paper expands the knowledge‐base on the topic, presenting lessons learned on integration and recent developments in selected countries, which can support integration efforts in the region.

Keywords

Citation

Montenegro, H., Holder, R., Ramagem, C., Urrutia, S., Fabrega, R., Tasca, R., Alfaro, G., Salgado, O. and Angelica Gomes, M. (2011), "Combating health care fragmentation through integrated health service delivery networks in the Americas: lessons learned", Journal of Integrated Care, Vol. 19 No. 5, pp. 5-16. https://doi.org/10.1108/14769011111176707

Publisher

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Emerald Group Publishing Limited

Copyright © 2011, Emerald Group Publishing Limited