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

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.