Integration of targeted health interventions into health systems: a conceptual framework for analysis
Integration of targeted health interventions into health systems: a conceptual framework for analysis
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DOI：
10.1093/heapol/czp055
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发表时间：
2010-03-01
影响因子：
3.2
通讯作者：
Adeyi, Olusoji
中科院分区：
文献类型：
--
作者：
Atun, Rifat;de Jongh, Thyra;Adeyi, Olusoji
将强调特定干预措施的计划纳入卫生系统以改善健康结果的好处已引起广泛争论。这场辩论是由综合（水平）与非综合（垂直）计划的狭隘二元考虑所驱动的，其特点是观点两极分化，支持和反对综合的支持者争论每种方法的相对优点。许多国家同时存在综合和非综合计划，这表明每种方法都有好处。虽然“垂直”和“综合”这两个术语被广泛使用，但它们各自描述了一系列现象。在实践中，垂直和水平之间的二分法并不严格，垂直或整合的程度因项目而异。然而，对不同背景和不同干预措施中整合的相对优点进行系统分析是很复杂的，因为“整合”没有一个普遍接受的定义——这个术语广泛地用于描述不同环境下一系列计划的各种组织安排。我们提出了一个分析框架，可以将整合一词解构为多个方面，每个方面对应一个关键的卫生系统功能。我们的概念框架建立在理论命题和实证基础上。 创新研究，特别是卫生系统内创新的采用和传播，并建立在我们自己早期的实证研究的基础上。它汇集了影响健康干预措施的采用、传播和同化的关键要素，从而能够系统和全面地探索不同干预措施在不同环境中的整合程度以及差异的原因。我们提出的概念框架和分析方法旨在促进一体化的评估性和形成性研究和政策的分析，用于系统地比较和对比一个国家或不同环境下的卫生干预措施，以生成有意义的证据来为政策提供信息。
The benefits of integrating programmes that emphasize specific interventions into health systems to improve health outcomes have been widely debated. This debate has been driven by narrow binary considerations of integrated ( horizontal) versus non-integrated ( vertical) programmes, and characterized by polarization of views with protagonists for and against integration arguing the relative merits of each approach. The presence of both integrated and non-integrated programmes in many countries suggests benefits to each approach.While the terms 'vertical' and 'integrated' are widely used, they each describe a range of phenomena. In practice the dichotomy between vertical and horizontal is not rigid and the extent of verticality or integration varies between programmes. However, systematic analysis of the relative merits of integration in various contexts and for different interventions is complicated as there is no commonly accepted definition of 'integration'-a term loosely used to describe a variety of organizational arrangements for a range of programmes in different settings.We present an analytical framework which enables deconstruction of the term integration into multiple facets, each corresponding to a critical health system function.Our conceptual framework builds on theoretical propositions and empirical research in innovation studies, and in particular adoption and diffusion of innovations within health systems, and builds on our own earlier empirical research. It brings together the critical elements that affect adoption, diffusion and assimilation of a health intervention, and in doing so enables systematic and holistic exploration of the extent to which different interventions are integrated in varied settings and the reasons for the variation. The conceptual framework and the analytical approach we propose are intended to facilitate analysis in evaluative and formative studies of-and policies on-integration, for use in systematically comparing and contrasting health interventions in a country or in different settings to generate meaningful evidence to inform policy.