Imperial College Business School, Imperial College London, London SW7, UK.
Health Policy Plan. 2010 Jan;25(1):1-14. doi: 10.1093/heapol/czp053. Epub 2009 Dec 2.
A longstanding debate on health systems organization relates to benefits of integrating health programmes that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes. This debate has long been characterized by polarization of views and ideologies, with protagonists for and against integration arguing the relative merits of each approach. However, all too frequently these arguments have not been based on hard evidence. The presence of both integrated and non-integrated programmes in many countries suggests there may be benefits to either approach, but the relative merits of integration in various contexts and for different interventions have not been systematically analysed and documented. In this paper we present findings of a systematic review that explores a broad range of evidence on: (i) the extent and nature of the integration of targeted health programmes that emphasize specific interventions into critical health systems functions, (ii) how the integration or non-integration of health programmes into critical health systems functions in different contexts has influenced programme success, (iii) how contextual factors have affected the extent to which these programmes were integrated into critical health systems functions. Our analysis shows few instances where there is full integration of a health intervention or where an intervention is completely non-integrated. Instead, there exists a highly heterogeneous picture both for the nature and also for the extent of integration. Health systems combine both non-integrated and integrated interventions, but the balance of these interventions varies considerably.
长期以来，卫生系统组织一直存在一个争论，即整合强调特定干预措施的卫生方案是否有利于增加获得卫生服务的机会并改善卫生结果。这场争论长期以来一直存在观点和意识形态的两极分化，支持和反对整合的人都在争论每种方法的相对优点。然而，这些论点往往没有确凿的证据支持。许多国家同时存在整合和非整合的方案，这表明这两种方法都可能有好处，但在不同情况下整合的相对优点以及对不同干预措施的整合，尚未得到系统分析和记录。本文介绍了一项系统评价的结果，该评价广泛探讨了以下方面的证据：（i）强调特定干预措施的目标卫生方案整合到关键卫生系统功能的程度和性质；（ii）在不同情况下，卫生方案整合或不整合到关键卫生系统功能如何影响方案的成功；（iii）在何种程度上受到背景因素的影响，这些方案被整合到关键卫生系统功能中。我们的分析表明，完全整合卫生干预措施或完全不整合干预措施的情况很少见。相反，无论是整合的性质还是程度，都存在着高度异质的情况。卫生系统同时结合了非整合和整合的干预措施，但这些干预措施的平衡差异很大。
