MEASURE Evaluation, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA.
BMC Health Serv Res. 2013 May 6;13:168. doi: 10.1186/1472-6963-13-168.
Because of the current emphasis and enthusiasm focused on integration of health systems, there is a risk of piling resources into integrated strategies without the necessary systems in place to monitor their progress adequately or to measure impact, and to learn from these efforts. The rush to intervene without adequate monitoring and evaluation will continue to result in a weak evidence base for decision making and resource allocation. Program planning and implementation are inextricability linked to monitoring and evaluation. Country level guidance is needed to identify country-specific integrated strategies, thereby increasing country ownership.
This paper focuses on integrated health services but takes into account how health services are influenced by the health system, managed by programs, and made up of interventions. We apply the principles in existing comprehensive monitoring and evaluation (M&E) frameworks in order to outline a systematic approach to the M&E of integration for the country level. The approach is grounded by first defining the country-specific health challenges that integration is intended to affect. Priority points of contact for care can directly influence health, and essential packages of integration for all major client presentations need to be defined. Logic models are necessary to outline the plausible causal pathways and define the inputs, roles and responsibilities, indicators, and data sources across the health system. Finally, we recommend improvements to the health information system and in data use to ensure that data are available to inform decisions, because changes in the M&E function to make it more integrated will also facilitate integration in the service delivery, planning, and governance components.
This approach described in the paper is the ideal, but its application at the country level can help reveal gaps and guide decisions related to what health services to prioritize for integration, help plan for how to strengthen systems to support health services, and ultimately establish an evidence base to inform investments in health care. More experience is needed to understand if the approach is feasible; similarly, more emphasis is needed on documenting the process of designing and implemented integrated interventions at the national level.
由于当前对卫生系统整合的重视和热情，有可能在没有适当系统来充分监测其进展或衡量其影响以及从中吸取经验的情况下，将资源投入到综合战略中。在没有充分监测和评估的情况下仓促干预，将继续导致决策和资源分配的证据基础薄弱。规划和实施方案与监测和评估密不可分。需要国家一级的指导来确定具体国家的综合战略，从而增强国家自主权。
本文侧重于综合卫生服务，但同时考虑了卫生服务如何受到卫生系统的影响、由方案管理以及由干预措施组成。我们应用现有综合监测和评价（M&E）框架中的原则，以便为国家一级的整合 M&E 勾勒出一个系统的方法。该方法的基础是首先定义整合旨在影响的具体国家卫生挑战。护理的优先接触点可以直接影响健康，并且需要为所有主要患者群体确定基本的整合一揽子计划。逻辑模型是必要的，以勾勒出合理的因果途径，并定义整个卫生系统中的投入、角色和责任、指标和数据源。最后，我们建议改进卫生信息系统和数据利用，以确保有数据可用于决策，因为 M&E 功能的变化使其更具综合性，也将促进服务提供、规划和治理部分的整合。
本文所述的方法是理想的，但在国家一级的应用可以帮助揭示差距，并为优先考虑整合哪些卫生服务做出决策提供指导，帮助规划如何加强系统以支持卫生服务，并最终建立一个循证基础，为医疗保健投资提供信息。需要更多的经验来了解该方法是否可行；同样，需要更加重视记录在国家一级设计和实施综合干预措施的过程。
