Primary health care can address 90% of people’s health needs, yet in many countries, governments spend only one third of already limited health budgets on primary health care (PHC). Despite continued commitment to the achievement of universal health coverage through strong PHC systems from country and global stakeholders, significant funding and service delivery models are still oriented around vertical programs. This may yield positive impact for those programs, particularly in the near term, but can lead to the development of parallel systems or broader system inefficiencies, challenges in sustaining coverage in the longer term, and missed opportunities to manage multiple health concerns of individuals and families in a coordinated manner.
Decisions about whether, when, and how to integrate vertical programs into mainstream PHC systems can benefit from better evidence about the potential benefits and pitfalls of such reforms. While there have been numerous studies on the implications of more integrated service delivery, relatively little research has been on the spectrum of integration across other health system domains, including governance, financing, and key health care inputs like human resources and commodities.
R4D is partnering with Population Services International (PSI) to develop a generalized analytic approach and methodology for identifying appropriate investments to integrate components of vertical programs into PHC systems and analyzing their effects on outcomes of concern to vertical program constituencies. We will then apply the approach to family planning programs to determine what case can be made to governments and family planning funders that their objectives will best be met through investment in strong PHC systems. A second phase might include application to additional program areas and deeper investigation in selected countries.