Integrating priority health and disease programs within health systems

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As countries make progress toward their Universal Health Coverage (UHC) goals, many policy reforms have focused on enhancing sustainability and efficiency in access to essential health services. Meanwhile, declining donor funding for siloed (“vertical”) health programs can create service and coverage gaps, leaving certain populations vulnerable.

The Health Systems Strengthening Accelerator supported initiatives to integrate vertical programs into broader health systems, helping to generate knowledge, produce practical guidance, and advance policy and implementation. This included working closely with national governments, USAID and other global actors, and local partners and experts to integrate the following programs and services (among others) into health systems:

Rehabilitation services and technologies
Mental health and psychosocial support services
National safe blood systems
COVID-19 immunization programs

Integrating rehabilitation services and technologies within health systems

Rehabilitation services and technologies are essential components of UHC for “Ensuring Healthy Lives and Promoting Well-being at All Ages” (SDG#3). The Accelerator worked with governments and other partners to scale up the provision of rehabilitative care within health systems by breaking rehabilitation programming out of traditional humanitarian and disability care siloes and incorporating it into broader health financing, service delivery, and governance mechanisms. The Accelerator also worked with the World Health Organization’s Rehabilitation 2030 Initiative to produce the first-ever global knowledge product on optimizing health financing for rehabilitation in low- and middle-income countries (LMICs).

In Ethiopia, Georgia and Nepal, the Accelerator supported national governments with defining essential rehabilitation services, improving access to assistive technologies like wheelchairs and hearing aids, monitoring spending and resource flows, and expanding existing health management information systems (HMIS) to include routine rehabilitation data collection. The Accelerator encouraged greater awareness and prioritization of rehabilitative care, supported governance structures and “focal points” within Ministries of Health (MOHs) as essential starting points for initiating integration, and enabled evidence-informed decision-making.

Five key lessons from this experience can help inform the integration of rehabilitation services—and likely other health challenges as well— within health systems in many other contexts.

Five universal lessons from integrating rehabilitation

Five key lessons for integrating rehabilitation services from the Accelerator’s work in Ethiopia, Nepal, and Georgia:

Awareness drives prioritization: Non-governmental advocates, along with technical assistance and service providers, play a crucial role in educating health systems stakeholders about the importance of rehabilitation. Reframing rehabilitation as an essential health service helps elevate its status and integrate it across the health system.
Governance structures are foundational: Establishing clear governance structures and designating a “focal point” within the Ministry of Health, at national and sub-national levels, is essential for driving policy and actions that integrate rehabilitation services.
Data for decision-making requires flexibility: While health information systems with rehabilitation modules are important for informed decisions, gaps in service delivery and expansion often delay data collection. Decision makers must use alternative sources of formal or informal data, using creative survey and estimation approaches to fill the gaps.
Dialogue and transparency protect rights: Continuous dialogue with policymakers is vital to safeguarding the rights of persons with disabilities, especially when resources are limited. Policymakers must maintain transparency in balancing rights-based concerns with programmatic priorities.
Addressing workforce shortages is key: The demand for rehabilitation services often exceeds the availability of trained professionals. To meet this need, it is essential to allocate resources for task-shifting strategies while expanding and strengthening formal degree programs.

Key resource for integrating rehabilitation into health systems

WHO Bulletin: How to become a strategic purchaser of rehabilitation services

Integrating mental health and psychosocial services within health systems

Mental health, neurological and substance use disorders account for a large and growing proportion of the world’s disease burden. According to the World Health Organization, as many as one in eight people worldwide live with a mental health condition. Yet 85% of people with a mental disorder do not receive the treatment they need.

To address this gap in service and treatment, the Health Systems Strengthening Accelerator supported the Mental Health Unit of the Liberia Ministry of Health to scale-up integrated mental health and psychosocial support (MHPSS) services. The Accelerator helped build the health system infrastructure for enhancing MHPSS care — including developing local capacity for training of mental health clinicians, integrating mental health indicators into routine HMIS, conducting quantification and supply planning for essential psychotropic medicines, charting the course for scaling up, and strengthening MOH planning and governance, including support for developing a national mental health policy and strategy.

Key Resource for integrating mental health and psychosocial support services within health systems

Community-level mental health services in Liberia: Programs, learnings and challenges

Integrating safe blood systems within the broader health system

Blood and blood products — such as red blood cells, platelets and plasma — are critical lifesaving commodities to treat conditions like severe postpartum hemorrhage and widespread childhood anemia.

Liberia, Malawi and Rwanda launched a novel program to strengthen national safe blood systems as part of health sector planning and programming. With support from the Health Systems Strengthening Accelerator, the three countries piloted a global tool to assess national safe blood systems and co-developed agendas for blood systems strengthening with national blood transfusion services and MOHs. The Accelerator followed up with support to develop national blood system policies and strategies as integral elements of health sector planning. This included harnessing new evidence within the health system planning and policy processes to enhance the allocation of greater domestic resources and facilitate transition from declining (PEPFAR and Global Fund) donor funding, and working to enhance the collection of blood stocks, integration in routine information systems, and facility readiness for high-quality service delivery.

Resources for integrating safe blood systems into health systems

Integrating COVID-19 vaccination within health systems

Integration is a key strategy for ensuring the long-term sustainability of COVID-19 vaccination in LMICs as financial, human and vaccine support from external partners wanes. The Accelerator — together with MOMENTUM Routine Immunization Transformation and Equity (M-RITE) program — gathered evidence on how countries have been integrating COVID-19 vaccination with routine immunization programs and/or other health interventions and on planning for sustaining COVID-19 vaccination in the long-term.

Drawing on experiences from Benin, Ethiopia, Ghana, Liberia, Nigeria, and Togo, the Accelerator and M-RITE produced guidance on how to consider priority populations in decision-making about COVID-19 vaccination integration, and identified opportunities for building on the COVID-19 experience to develop life-course vaccination approaches to routine immunization, sustainable financing for COVID-19 vaccination, and integration of COVID-19 vaccination into routine health system components such as health sector strategies, plans, and monitoring and evaluation systems.

Resources for integrating COVID-19 vaccinations into health systems

Key Lessons

The Accelerator’s experience offers valuable lessons on how to bring external (and domestic) verticalized programs into routine health system operations. The project emphasized facilitating interagency collaboration and developing context-specific policy pathways for key responsibilities to be distributed. It also helped extend the integration agenda to non-traditional but pressing health areas that are often underprioritized — such as mental health, rehabilitation and blood safety — and where the voices of key stakeholders, such as persons with disabilities, should be elevated.

To facilitate the transition from donor financed and delivered services to domestically-financed, integrated services, donors should increasingly coordinate with and co-finance countries’ own health priorities and programs in integrated ways, minimizing fragmentation and iteratively increasing financial sustainability. Health benefits policy and purchasing modalities, for example, can begin to cover previously siloed services programs, and resources can be better tracked and merged to enhance efficiency and value for money. Doing so will enable countries to minimize overlaps and inefficiencies in programming, and — as in the case of mental health and rehabilitation — will help LMICs gear up to manage the ongoing epidemiological transition to non-communicable diseases.