Integration of immunization services with other health interventions in the developing world: what works and why? Systematic literature review

Abstract

Summaryobjective To assess benefits, challenges and characteristics of integrating child and maternal health services with immunization programmes.methods Literature review using journal databases and grey literature. Papers meeting the inclusion criteria were rated for the quality of methodology and relevant information was systematically abstracted.results Integrated services were vitamin A supplementation, bednet distribution, deworming tablet distribution, Intermittent Preventive Therapy for infants and referrals for family planning services. Two key characteristics of success were compatibility between interventions and presence of a strong immunization service prior to integration. Overburdened staff, unequal resource allocation and logistical difficulties were mentioned as risks of integration, whereas rapid uptake of the linked intervention and less competition for resources were listed as two key benefits of integration.conclusion The theoretical strengths of integrating other health services with immunization services remain to be rigorously proved in practice. When additional interventions are carefully selected for compatibility and when they receive adequate support, coverage of these interventions may improve, provided immunization coverage is already high. Evidence for the effectiveness of integration in increasing efficiency of resource use was insufficient and most benefits and challenges were not statistically quantified. More substantive information about the costs of integrated vs. vertical programmes and full documentation of the impacts of integration on immunization services should be published.

Building on community outreach for childhood vaccination to deliver maternal and child health services in Laos: a feasibility assessment

“…Supervision tended to be conducted at quarterly intervals, subject to availability of funds, except for staff members of facilities supported by external agencies. Well-performing vaccination services appeared to be those benefiting from regular, intense supervision, in line with recommendations by Wallace, Dietz and Cairns, 6 who conducted a systematic review of the literature on integrating health services, including MCH care with immunization outreach.…”

“…The current low coverage of immunization is also inequitable, with the lowest levels among remote and poor communities, 21 which will most likely be exacerbated when more MCH services are added under the current conditions. In line with recommendations by Wallace et al, 6 it may be better to ensure high vaccination coverage through outreach before integrating other services. However, considering the inequitable access to MCH services by women in remote communities, together with the government's intention to extend such services to them, it may make more sense to increase the type and number of MCH services gradually during vaccination outreach, while simultaneously improving coverage of children and women receiving them.…”

“…3,4 Outreach also provides a useful way to concurrently deliver other primary health care interventions, such as micronutrient supplementation or antenatal care to hard-to-reach groups. 1,5,6 Criteria for selecting health interventions for integration into the package of outreach services include: the population burden of the condition, cost-effectiveness, availability of required supplies and materials, skills of existing health personnel, and the feasibility and acceptability of the intervention. 5 The resulting intervention package must also be tailored to the specific context.…”

“…7 Country experiences with outreach services, however, have been mixed, 8 and there is little evidence on the conditions for their effective delivery, including on the integration of broader maternal and child health (MCH) services (such as antenatal care, vitamin A supplementation, de-worming, family planning) in such programmes. 6,9 With this study we sought to gather evidence on the success of recent efforts to strengthen outreach services for integrated child vaccination and maternal and child health in Laos.…”

Integrating pneumonia prevention and treatment interventions with immunization services in resource-poor countries

“…3 A growing body of literature describes research that integrates routine immunization services with health interventions such as bednet distribution for malaria control, mebendazole treatment for intestinal parasitosis, vitamin A supplementation, household water treatment and family planning. 4,5 As health officials work to reduce the global burden of pneumonia, we are provided with an opportunity to learn from these integration efforts. This paper explores practical approaches for integrating diverse pneumonia prevention and treatment interventions with immunization services.…”