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Hernán Montenegro, Reynaldo Holder, Caroline Ramagem, Soledad Urrutia, Ricardo Fabrega, Renato Tasca, Osvaldo Salgado, Gerardo Alfaro, Maria Angélica Gomes. Combating Health Care Fragmentation through Integrated Health Service Delivery Networks in the Americas: Lessons Learned [2011]


"This paper analyzes the challenge of health services fragmentation, presents the attributes of Integrated Health Service Delivery Networks (IHSDNs), reviews lessons learned on integration, examines recent developments in selected countries, and discusses policy implications of implementing IHSDNs. Design/methodology/approach: A literature review, expert meetings and country consultations (national, subregional and regional) in the Americas resulted in a set of consensus-based essential attributes for implementing IHSDNs. The analysis of eleven country case studies on integration allowed for the identification of lessons learned. Findings: Studies suggest that IHSDN could improve health systems performance. Principal findings include: i) integration processes are difficult, complex and long term; (ii) integration requires extensive systemic changes and a commitment by health workers, health service managers and policymakers; and, iv) multiple modalities and degrees of integration can coexist within a system. The public policy objective is to propose a design that meets each system’s specific organizational needs. Research limitations/implications: The analysis presented in this paper is qualitative. Practical implications: Some policy implications for implementing IHSDNs are presented in this paper.  Originality/value: The research and evidence on integration remains limited. The paper expands the knowledge-base on the topic, presenting lessons learned on integration and recent developments in selected countries, which can support integration efforts in the region." ...  (Au) 

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