Research Article: Conceptualizing Integration: A Framework for Analysis Applied to Neglected Tropical Disease Control Partnerships

Date Published: April 30, 2008

Publisher: Public Library of Science

Author(s): Karen A. Grépin, Michael R. Reich, Juerg Utzinger

Abstract: None

Partial Text: The timely and sustained delivery of effective health interventions to communities in developing countries is one of the greatest challenges in global health. Millions of the world’s poorest citizens continue to be afflicted by bacterial, viral, and parasitic infections that have persisted, mainly in the tropics—the so-called neglected tropical diseases (NTDs)—despite the availability of safe and cost-effective interventions for the control and elimination of many of these diseases. Access to these interventions (or control tools) remains low and inadequate, particularly in sub-Saharan Africa [1],[2]. The NTDs, including onchocerciasis, schistosomiasis, lymphatic filariasis, trachoma, and soil-transmitted helminthiasis, have been shown to affect the poorest of the poor disproportionately. Addressing the NTDs, therefore, will be an essential element in poverty alleviation programs [3],[4].

Integration has been interpreted to mean different things to different organizations and individuals. In fact, many different options exist for integration. To understand the differences among these options, it is important to define with some precision the dimensions along which integration can occur. The following framework can be used to conceptualize the options based on differences in domain, level, and degree of integration.

To illustrate the above framework, we have taken real-world examples of and potential opportunities for integration in NTD control programs and have categorized them in Table 1 by level (global, national/regional, and local) and domain (activity, policy, and organizational), using the framework. For each example, the text in Table 1 describes the degree of integration.

A common understanding of the concept of integration can help guide future discussions about the opportunities and challenges for integration among NTD control programs. The framework presented in this article provides a tool for clarifying the different domains, levels, and degrees of integration. This framework has already been used in two situations: to assist in the development of new integration strategies for APOC, and to guide the development of strategies to integrate trachoma and lymphatic filariasis control programs; in both instances, the framework was helpful.



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