Abstract:
Background: Health systems integration is becoming increasingly important as the global health community
transitions from acute, disease-specific health programming to models of care built for chronic diseases, primarily
designed to strengthen public-sector health systems. In many countries across sub-Saharan Africa, including
Kenya, prevention of mother-to-child transmission of HIV (pMTCT) services are being integrated into the general
maternal child health (MCH) clinics. The objective of this study was to evaluate the benefits and challenges for
integration of care within a developing health system, through the lens of an evaluative framework.
Methods: A framework adapted from the World Health Organization’s six critical health systems functions
was used to evaluate the integration of pMTCT services with general MCH clinics in western Kenya.
Perspectives were collected from key stakeholders, including pMTCT and MCH program leadership and
local health providers. The benefits and challenges of integration across each of the health system functions
were evaluated to better understand this approach.
Results: Key informants in leadership positions and MCH staff shared similar perspectives regarding benefits
and challenges of integration. Benefits of integration included convenience for families through streamlining
of services and reduced HIV stigma. Concerns and challenges included confidentiality issues related to HIV
status, particularly in the context of high-volume, crowded clinical spaces.
Conclusion and Global Health Implications:The results from this study highlight areas that need to be
addressed to maximize the effectiveness and clinical flow of the pMTCT-MCH integration model. The lessons
learned from this integration may be applied to other settings in sub-Saharan Africa attempting to integrate
HIV care into the broader public-sector health system.
