Strategies for integrating primary health services in middle- and low-income countries at the point of delivery

RHL practical aspects by Magtymova A

Strengthening local/national research institutions and regional and international networks to conduct rigorous evaluation studies is important to ensure quality and reliability of study results and generating evidence for national and international policy decisions.

The monitoring and evaluation (M&E) mechanisms should be an integral part of Health Management Information Systems (HMIS) where possible in order to cause fewer burden on human resources/health staff. Simple mechanisms for routine data collection should be sought with training provided for both health service providers and planners/managers (on M&E, epidemiology and biostatics). The data collection and maintenance should be part of the job description of health staff with some incentives attached to it. If not, oftentimes the data might not necessarily be of acceptable quality, incomplete or misreported.


Local health management should play a vital role in choosing integration strategies. As there is no evidence on the differential effects of integration strategies within different contexts, it is important to be vigilant and monitor the intended change by rigorous evaluation methods.


There would be implications of the integrated service provision at the primary level on the referral hospital. The effectiveness and quality of the integrated services will affect the numbers, timeliness and quality of patient referrals, thus workload, effectiveness of services at the hospital level and ultimately the health outcomes of the populations served.

Ideally, primary health care level providers should be able to:

  • recognize complications or danger signs.
  • provide first aid in emergencies, stabilize the patient, arrange a timely referral of the patient for comprehensive specialist care under medical supervision if necessary.
  • provide follow-up and rehabilitation services.

Integration of multiple basic health service should not be resulting in “deskilling” health providers in some aspects of service provision, thus it is important to train staff putting emphasis on the referrals for specialized care and maintaining strong operational linkages between primary health and referral hospitals.


Community participation as part of the evaluation studies to find the users views on integrated services have been stressed in the review. The data should be disaggregated by age, sex, education, income level and social groups, where possible, to consider issues of equity.

This document should be cited as: Magtymova A. Strategies for integrating primary health services in middle- and low-income countries at the point of delivery : RHL practical aspects (last revised: 25 September 2007). The WHO Reproductive Health Library; Geneva: World Health Organization.

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