Community and health worker perceptions and preferences regarding integration of other health services with routine vaccinations: four case studies.
BACKGROUND
Integration of routine vaccination and other maternal and child health services is becoming more common and the services being integrated more diverse. Yet knowledge gaps remain regarding community members and health workers acceptance, priorities, and concerns related to integration.


METHODS
Qualitative health worker interviews and community focus groups were conducted in 4 African countries (Kenya, Mali, Ethiopia, and Cameroon).


RESULTS
Integration was generally well accepted by both community members and health workers. Most integrated services were perceived positively by the communities, although perceptions around socially sensitive services (eg, family planning and human immunodeficiency virus) differed by country. Integration benefits reported by both community members and health workers across countries included opportunity to receive multiple services at one visit, time and transportation cost savings, increased service utilization, maximized health worker efficiency, and reduced reporting requirements. Concerns related to integration included being labor intensive, inadequate staff to implement, inadequately trained staff, in addition to a number of more broad health system issues (eg, stockouts, wait times).


CONCLUSIONS
Communities generally supported integration, and integrated services may have the potential to increase service utilization and possibly even reduce the stigma of certain services. Some concerns expressed related to health system issues rather than integration, per se, and should be addressed as part of a wider approach to improve health services. Improved planning and patient flow and increasing the number and training of health staff may help to mitigate logistical challenges of integrating services.
Global Immunization Division, US Centers for Disease Control and Prevention, Atlanta, Georgia 30307, USA. tryman@cdc.gov
Tove K
TK
Ryman
Aaron
A
Wallace
Richard
R
Mihigo
Patricia
P
Richards
Karen
K
Schlanger
Kelli
K
Cappelier
Serigne
S
Ndiaye
Ndoutabe
N
Modjirom
Baba
B
Tounkara
Gavin
G
Grant
Blanche
B
Anya
Emmanuel C
EC
Kiawi
Cliff
C
Ochieng
Sekou
S
Kone
Habtamu
H
Tesfaye
Nathan
N
Trayner
Margaret
M
Watkins
Elizabeth T
ET
Luman
D002163:Cameroon; D002648:Child; D002662:Child Health Services; D003153:Community Health Services; D019033:Delivery of Health Care, Integrated; D005002:Ethiopia; D006282:Health Personnel; D006801:Humans; D007630:Kenya; D008302:Mali; D008427:Maternal Health Services; D010465:Perception; D014611:Vaccination