title: Integrated Healthcare Delivery: A Qualitative Research Approach to Identifying and Harmonizing Perspectives of Integrated Neglected Tropical Disease Programs.
abstract: BACKGROUND
  While some evidence supports the beneficial effects of integrating neglected tropical disease (NTD) programs to optimize coverage and reduce costs, there is minimal information regarding when or how to effectively operationalize program integration. The lack of systematic analyses of integration experiences and of integration processes may act as an impediment to achieving more effective NTD programming. We aimed to learn about the experiences of NTD stakeholders and their perceptions of integration.
  
  
  METHODS
  We evaluated differences in the definitions, roles, perceived effectiveness, and implementation experiences of integrated NTD programs among a variety of NTD stakeholder groups, including multilateral organizations, funding partners, implementation partners, national Ministry of Health (MOH) teams, district MOH teams, volunteer rural health workers, and community members participating in NTD campaigns. Semi-structured key informant interviews were conducted. Coding of themes involved a mix of applying in-vivo open coding and a priori thematic coding from a start list.
  
  
  RESULTS
  In total, 41 interviews were conducted. Salient themes varied by stakeholder, however dominant themes on integration included: significant variations in definitions, differential effectiveness of specific integrated NTD activities, community member perceptions of NTD programs, the influence of funders, perceived facilitators, perceived barriers, and the effects of integration on health system strength. In general, stakeholder groups provided unique perspectives, rather than contrarian points of view, on the same topics. The stakeholders identified more advantages to integration than disadvantages, however there are a number of both unique facilitators and challenges to integration from the perspective of each stakeholder group.
  
  
  CONCLUSIONS
  Qualitative data suggest several structural, process, and technical opportunities that could be addressed to promote more effective and efficient integrated NTD elimination programs. We highlight a set of ten recommendations that may address stakeholder concerns and perceptions regarding these key opportunities. For example, public health stakeholders should embrace a broader perspective of community-based health needs, including and beyond NTDs, and available platforms for addressing those needs.
authors: Department of Global Health, University of Washington, Seattle, Washington, United States of America.
authors: Arianna Rubin
authors: http://orcid.org/0000-0002-4087-7080
authors: AR
authors: Means
authors: Neglected Tropical Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America.
authors: Julie
authors: J
authors: Jacobson
authors: Neglected Tropical Diseases, Global Health, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America.
authors: Aryc W
authors: AW
authors: Mosher
authors: Department of Global Health, University of Washington, Seattle, Washington, United States of America.|Departments of Medicine, Pediatrics, Epidemiology, University of Washington, Seattle, Washington, United States of America.
authors: Judd L
authors: JL
authors: Walson
mesh_terms: D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated; D006801:Humans; D058069:Neglected Diseases; D015397:Program Evaluation; D011634:Public Health; D036301:Qualitative Research; D014330:Tropical Medicine