Adding other health services to the immunization platform: Potential benefits and risks

The WHO/UNICEF Global Immunization Vision and Strategy has integration of critical health interventions with immunization as one of its four main aims, and there are efforts to increase the coverage of several health interventions by integrating their delivery into child immunization services. However the theoretical strengths of delivery integration are yet to be rigorously proven and there is little robust information on the benefits and risks. Centers for Disease Control and Prevention's research includes 1) a review of the literature undertaken to assess benefits, challenges and characteristics of integrating child and maternal health services with immunization programs, 2) recent studies in which other health interventions were integrated into child immunization services, and 3) plans for future studies of integrated service delivery. Reviewed integrated services include vitamin A supplementation, bednet distribution, deworming tablet distribution, safe water/hygiene interventions, and referrals for family planning services. From the literature review, characteristics of successful implementation included compatibility between interventions and presence of a strong immunization service prior to integration. Rapid uptake of the linked intervention and decreased competition for resources were two benefits of integration described. Overburdened staff, unequal resource allocation and logistical difficulties were among risks of integration. When additional interventions are carefully selected for compatibility and receive adequate support, coverage of these interventions may improve, provided immunization coverage is already high. Evidence for the effectiveness of integration in increasing efficiency of resource use was considered insufficient. Future studies should attempt to quantify the benefits, challenges and costs of integrated versus vertical programs.