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Professor Rifat Atun MBBS MBA FRCGP FFPH FRCP Professor of International Health Management Imperial College Business School and Faculty of Medicine Imperial College London
Malaria in Pregnancy An analysis of achievements and limitations to meeting Women’s comprehensive needs during pregnancy Istanbul Imperial College London 26-28 June 2012
Preventing mother-to-child transmissionCoverage of antenatal care services and services for preventing mother-to-child transmission among women living with HIV in high-prevalence countries, 2010
Source: The Lancet 2010; 375:2032-2044 (DOI:10.1016/S0140-6736(10)60678-2)
Proportion of livebirths attended by skilled personnel in 34 Countdown countries with nationally representative measurements around 2000 and around 2008
Primary Community Secondary Primary Community Secondary
b. Partial integration c. Horizontal or vertical integration
Potential integration strategies within and across care domains
Atun et al.: Integration of priority population, health and nutrition interventions into health systems: systematic review. BMC Public Health 2011 11:780. 18
Substance abuse treatment with integrated medical treatment of substance abuse-related co-morbidities
Improved abstinence. Cost effective
Mental health provision in PHC (Gater 1997, Watts 2007)
Depression and schizophrenia treatment integrated into PHC
Improved access and treatment, resources more effectively used
Atun et al.: Integration of priority population, health and nutrition interventions into health systems: systematic review. BMC Public Health 2011 11:780.
Integration of Targeted Health, Nutrition and Population Interventions: Cochrane+ Review
Atun R, de Jongh T, Secci F, et al, A systematic review of the evidence on integration of targeted health interventions into health systems. Health Policy & Planning 2010; 25 :1-14
Tudor Car L, van-Velthoven MH, Brusamento S, Elmoniry H, Car J, Majeed A, Atun R, Integrating prevention of mother-to-child HIV transmission (PMTCT) programmes with other health services for preventing HIV infection and improving HIV outcomes in developing countries., Cochrane Database Systematic Review 2011
One study • Integra3ng HIV tes3ng and NVP
adherence assessment at labour ward resulted in substan3al increase in mother-‐infant NVP coverage.
• No research assessing the impact on coverage of integra3ng with other perinatal PMTCT interven3ons
Key barrier (3): imbalance in health and financing policies
Industrial policies encourage technology push, but health systems constrain innovation:
– Not enough emphasis on demand side factors – Inadequate incentives and downstream rewards
for adoption – Inefficiency/ineffectiveness tolerated – No incentives for innovation
Atun RA, Gurol-Urganci I, Sheridan D. Uptake and diffusion of pharmaceutical innovations in health systems. International Journal of Innovation Management 2007; 11 (2): 299-321
Fisk NM, McKee M, Atun R. Relative and absolute addressability of global disease burden in maternal and perinatal health by investment in R&D. Trop Med Int Health 2011. Apr 7. doi: 10.1111/j.1365-3156.2011.02778.x.
Atun R, et al. A systematic review of the evidence on integration of targeted health interventions into health systems. Health Policy and Planning 2010; 25: 1-14.