Health Systems Analysis A practical approach Integration of Health Systems and Priority Health, Nutrition and Population Interventions, A Framework for Analysis and Policy Choice R Atun et al 2008

Objective: Examine how a health program innovation is introduced and incorporated into a health system An innovation in this context refers to the combination of technologies, inputs into service delivery, organizational changes and modifications in processes related to decision making, planning and service delivery.

Definition of integration The extent, pattern, and rate of adoption and assimilation of an innovation into each of the critical functions of a health system: Governance Financing Planning Service delivery M&E Demand generation

Empirical Evidence The innovation The diffusion and dissemination of the innovation The adaptation and translation process Factors related to implementation and routinization We already know that there are at least four distinct parts influencing the success of the adaptation and success of the new innovation: The innovation itself – complexity How the innovation is perceived by the users and adopters Contextual circumstances – what the local context looks like and how the innovation can be adapted to fit into that context. Health systems factors – strucutres in the health system and absorptive capacity

The Conceptual Framework The problem The intervention The adoption system The health system characteristics The context Based on the empirical evidence we have a conceptual framework which use fairly easy to use and to understand. The general idea is that the extent to which an innovation will be adopted and assimilated into the general health system depends on: The nature of the problem being addressed: The scale of the burden will influence the perceived necessity for response, rapid response, slow incremental response etc The intervention: The complexity of the intervention, technology, users, levels, stakeholders etc The adoption system: What is the system for adoption in the organization (health systems), number of key actors with varied interests, values etc inc health workers, patients, professional associations, CSOs etc etc The Health System Characteristics: Adoption and integration means regulatory, organizational, financial, clinical and relational changes involving multiple stakeholders. This integration should be seen in all the critical functions. The context: Political, legal, ecological, socio-cultural factors that influence the adoption and assimilation of an innovation into the health system.

Assignment for discussion MoH in Tanzania has decided that bed-nets are to be distributed for free in two districts in the Rufiji delta area where malaria is endemic. Discuss issues and potential problems in relation to the implementation of this project and its integration into the health system, using the conceptual framework.