1. 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

2. 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.

3. 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

4. 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

5. 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.

6. 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.