Grant: Travel Awards - Institute Community Support

Background: Strengthening health-systems requires multi-stakeholders partnerships through the integration of vertical programs to increase availability, access, affordability, and use of medicines and services. This review explores inputs, organization, and outcomes of efforts to coordinate and integrate vertical interventions to increase efficiency, quality, acceptability and coverage among national health services in sub-Saharan Africa. It informs a developing research agenda for responsive and resilient health systems integration in three selected countries. Methods: Through a scoping review process, the articles documenting integration of vertical programmes within health systems in sub-Saharan Africa (SSA) in general and Cameroon, Nigeria and Rwanda were sought through searches of the following seven electronic databases: PubMed, Medline, EMBASE, African Journals Online, Evidence Based Medicine Reviews, Google Scholar, and Cairn, between 1996-2016. Results: Most integration research has focused on linkages between a few closely related health services and not on the whole system. Implementation challenges to extend from partial integration to full integration and include the lack of coordinated leadership and unified national integration policies; continued separate financing streams; inadequate health worker training, supervision and retention. Conclusions: Well-funded, technically supported vertical programmes perform on single diseases and can lead to positive synergies when integrated but opportunities to strengthen local health systems are generally missed, especially in Cameroon, among our studied countries. There is a continued research gap on health systems integration as a whole or in the wider context of services and settings regarding impact, performance and economic evaluation for sustainability (resilience) and responsiveness.