1. Integrated Service Delivery Case Study: Kenya Erin E. Sullivan, Ph.D. Global Health Delivery Project Harvard School of Public Health July 16, 2010

2. Kileken ole-MoiYoi, Erin Sullivan, Nayana Dhavan, George Kimathi, Joseph Rhatigan, Ephantus Kabiru, Rebecca Weintraub

3. Data Collection 50 key informants –Well-defined roles in the country’s health system – Represented: Government of Kenya Kenya-based NGOs Internationally-based NGOs Multilateral organizations Private sector

4. Kenya: Country Context Population: 38.5 million Life expectancy: 56 for females 53 for males UN Human Development Index: 147 out of 182 GDP per capita: US$ 1,590 (in PPP)

5. Kenya: Health System

6. Integration of HIV Program with Health System Health System FunctionIntegration with Health System Stewardship and GovernanceNone FinancingNone PlanningNone Service Delivery Human Resources None InfrastructureModerate Procurement & Supply Chain Moderate Monitoring and EvaluationLimited Demand GenerationNone

7. HIV Program Financing GoK Ministry of Medical Services Ministry of Public Health & Sanitation Office of the President NACC

8. Integration of HIV Program with Health System Health System FunctionIntegration with Health System Stewardship and GovernanceNone FinancingNone PlanningNone Service Delivery Human Resources None InfrastructureModerate Procurement & Supply Chain Moderate Monitoring and EvaluationLimited Demand GenerationNone

9. Integration of HIV Program with Health System Health System FunctionIntegration with Health System Stewardship and GovernanceNone FinancingNone PlanningNone Service Delivery Human Resources None InfrastructureModerate Procurement & Supply Chain Moderate Monitoring and EvaluationLimited Demand GenerationNone

10. Integration Challenges Global Fund model Limited infrastructure to support programs Poor M&E structures Conflicts of interest within the CCM Delays in funding

11. System-wide Effects Concerns about long-term sustainability Neglect of non-target diseases Parallel systems Human resource challenges

12. Conclusions Disease programs should improve integration with public health system A relatively strong health system maximizes Global Fund resources Investments in workforce, infrastructure and government capacity ensure sustainability Coordination and alignment between health system stakeholders is needed

13. Further Research Sustainability and governmental capacity Donor alignment and management

15. Integration ‘integration’—a term loosely used to describe a variety of organizational arrangements for a range of programmes in different settings. we define integration as the extent, pattern, and rate of adoption and eventual assimilation of health interventions into each of the critical functions of a health system which include, (i) governance, (ii) financing, (iii) planning, (iv) service delivery, (v) monitoring and evaluation (M&E), and (vi) demand generation.