What We Do

Integrated Delivery

Strategy Overview

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A family planning consultation at the Virangana Avanti Bai Hospital in Lucknow, India.

A family planning consultation at the Virangana Avanti Bai Hospital in Lucknow, India.

Our Goal:

Accelerate the launch, delivery, use, and impact of life-saving and life-changing health products and services, and improve access to quality health care for people around the world.

The Challenge

At A Glance

Low- and middle-income countries are making huge strides in combating deadly diseases, but they increasingly face common, connected challenges in delivering affordable, quality health care to everyone.

We can address challenges in health care delivery by increasing the supply of effective services while maintaining efficiency, and by improving people’s experiences with the health system to build trust and demand for services.

Our Integrated Delivery team works with other foundation teams, country governments, and global and local partners to coordinate health care delivery efforts and improve health systems.

Our strategy focuses on three areas: health products and services; the systems that deliver them; and the people who provide, manage, and seek care.

Our Integrated Delivery team is led by Dana Hovig, director, and is part of the foundation’s Global Development Division.

Over the past few decades, advancements in science and medicine have helped save and improve lives around the world. However, many countries still struggle to provide essential health products and services to people in need. Challenges include products that work in clinical trials but not in the real world; a lack of data and resources needed for health system improvements; and frontline providers who don’t have the latest clinical protocols, or who aren’t adequately managed, mentored, and motivated.

While these challenges, and people’s needs, span diverse disease areas, health care is often funded, managed, and delivered in siloes. This makes delivery systems inefficient and ineffective. As a result, half of the world’s 7.3 billion people do not receive essential health services.

The Opportunity

It’s more important than ever to focus on health care delivery, which is becoming increasingly complex. In low- and middle-income settings, countries struggle with infectious and chronic disease, unprecedented levels of human mobility, and stagnant or declining donor investments.

Coordinated approaches to delivering care can help ensure that new vaccines, medicines, diagnostics, and other health tools reach the people who need them most. If we get health care delivery right, we can save and improve the lives of millions of people.

Our Strategy

An outreach worker uses a cell phone to register a mother and child near Accra, Ghana.

An outreach worker uses a cell phone to register a mother and child near Accra, Ghana.

The Integrated Delivery team works closely with other foundation teams, country governments, and global and local partners to coordinate delivery efforts and improve health systems.

Our goal is to accelerate the launch, delivery, use, and impact of life-saving and life-changing health products and services. We want to make sure quality health products and services reach the people who need them most, when they need them, and at a cost they can afford.

We believe that improving coordination and taking a systemwide approach can help address two key challenges in health care delivery: increasing the supply of effective services while maintaining efficiency, and improving people’s experiences with the health care system to build trust and demand for services.

Areas of Focus

Products and Services

Every health system needs safe and effective products and services, including medicines, vaccines, and diagnostics. But to support better health, these tools must work for the people and communities who need them.

The Integrated Delivery team invests in products and services that are easy to use and affordable. We have two key priorities:

1. Rethinking products and services from the patient perspective: Products and services must be designed with people’s real needs in mind. For example, while more women are giving birth in health clinics, those facilities are often overcrowded, unclean, or lack the supplies needed to guarantee women and babies a safe and comfortable experience. We partnered with the foundation’s Maternal, Newborn, and Child Health team to rethink the design of labor wards in low- and middle-income countries.

2. Introducing life-saving interventions affordably: Products must be affordably and sustainably priced. We support teams to address pricing challenges by taking steps such as incentivizing research and development while ensuring affordability, and matching supply with demand. For instance, we work with the foundation’s HIV team to assess the demand for HIV self-tests, support manufacturers with product development and approval, and ultimately lower prices so self-tests can be used widely.

Systems

Primary health care is a person’s first point of contact with the health system, whether that be in the home, the community, or in a health facility. Primary health care can and should be a person’s first and main source for care. Effective primary health care connects people with trusted providers who can address the majority of their health needs at every stage of life. In countries with strong primary health care systems, fewer children die before their 5th birthday, and more people live longer, healthier lives.

The Integrated Delivery team works with countries and partners to improve the design, financing, and management of primary health care systems:

A mother feeds oral rehydration solution to her child in Dhaka, Bangladesh.

A mother feeds oral rehydration solution to her child in Dhaka, Bangladesh.

Design: While there are recognized best practices in health system design, there is no one-size-fits-all approach. We work closely with governments, stakeholders, and our offices in Ethiopia, India, and Nigeria to help design and implement tailored health sector reforms and strategies. We also work with partners to improve key parts of the health system, from harmonizing supply chain investments to deploying information communications technology.

Financing: Many countries spend very little on health overall, and even less on primary health care—despite the fact that strong primary care can meet 90 percent of people’s health needs. As we work to ensure enough money is flowing into health systems, we also aim to understand how money is being spent so that countries and partners can direct resources to the areas of greatest need. We also help countries purchase health services more effectively, including by using the private sector for health care delivery.

Management: Lack of data on health system performance is a major barrier to improvement. We help countries and partners collect the information they need to pinpoint gaps and make smart investments in health systems, particularly in service delivery. For instance, we joined the World Health Organization and World Bank to launch the Primary Health Care Performance Initiative, which tracks key performance indicators for primary health care systems.

People

People form the heart of the health system—from the managers who support health workers and keep the system functioning, to frontline health workers, to the patients seeking care. We know efforts to improve health systems must be led by countries, and we also recognize that health system managers and providers often don’t have the tools they need. Moreover, many programs fail to take people’s actual needs and behaviors into account.

The Integrated Delivery team supports people in three key ways:

1. Investing in health system “middle managers”: Health system managers play a crucial role in the health workforce. Emerging studies suggest that investments in management can drive sustained improvements without substantial resources. This is especially true for “middle managers” working at the district, local, facility, or community level. We support efforts to provide tools, training, and mentorship for these middle managers, who serve as a critical lynchpin for any well-functioning primary health care system.

A health extension worker in Ethiopia teaches about nutrition, breastfeeding, and vaccinations.

A health extension worker in Ethiopia teaches about nutrition, breastfeeding, and vaccinations.

2. Equipping the frontline of care: Whether it’s a friend, the internet, a community health worker, a drug shop, or a primary health care facility, the first point of contact people turn to for health information influences whether they get the care they need. To strengthen this “frontline,” we focus on piloting and scaling interventions, such as mobile health (mHealth) technologies, to make providers’ work easier and better.

3. Building and sharing evidence on demand creation and behavior change: A variety of dynamic social, cultural, and economic factors influence people’s health knowledge, attitudes, and behaviors. We promote the design of programs that empower people to make better health decisions, including by building evidence on what’s working and why. For example, we found that embedding messages on safer sex practices and HIV testing into the popular Nigerian TV show MTV Shuga positively influenced viewers’ behavior. Based on this success, we supported the foundation’s Family Planning team to incorporate additional messages into the show.

 

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