Our analysis shows few instances where there is full integration of a health intervention or where an intervention is completely non-integrated .
Instead , there exists a highly heterogeneous picture both for the nature and also for the extent of integration .
Health systems combine both non-integrated and integrated interventions , but the balance of these interventions varies considerably
A longst and ing debate on health systems organization relates to benefits of integrating  health programmes that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes .
This debate has long been characterized by polarization of views and ideologies , with protagonists for and against integration arguing the relative merits of each approach .
However , all too frequently these arguments have not been based on hard evidence .
The presence of both integrated and non-integrated programmes in many countries suggests there may be benefits to either approach , but the relative merits of integration in various context s and for different interventions have not been systematic ally analysed and documented .
In this paper we present findings of a systematic review that explores a broad range of evidence on : ( i ) the extent and nature of the integration of targeted health programmes that emphasize specific interventions into critical health systems functions , ( ii ) how the integration or non-integration of health programmes into critical health systems functions in different context s has influenced programme success , ( iii ) how context ual factors have affected the extent to which these programmes were integrated into critical health systems functions .
Integrated Management of Childhood Illness (IMCI) in Bangladesh: early findings from a cluster-randomised study
BACKGROUND We report the preliminary findings from a continuing cluster r and omised evaluation of the Integrated Management of Childhood Illness ( IMCI ) strategy in Bangladesh . METHODS 20 first-level outpatient facilities in the Matlab sub-district and their catchment areas were r and omised to either IMCI or st and ard care . Surveys were done in households and in health facilities at baseline and were repeated about 2 years after implementation . Data on use of health facilities were recorded . IMCI implementation included health worker training , health systems support , and community level activities guided by formative research . FINDINGS 94 % of health workers in the intervention facilities were trained in IMCI . Health systems supports were generally available , but implementation of the community activities was slow . The mean index of correct treatment for sick children was 54 in IMCI facilities compared with 9 in comparison facilities ( range 0 - 100 ) . Use of the IMCI facilities increased from 0.6 visits per child per year at baseline to 1.9 visits per child per year about 21 months after IMCI introduction . 19 % of sick children in the IMCI area were taken to a health worker compared with 9 % in the non-IMCI area . INTERPRETATION 2 years into the assessment , the results show improvements in the quality of care in health facilities , increases in use of facilities , and gains in the proportion of sick children taken to an appropriate health care provider . These findings are being used to strengthen child health care nationwide . They suggest that low levels of use of health facilities could be improved by investing in quality of care and health systems support
Our analysis shows few instances where there is full integration of a health intervention or where an intervention is completely non-integrated .
Instead , there exists a highly heterogeneous picture both for the nature and also for the extent of integration .
Health systems combine both non-integrated and integrated interventions , but the balance of these interventions varies considerably
A longst and ing debate on health systems organization relates to benefits of integrating  health programmes that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes .
This debate has long been characterized by polarization of views and ideologies , with protagonists for and against integration arguing the relative merits of each approach .
However , all too frequently these arguments have not been based on hard evidence .
The presence of both integrated and non-integrated programmes in many countries suggests there may be benefits to either approach , but the relative merits of integration in various context s and for different interventions have not been systematic ally analysed and documented .
In this paper we present findings of a systematic review that explores a broad range of evidence on : ( i ) the extent and nature of the integration of targeted health programmes that emphasize specific interventions into critical health systems functions , ( ii ) how the integration or non-integration of health programmes into critical health systems functions in different context s has influenced programme success , ( iii ) how context ual factors have affected the extent to which these programmes were integrated into critical health systems functions .