By: Valerie Fitton-Kane

When you go to the doctor for a check-up, do you go just to get your blood pressure checked?  Probably not.  More than likely, your doctor checks your blood pressure, listens to your heart, takes a blood sample, and asks you lots of questions about your physical and mental symptoms.  You talk to him or her about that funny rash you had last week, and you ask for a refill on your birth control or allergy medication.  This is integrated healthcare.  Our doctors never just test for or treat one disease when they see you.  They test you for anything and everything … and they cover off contraception and other preventative care while they’re at it.

Meanwhile, our public health experts and government officials are providing all sorts of services that, while we don’t often think of them in terms of health, they do help to keep us healthy.  For example, they ensure clean, uncontaminated water comes out of your kitchen faucet every morning.  And they’re helping to drill it into your head that you need to wash your hands when you finish in the bathroom … and darn it, you better wash them correctly.

In developing countries, there aren’t always doctors and nurses, public health experts, or strong governments to provide all of these services.  Quite often, there are non-governmental organizations (NGOs) that specialize in delivering a few key services such as the treatment of eye diseases or the building of wells to provide clean water.  Some organizations, such as CARE or Save the Children, have expanded to provide a range of different services, but quite often it takes many government and non-government groups with various specialties to deliver all the services that you and I are used to.  And even then, service delivery is often pretty uneven because most of the organizations that deliver these services have to ask for donations from people like us in order to pay for the work they do.

A couple of weeks ago, I attended CARE‘s annual conference, which was focused on how organizations working in developing countries can help women and girls become healthy, educated, and self-sufficient.  Two influential people – Melinda Gates and Raj Shah (Administrator for USAID) – shared their views on the matter, and the one message that came through loud and clear was this: All of the organizations doing this work need to coordinate, collaborate, and integrate the services they provide.

Duh, right?  Integrated healthcare is what we expect in the US.  Why wouldn’t we aim to provide that service elsewhere?

Well, coordinating, collaborating, and integrating healthcare isn’t easy.  Each organization believes they provide the best service.  Each organization has different levels of resources to be able to deliver services.  Someone has to decide:

• What healthcare services are really needed? Sometimes this is obvious: Every country needs healthcare workers that can provide basic first aid and help deliver babies.  Every country needs to educate people on how to avoid infectious diseases by practicing good hygiene.  But many countries have specific diseases that plague their people, and these diseases require specific medicines and programs to address them.
• Where are healthcare services needed? Where are the people and what are the diseases and other health issues each cluster of people have in common?
• Who is best suited to provide the healthcare services needed? Can the country government handle it?  Do they need assistance from specialists or NGOs?
• How can healthcare services be delivered to the people? If some people live out in the country where there are no roads or health clinics, what is the best way to reach them with healthcare services?
• When can healthcare services be delivered? Some infectious diseases are best treated if medicine is given to everyone in the community at once.  When can we do that?

Also important: How do we ensure that people continue to get the healthcare services they need without interruption? Poor people can’t often afford healthcare services (even in the US!) and if the government or an NGO can no longer afford to provide the services for free, people won’t get the healthcare they need.  They’ll get sick and might die.

The Global Network believes that a country government is best placed to ensure coordinated, integrated healthcare is provided to its people. We work with the World Health Organization and others to help countries make plans for integrated healthcare, and we encourage NGOs to always work with a country government, not independent of it.  We don’t want to create new corps of community health workers that only offer treatment for the diseases we care about; we want to find groups of community health workers that can add neglected tropical diseases to all the other services they deliver.  We don’t want country governments or NGOs to deliver treatment for just one NTD; we want them to deliver treatment for all the NTDs that affect their population.  If one NGO is a specialist in malaria and another is a specialist in lymphatic filariasis, can’t they work together to deliver bed nets?  (Both diseases are transmitted by the same mosquito.)

It all sounds so simple and obvious, but it’s not. Governments are not always strong enough and they don’t always have enough human resources to answer the questions above and then coordinate a number of service providers.  NGOs are often competing for donor money, or sometimes they don’t agree on how to provide a particular service, so it can be hard to get them to work together.

But if we want a range healthcare services provided continuously over time to people who can’t afford to pay for it, coordination, collaboration, and integration is the only way to go.

Valerie Fitton-Kane is the Senior Resource Development Officer at Global Network for Neglected Tropical Diseases.