Integra research is being conducted in government and IPPF clinics in the three study countries, Kenya, Malawi and Swaziland. In all three countries, the implementation environment is very complex, with government policies and practices around integration in constant development.
The Integra project is seeking to embed rigorous evaluation research of the different models of integration within the ‘reality’ of the large-scale delivery of integrated HIV and SRH services, and to use the findings to strengthen ongoing service provision at each site. The focus of the evaluation is to assess the plausibility of integration leading to a range of service-related, client-related and health-related outcomes.
Logical Flow Model
To help structure the research, a ‘logic model‘ (looking at inputs, processes, outcomes) has been developed. This model encompasses the different integration components and processes, ranging from community needs through to service infrastructure along with implementation, and the perspectives of providers and clients.
This model is being used to help structure and frame different components of the research. Each component in this model is investigated using multiple methods, including an intervention-comparison design to compare more integrated and less integrated clinics; detailed economic evaluations; and quantitative and qualitative data collection tools. Collectively, this mixed-method approach to evaluation will ensure that researchers are able to capture the whole picture rather than the fragments of a disparate and fast-moving intervention, and to investigate the interconnections between the different components of integration.
Working through the model from the left-hand side to the right:
Column 1 shows the baseline readiness for integration in the study facilities (1). This influences the process of integration (Column 2), within which we explore the development of the intervention (2a), the nature of implementation of integration at the study facilities including a focus on providers (2b) together with a specific measure of the extent to which integration is actually being achieved at each study facility (2c) (regardless of whether it is considered an intervention or a comparison clinic).
These process factors in turn influence the outcomes we see at a service level, including quality of care (3a), efficiency of resources-use (3b) and services utilisation (3c) which influence the client-and health-level outcomes (4a, 4b, 4c) that we are ultimately interested in. The whole is influenced by a larger context (5a, 5b, 5c, 5d).
To view the model with findings included, click here.