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What is the Integra Index?

Summary: Integration is very complex and difficult to evaluate. The Integra Index is a unique measurement tool that can sufficiently describe the extent of integration at the facility level and its change over time to allow for robust impact-analysis in real world settings.

Detail: The Integra research was conducted within operational healthcare facilities to maximise the impact of the project and to ensure data validity. However, this approach also presents challenges to measuring integration. The creation of a multidimensional ‘Index’ enabled the researchers to account for the actual degree of integration at each facility over time and to account for external factors which might otherwise interfere with results. This has not been done previously for something as complex as integration of services in a ‘real world’ setting.

Whilst the need for the Index was not initially anticipated, it has enabled much greater understanding of what is required at facility level in order to achieve functioning integration.

The index is split into four dimensions and includes a total of eight indicators. All of the data comes directly from various data collection tools. The components of the index are summarized below:

Dimension  Indicator Name Data Source
Physical Integration Service availability within MCH/FP unitService availability in facilityRange services provided in each consultation room

ART location and referral

Periodic Activity Review Periodic Activity Review Costing data (clinic registers)

Client Flow tool

Temporal integration Range of services accessed daily Client flow tool
Provider Integration Range of services provided per clinical staff member Costing data (clinic registers)
Functional Integration Range of services provided in one consultationRange of services provided in 1 visit Client flow toolClient flow tool

 

In terms of the range of services, eight core services were chosen which were: 1) Antiretroviral therapy; 2) Cervical cancer screening; 3) CD4 count services; 4) HIV testing services; 5) Treatment for sexually transmitted infections; 6) Family planning; 7) Post-natal care; 8) Antenatal care

One of the interesting results from the index was that structural integration did not correlate to functional integration. In other words, the ability of a facility to provide integrated services did not necessarily mean that clients would receive integrated care. Therefore, when measuring integration it is important to measure whether clients actually receive integrated care rather than just the availability of integrated services.

Further information on the methodology and findings is available from these presentations:

  1. Presentation: Innovation in measurement to assess health service Integration & effect over time
  2. Presentation: Innovation in measuring health service Integration: The Integra Index
  3. Peer reviewed paper: forthcoming.