Intro
No matter how thoroughly they are researched and how carefully they are designed, interventions are useless without mechanisms for delivering them. Delivery mechanisms are critical to both the effectiveness and the cost of any intervention. They vary considerably from one country to the next depending on broad factors like a country's economy, politics, and culture, but also on the presence of a well-functioning health system.
While conducting public health interventions in isolation is occasionally possible, for the most part, health interventions form a web of services that work best when they are coordinated. Screening provides no benefits without subsequent treatment, referrals are no help without access to the required care, and treatment centers will be overwhelmed if essential preventive care is neglected.
In a static world, any decisions about health system structure would involve a trade-off between specialization and integration, between care at one level versus that at another. However, the world is dynamic, and the key to progress is to think of health system development as a phased process, beginning with use of the institutions, resources, and staffing currently available to establish a platform for health care delivery that through time fills in, expands, and deepens the web of services and interventions offered.
This chapter discusses the challenge of implementing and delivering health interventions. It describes and assesses approaches to delivering care at different levels and then highlights a few elements of the health system that need to function across all these levels. It also discusses ways to integrate care for people in different parts of the life cycle.
"Programs based in communities can reduce the costs and barriers that impede people's access to services"
