​The Challenge

The entailing shift from health systems designed around diseases and health institutions towards health systems designed around the needs of people places a heavy demand on care coordination strategies that cut across all actors in the care continuum – including primary care providers, hospitals, community agencies and home care providers.

Most countries, however, struggle with fragmented delivery systems, which are increasingly becoming a roadblock in the context of the rise in non-communicable diseases.

Vertical integration, part of a broader care coordination strategy, aims to enable care models that are organized around the health care needs of populations. Often conceptualized in terms of referral systems, most initiatives involving vertical integration have only focused on standardizing and improving referral systems.

These initiatives have not explored other modalities of vertical integration, such as redefining the role of and interactions among health facilities, especially hospitals; linking providers at different levels to provide one another with support and technical assistance; or strengthening the quality of care across the different levels.

Even in countries that have focused on referral systems, there is a consensus that these systems have not worked well. Referral systems often encounter bureaucratic obstacles due to provider divisions, differing priorities and distinct administrative and budgeting processes, particularly in the case of primary health care, vertical disease programs, and hospitals. Taken together, these complications challenge better integration between the different levels of care.

About the Vertical Integration Learning Exchange

The Vertical Integration learning exchange aims to provide a platform for countries to share their experiences with vertical integration initiatives, learn from each other’s successes and challenges, and open the discussion on the enablers for and barriers to vertical integration.

The group will particularly focus on the financial, institutional, and logistical barriers to vertical integration and further study the transitions between primary care and hospitals, primary care and specialist care, and hospitals and home care.

Th participants in the learning exchange aim to produce a practical tool that will allow countries to both assess and learn from existing initiatives within their countries, assess institutional readiness for vertical integration, and adapt to country-specific specific contexts. The Vertical Integration learning exchange is funded by the Bill and
Melinda Gates Foundation.

Participating Countries

Indonesia, Malaysia, the Philippines, Sudan, and Vietnam

Technical Facilitators

Jerry La Forgia

Chief Technical Officer and Founding Director, Aceso Global; Population Targeting initiative

Paul Molloy

Research Analyst; Aceso Global

Joanne M. Shear

Family Nurse Practitioner; Consultant with Aceso Global

Robert Janett

Physician; Consultant with Aceso Global


Vertical Integration Learning Exchange

The JLN Vertical Integration learning exchange will meet for an in-depth joint learning session facilitated