Integrating PHC services: evidence from Narangwal, India. Health Policy and Planning 2

Integration of services within primary health care is a concern which continues to be debated. The current advocacy for introducing selective and vertically organized health care interventions is the latest in a series of swings in the balance between integrated and vertical approaches. This paper reviews the findings from Narangwal in North India, where several experimental packages of primary health care services were introduced into different sets of villages. Significant reductions occurred in morbidity and mortality in children, their growth improved and family planning use increased, all at a combined cost of about $US 2.00 per capita (1971 prices). Integrated or combined services generally performed at least as well as more selective approaches and because of their integrated nature were often more efficient. The major advantage of integrated services was that they provided multiple benefits, an important consideration in areas with many competing causes of morbidity and mortality. Although it was not demonstrated conclusively that either women's and children's health services or family planning services improved the utilization of the other, the results lend support to the value of integrating these services. It was concluded that Narangwal demonstrated the potential of an incremental approach to integration, based on a process of learning by experience and supported by a continuous feedback of information from both formal and informal assessments