Integración de los servicios de inmunización con otras intervenciones de salud en países en vías de desarrollo: ¿Qué funciona y porqué? Revisión sistemática de la literatura

Summary Objective  To assess benefits, challenges and characteristics of integrating child and maternal health services with immunization programmes. Methods  Literature review using journal databases and grey literature. Papers meeting the inclusion criteria were rated for the quality of methodology and relevant information was systematically abstracted. Results  Integrated services were vitamin A supplementation, bednet distribution, deworming tablet distribution, Intermittent Preventive Therapy for infants and referrals for family planning services. Two key characteristics of success were compatibility between interventions and presence of a strong immunization service prior to integration. Overburdened staff, unequal resource allocation and logistical difficulties were mentioned as risks of integration, whereas rapid uptake of the linked intervention and less competition for resources were listed as two key benefits of integration. Conclusion  The theoretical strengths of integrating other health services with immunization services remain to be rigorously proved in practice. When additional interventions are carefully selected for compatibility and when they receive adequate support, coverage of these interventions may improve, provided immunization coverage is already high. Evidence for the effectiveness of integration in increasing efficiency of resource use was insufficient and most benefits and challenges were not statistically quantified. More substantive information about the costs of integrated vs. vertical programmes and full documentation of the impacts of integration on immunization services should be published.