Integrated Primary Healthcare Delivery (ISD)

Strengthening clinical and community service delivery for maternal, newborn, child, and respiratory health across northern Cameroon.

Core Dimensions:
🏥 Maternal & Neonatal Care 👶 iCCM & Pediatric IMCI 🫁 Active Respiratory Care 🔄 Bidirectional Referral Networks

Integrated Service Delivery (ISD)

Strengthening clinical and community service delivery for maternal, newborn, child, and respiratory health across northern Cameroon.

Primary healthcare consultation in northern Cameroon

Moving from Fragmented Disease Silos to Person-Centered Primary Care

Historically, health programming in low- and middle-income countries (LMICs) has suffered from vertical, single-disease approaches. While effective for isolated outbreaks, vertical interventions create fragmented care, burden overworked healthcare staff, and leave patients with overlapping conditions undiagnosed.

Integrated Service Delivery (ISD) reorganises health services so that patients receive comprehensive, person-centered care during a single point of contact with the health system.

Documented Advantages of ISD over Isolated Disease Models

Evidence-backed rationale for consolidating maternal, pediatric, and chronic respiratory interventions.

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Maximises Patient Contact and Equity

A mother bringing her child for routine immunisation or an iCCM consultation can be screened for respiratory symptoms and receive family planning counseling during the same visit, drastically reducing out-of-pocket costs and travel burdens.

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Optimises Health Workforce and Resource Use

Rather than training clinical staff on separate, competing disease protocols, ISD equips healthcare workers with unified, syndromic algorithms, maximising efficiency in low-resource primary healthcare (PHC) settings.

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Eliminates Diagnostic Blind Spots

Overlapping symptoms, such as a persistent pediatric cough caused by pneumonia, asthma, or tuberculosis are systematically evaluated rather than misdiagnosed through single-disease filters.

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Strengthens Health System Resilience

Integrated supply chains, unified data collection (DHIS2), and multi-condition referral pathways strengthen the entire PHC platform rather than leaving behind fragile disease siloes.

Core Operation Focus Areas

Bridging community and facility care across maternal, neonatal, child, and chronic respiratory health.

001 Maternal & Child Health

Comprehensive MNCH Care and iCCM Expansion

Standardizing end-to-end clinical and community care pathways from village households to health facility delivery rooms.

Reinforce Integrated Community Case Management (iCCM)

Training and equipping Community Health Workers (CHWs) to diagnose and treat childhood pneumonia, malaria, and diarrhea at the village level.

Integrated Management of Childhood Illness (IMCI)

Standardizing facility-based triage and treatment protocols for infants and young children presenting with acute infections or nutritional deficits.

Continuity of Maternal and Newborn Care

Linking antenatal care (ANC) visits, skilled birth attendance, post-natal checks, and family planning into a seamless continuum.

002 Non-Communicable Diseases

Primary Respiratory Health and Chronic Lung Care

Decentralizing chronic respiratory disease detection to frontline facilities using pragmatic diagnostic tools and task-shifting.

Active Case Finding (ACF)

Systematic symptom screening for chronic respiratory conditions (Asthma, COPD, Tuberculosis) integrated into routine PHC consultations and community outreach.

Early Screening and Management

Equipping primary health centers with essential diagnostic tools (such as pulse oximetry, peak flow meters, and AI-assisted triage tools) to detect airflow obstruction early and initiate baseline management.

Core Pragmatic Activities

THRIVE operationalizes Pillar 1 across health facilities and target communities through seven core technical activities:

Activity 01

Integrated Multi-Disease Screening Protocols

Designing unified clinical protocols that group diseases sharing similar symptom profiles or clinical management pathways:

Pediatric Care Integration

Coupling iCCM and IMCI algorithms with early screening for childhood illnesses.

Adult Respiratory Integration

Combining active case finding for TB, Asthma, and COPD during routine primary care consultations, using standardized symptom checklists.

Activity 02

Standardising Triage, Referral, and Counter-Referral Pathways

Establishing clear, bidirectional clinical pathways that connect communities, primary health centers (CSI - Centres de Santé Intégrés), and district hospitals:

Standardised Triage & Emergency Referral

Implementing standardised referral slips and digital tracking tools to ensure patients with severe respiratory distress or obstetric emergencies reach secondary care rapidly.

Specialist Counter-Referral Protocols

Establishing formal counter-referral protocols so district hospital specialists can safely transition stabilised chronic asthma/COPD patients back to PHC facilities for long-term maintenance.

Activity 03

Integrated Clinical Skills and Capacity Building

Conducting targeted clinical capacity initiatives under unified, practical competency frameworks:

Joint Task-Shifting Curricula

Conducting joint task-shifting training programs for nurses and CHWs covering reproductive, maternal, pediatric, and chronic lung care under a unified curriculum.

Supervisory Mentoring Visits

Establishing quarterly clinical mentoring and supportive supervision visits in collaboration with District Medical Officers (DMOs).

Activity 04

Essential Medicine & Diagnostic Availability

Securing predictable point-of-care availability for vital frontline therapeutics and tools:

Essential Supply Chain Mapping

Mapping and strengthening the supply chain for essential primary care commodities including inhalers (salbutamol), spacer devices, pediatric antibiotics, oral rehydration salts (ORS), zinc, and oxytocin.

Low-Cost Point-of-Care Diagnostics

Distributing low-cost, durable diagnostic tools (pulse oximeters, peak flow meters, pediatric stethoscopes) tailored for low-resource PHC environments.

Activity 05

Point-of-Care Health Data Harmonisation

Eliminating reporting silos through seamless, frontline digital recording tools:

Single-Encounter Patient Records

Streamlining clinical registers and digital tools (e.g., ODK, KoboToolbox) so health workers capture integrated patient records during a single encounter without redundant documentation.

National DHIS2 System Alignment

Aligning primary care data indicators directly with the national Health Management Information System (DHIS2).

Activity 06

Facility-Community Linkage & Household Follow-up

Bridging clinical triage with proactive community engagement and home care:

Structured High-Risk Home Visits

Mobilising Community Health Workers to conduct structured home visits for high-risk maternal clients, postpartum mothers, and patients managing chronic respiratory conditions.

Community Adherence Tracking

Tracking treatment adherence and appointment attendance at the community level to minimise loss-to-follow-up.

Activity 07

Quality Improvement (QI) Learning Cycles

Instilling continuous, localized performance refinement at health facility levels:

Facility-Level QI Peer Review

Establishing facility-level QI teams that review monthly service delivery data to identify bottlenecks in maternal or respiratory care.

Localised PDSA Testing

Testing and iteratively validating localized clinical solutions using Plan-Do-Study-Act (PDSA) quality improvement cycles.

Strategic Alignment

Explore Connected Programs & Subsequent Pillars

See how Integrated Primary Healthcare Delivery connects seamlessly with Health Systems Strengthening, Implementation Research, and Community SBC.