Comparing Integrated Management of Child Illnesses at Kawempe Health Center (IV) in Uganda, Vertically Integrated Health System and a Horizontally Integrated Health System at two centers in San Francisco County California USA.

INTRODUCTION

In Uganda, a country in East Africa, collaboration with International teaching Hospitals has helped create opportunities for transfer of knowledge, best-practices and skills that would otherwise not be available at lower level health facilities. The Liverpool-Mulago Collaboration is one such example. This resulted in the integrated management of childhood illnesses where: identifying families with expecting mothers; immunization drives; neonatal care; postnatal care; involving men in caring for expectant mothers; voluntary medical male circumcision; HIV/STIs checking; Partner counselling; and home-based nutrition plans are performed as packaged health services. In USA, the San Francisco Bay Area’s San Francisco County has various health delivery services that are combined as a single package. In this discussion, one will read briefly about Kawempe Health Center (IV),  Kaiser Permanente (KP) and Mercy Housing.

Access is a proxy measure for patient experience around which health delivery is built. Access can be initiated in form of collaboration, vertical integration or horizontal integration. These three strategies make the initiatives provide better health outcomes such as: collaboration, integration and service expansion accessible to the people who need them.  Collaboration creates space for transfer of  health delivery skills, human resource,  capital and logistics (LMP, 2014). Integration is as a result of acquisition, merger, alliance networks and joint ventures. Service integration includes extension of core product or service and this is known as horizontal integration. 

The kind that involves entry into a new type of service along the continuum of care provides diversified services is called vertical integration. Vertical integration provides proximity to different services, specialties, research, clinic trials and availability of different health professionals (Memorial Hermann, 2015).  For the sake of this discussion, access is the ability of a person to obtain health care services when needed (Shi, 2015).

(i) Kawempe Health Center (IV), Kampala Uganda

Kawempe Health Centre (IV) is about 5-6 miles away from the National Referral Hospital, Mulago. The health facility is used as a primary health unit that offsets the congestion or referrals at Mulago. This ensured such activities that led to  over 6,000 deliveries per year (LMP, 2014). Funds to pay for resident doctors, a functioning operating theatre, blood transfusion facilities and Uganda government commitment to improve the functionality of Kawempe Health Centre have seen a fresh start there. Currently such services like caesarean sections and Voluntary Medical Male Circumcision are conducted there. This in turn is reducing the number of referrals to Mulago Hospital. Other services include: Mother and Child health services; Youth Friendly Services; HIV and STI counseling services; Laboratory Services;health Management Information Services; primary care;and a Health Centre (III) with a fully functional maternity unit. The long-term volunteers continue to offer support and training to the local midwives in areas such as neonatal resuscitation, patient monitoring and emergency obstetric skills. The form of collaboration has elements of vertical integration and is known for its cost-effective care with quality services to its enrollees. It is a yellow-star awardee providing quality services and access to healthcare services for a wide ranging population in Kawempe Division (a division of Kampala Capital City Authority-KCCA). 

The implications of  collaboration and integration for the management of the organization is that it has brought about facilitation that promotes healthy outcomes for the urban/sub-urban communities.

(ii) Kaiser Permanente, San Francisco Bay Area California USA

Kaiser Permanente is a vertically integrated health system that links services at different stages in the production process of health care, e.g., organization of primary care, acute care, post acute services and a hospital (Kaiser Permanente. (2014). The vertically integrated health system provides an environment in which an important element of health delivery or provision called access is possible. As one of America’s leading health care providers and not-for-profit health plans, founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of members and the communities. Kaiser Permenente serves more than 10 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health (kp.org/share). Kaiser Permenente provides employment, care, coverage, a list of doctors to choose from, get lab tests, and pick up medications all in one place. Under the same arrangement one is able to purchase individual or family health pan; Medicaid/Medical; Medicare; Employer-sponsored plans; as well as explore employment opportunities. Kaiser Permanente health plans ware expended to include breast cancer screenings and early detection (kp.org/healthy). The form of integration exhibited by Kaiser Permenente is known for its cost-effective care with quality services to its enrollees (Shi, 2015). It is a top-notch provider of quality services and it continues to provide access to healthcare services for a wide ranging population in Northern California. 

The implications of integration for the management of the organization is that scattered  entities are under one mutually cooperative arrangement. This has significant influence on patient well being as well as the patient/consumer experience along the continuum of care. Being under one roof the following six features, i.e., safety, effectiveness, patient-centeredness, timeliness, efficiency and equitable services that close the gap for minorities or underserved population groups are achievable.

(ii) Mercy Housing  San Francisco Bay Area California USA

Mercy Housing is in 41 states of US and is an example of horizontal integration that I chose to share with you. Mercy Housing, a national nonprofit organization, is working to build a more humane world where poverty is alleviated, communities are healthy and all people can develop to their full potential. Affordable housing and supportive programs improve the economic status of residents, revitalize neighborhoods and stabilize lives. Mercy Housing one of the nation’s largest affordable housing organizations participates in the development, preservation, management and/or financing of affordable, program-enriched housing across the country. It serves a variety of populations with housing projects for low-income families, seniors and people with special needs. It acquires and renovates existing housing, as well as develop new affordable rental properties. Mercy Housing created a stable foundation where residents can explore their full potential, supported by practical resident programs such as health classes, financial education, employment initiatives, parenting and after-school programs for children. Residents are supported with the resources they need to be good neighbors and members of a greater community. Mercy Housing begins with housing, but goes far beyond to strengthen the lives of the people who call Mercy Housing home. Whether it's educational support, a financial literacy program or health care education, Mercy Housing is always trying to provide services for local low-income community. Mercy Housing provides Resident Services that fall into four program areas: Economic Development, Education, Community and Health & Wellness. In an effort to assist the millions of people in need of stable affordable housing, Mercy Housing provides a wide range of affordable, low-income apartment rental opportunities across the United States.  The housing services are available for families, seniors and people with special needs, including those with developmental disabilities, HIV/AIDS, formerly homeless individuals and Veterans. 70% of  all residents are families;21% of our residents are seniors; 9% of residents are people with special needs (people with HIV/AIDS, formerly homeless individuals, veterans and people with physical and mental impairments). 

The implications of integration for the management of the organization is that the scattered housing are earmarked to serve different population groups geographically and health-wise. Mercy Housing can also go into mutual cooperative arrangement with other service providers. This has significant influence on resident well being as well as experience. Being that they are grounded in non-discrimination, Mercy Housing provides homes for vulnerable population groups. Other service providers are able to bring care to the home-bound and bed-ridden. Under such an arrangement, minorities or underserved population groups are able to access services that improve of their welfare (Mercy Housing Publications, 2015).

Source: LMP

Source: LMP

Source: LMP

Source: LMP

REFERENCES:

1). Being the Best Saves Lives: Kaiser Permanente Leads the Nation in 21 Quality Measures. October 22 2015. http://share.kaiserpermanente.org/article/being-the-best-saves-lives-kaiser-permanente-leads-the-nation-in-21-quality-measures. Retrieved on December 22 2015. 

2). Kaiser Permanente. (2014). Kaiser Permanente. Retrieved from http://kp.kaiserpermanente.org. Retrieved on December 22 2015.

3). Mercy Housing Publications. (2015). http://www.mercyhousing.org/Publications. Retrieved on December 22 2015.

4). Memorial Hermann. (2015). Memorial Hermann. Retrieved from http://www.memorialhermann.org. Retrieved on December 22 2015.

5) Liverpool-Mulago Partnership For Women's and Children's Health. 2014. http://lmpcharity.org/index.php/lmpprojects/hciv/kawempehciv. Retrieved on December 23 2015.

6). Shi, L., & Singh, D. A. (2015). Delivering health care in America: A systems approach (6th ed.). Burlington, MA: Jones & Bartlett.