Global HIV, TB and malaria responses have achieved substantial gains, largely
through vertical programs and parallel systems. With shrinking external funding,
integration is a strategic process that supports sustainability by replacing frag
mented approaches with unified models, embedded in public health systems.
Community-led monitoring (CLM) provides community-generated evidence that
can inform efforts to advance the integration agenda. This community case study
synthesizes evidence and lessons from secondary CLM reports covering more
than 4,000 health facilities in 16 African countries, according to integration focus
areas for the Global Fund to Fight AIDS, Tuberculosis and Malaria. At the ser
vice level, CLM identifies persistent fragmentation, including gaps in TB/HIV co
infection services, weak coordination between programs, and patient pathways
requiring multiple visits. CLM data have been used to advocate for integrated
solutions, including same-day service delivery and stronger linkages between
HIV, sexual and reproductive health, gender-based violence, and mental health
services. CLM also provides insights into the integration of vertical programs into
primary health care, particularly during donor transitions. At the systems level,
CLM is being used within efforts to strengthen integration, including through
unified monitoring frameworks, incorporation of community data into national
systems, and improvements in supply chains, laboratories and workforce capac
ity. CLM data have been used to inform advocacy and decision-making related to
integrated sample transportations systems, and expansion of social health insur
ance coverage. Key lessons highlight the importance of integrated monitoring
tools, the role of community actors in facilitating integration, and the potential
for CLM to contribute to broader health system reform processes.

Originally published here.