Why investing in health system capabilities—not just integrated programs—is key to sustainable, person-centered care.
A mother arrives at a clinic in Botswana expecting a routine refill of her antiretroviral therapy (ART), a daily medication regimen that suppresses HIV to undetectable levels. Instead of navigating three lines across three days, she receives everything she needs during a single clinic visit. This is care that feels seamless, efficient, dignified, and centered on her life, not the health system.
This is the promise of integrated care: health systems organized around people, not programs.
For two decades, HIV programs have saved millions of lives. They have enabled the rapid scale-up of testing, treatment, and prevention and built robust supply chains and data systems that transformed HIV from a fatal diagnosis into a manageable condition.
But these gains came with trade-offs. HIV services were often delivered through vertical systems. These systems were specialized, externally resourced, and operated in parallel with broader health systems. Over time, this approach created fragmentation, inefficiency, and significant administrative burdens for frontline providers. The result? Systems that worked for programs but not always for people.
Today, that legacy is meeting a changing reality. Donor financing is shifting toward government-led approaches. Global reforms emphasize alignment, efficiency, and sustainability. The push for country ownership reinforces "one plan, one budget" thinking.
These shifts reflect deeper transitions from externally driven, program-specific priorities to integrated, country-led health systems. Integration is no longer merely conceptual; it is becoming a practical necessity.
In many settings, integrated care is already taking shape.
"I receive the services I need all on the same day. It saves me so much time. And I don't feel stigmatized because the clinic doesn't only offer ART. It feels like I'm just coming for my health, like anyone else." —Health facility client, Botswana
"I can now offer my clients a whole range of services. When I go out for HIV testing, I also screen for hypertension and diabetes. Clients, especially our older ones, become far more interested when we offer a variety of services." —Community health worker, Botswana
These experiences show what works: fewer visits, reduced stigma, and more holistic care. But progress remains uneven. In many facilities, clients still navigate multiple clinics on different days. Providers deliver multiple services yet remain bound by siloed workflows, separate registers, and fragmented funding streams.
This is the tension today. Integration is visible, but it remains inconsistent.
Jhpiego's experience across more than 40 countries suggests that integration often emerges not from explicit strategies but from investments in quality, capacity, and coordination that create the right conditions. Three approaches have proven particularly effective:
The purpose of integration is not integration itself; it is better care for people.
When health systems align financing, governance, data, and workforce capacity around shared goals, providers gain the flexibility to organize services around patients' needs. People receive more comprehensive, coordinated care with fewer missed opportunities.
The challenge for policymakers, donors, and health system leaders is clear: invest in and strengthen the system capabilities that enable integration to thrive. Build systems that facilitate collaboration and continuous improvement, and providers will do what they do best: organize care around the people they serve.
Success should ultimately be measured by whether people experience care that is seamless, person-centered, and responsive to their lives.
Chantelle Allen is the senior principal technical advisor for primary health care at Jhpiego. Amon Marwiro is the country director for Jhpiego in Botswana. Silvia Kelbert is the technical director for HIV and infectious diseases at Jhpiego.
