Whether to integrate services at different levels cannot be decided in the abstract. Functional integration may increase the convenience of services for clients, increase the likelihood that their particular needs will be diagnosed and met, and minimize ''down time" for multipurpose providers. Its disadvantages come when providers are overloaded or insufficiently trained and supervised for some of their functions.

Examples of successful functional integration of reproductive health services already exist, particularly in provision of information and counseling. HIV/AIDS information and prevention messages have been incorporated into some family planning information, education, and communication efforts. Provision of information about STDs and about danger signs in pregnancy and labor, and where to go for help, should likewise be added to the duties of every service provider who comes into contact with adult women and their families.

There are also examples of successful linkage of different reproductive health services at the clinic level. In many countries, linkage with child health services is a major convenience for mothers or legitimizes what would otherwise be an embarrassing clinic visit or one considered not worth the cost.

Administrative integration in public systems is often difficult to impose. Its advantages are that it allows coordination and setting of priorities across services and that it spreads the cost of overhead services across many programs. The disadvantages are that particular functions may be neglected and managers may not feel accountable for their successful performance.

Effective reproductive health programs will require a focused and measurable set of objectives, adequate resources, and, sometimes, generation of demand for their services. Reproductive health is most likely to succeed if objectives are focused and managers held accountable for their achievement. Implementation of effective reproductive health programs will require significant and continuous building of local capacity in systems such as training, supervision, and management; procurement and distribution of supplies; information, education, and communication efforts; and record-keeping and evaluation.

Both public- and private-sector organizations have an important role to play in increasing awareness of reproductive health services and how and when to use them—particularly recognition and treatment of RTIs and pregnancy complications. Research is needed on the determinants of demand for specific components of reproductive health services, especially how women and men come to believe treatment is needed and what motivates them to seek care in various settings.



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