Abstract

PIP: Attempts to implement the integration of maternal-child health and family planning programs require careful attention to potential national and international obstacles to such a change. A major constraint is overcoming staff resistance to the simple organizational changes required for integration. Health workers must be convinced that an integrated service will not only benefit patients, but also simplify and systematize clinical procedures. Patient flow plans, outreach services, case records, and supervisory forms must be modified and health staff will require training on maternal-child health care components that are not being provided adequately. The community must be consulted on when and where outreach clinics should be held and intersectoral coordination must be initiated to maximize opportunities for health promotion. Also required is attention to the structure, systems, and priorities of the Ministry of Health and relevant international agencies. Strategies must be devised for utilizing their technical expertise and support without upsetting vested interests. In some cases, programs are given attention based on the availability of international resources rather than recognition of district-level needs. Implementation of pilot health facilities helps to identify feasible approaches and provides a focus for staff training.