Updated conceptual and operational framework for integrated health service delivery networks in the Americas. A technical consensus of the Inter-American Development Bank, the World Bank, and the Pan American Health Organization to strengthen integrated health service delivery networks in the Region of the Americas
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Updated conceptual and operational framework for integrated health service delivery networks in the Americas. A technical consensus of the Inter-American Development Bank, the World Bank, and the Pan American Health Organization to strengthen integrated health service delivery networks in the Region of the Americas. (2025). [Publications]. PAHO. https://iris.paho.org/handle/10665.2/69017
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2025-10-23
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978-92-75-23069-5 (Print version)
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In the face of fragmentation of health systems, persistent inequities, and the challenges exposed by the COVID-19 pandemic, moving toward more integrated, resilient models of care is a priority for countries in the Region. Integrated health service delivery networks (IHSDNs) provide a solid strategy for reorganizing services around individuals, families, and communities, ensuring effective access to and continuity and quality of care, in accordance with the tenets of primary health care. This publication – developed jointly by the Pan American Health Organization, the World Bank, and the Inter-American Development Bank within the framework of the Alliance for Primary Health Care in the Americas (A4PHC) initiative – summarizes an update to the conceptual and operational framework for IHSDNs in the Region of the Americas. The product of a wide-ranging cooperative process that built on over a decade of accrued experience and regional evidence, the strategy proposes a revamped, flexible framework that can be adapted to the varied institutional and territorial realities of the countries of the Region. The update introduces key innovations, such as strengthening multilevel governance, progressive network maturation, change management, digital transformation, and a territorial approach incorporating social participation. It also lays out a robust theory of change, a set of updated core domains and attributes, and operational guidelines that integrate individual-level care, public health, and intersectoral action. Through a clear, evidence-based approach, this publication offers decision-makers, managers, and technical teams a practical tool for planning, adapting, and implementing strategies to strengthen the equity, sustainability, and responsiveness of health systems in the Region of the Americas.
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Pan American Health Organization, Inter-American Development Bank, and The World Bank. Updated conceptual and operational framework for integrated health service delivery networks in the Americas. A technical consensus of the Inter-American Development Bank, the World Bank, and the Pan American Health Organization to strengthen integrated health service delivery networks in the Region of the Americas. Washington, D.C.: PAHO; 2025. Available from: https://doi. org/10.37774/9789275130698.
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Item Integrated health service delivery networks: Updated conceptual and operational framework for the Region of the Americas(PAHO, 2025-11-14)Updating the conceptual and operational framework of integrated health service delivery networks (IHSDNs) represents a response to the structural challenges affecting the organization and performance of health systems in the Region of the Americas. The purpose of this technical document is to improve the understanding and implementation of IHSDN components, by proposing strategic interventions adapted to different institutional and geographic contexts. This publication highlights the most critical challenges faced by the Region, which include segmentation and fragmentation of health systems as well as multiple barriers hindering access to comprehensive services. Among these are poor articulation across management levels, lack of coordination between public and private providers, and inadequate territorial distribution of services. These issues lead to discontinuity of care, duplication of efforts, and inefficiencies in resource utilization, and deepen existing health inequalities. These structural difficulties are compounded by high-priority epidemiological challenges, such as the sustained increase in noncommunicable diseases, which represent the greatest morbidity and mortality burden; persistent preventable maternal mortality in highly inequitable settings; the high prevalence of communicable diseases associated with social determinants that are inadequately addressed; and the growing impact of climate change on health. In this context, IHSDNs represent a structural and operational response that can overcome the aforementioned obstacles. Their objective is to reorganize services around the tenets of comprehensiveness, continuity, coordination, and a territorial-based approach, ensuring the provision of people-centered care based on primary health care priorities, in accordance with the principles of the Declaration of Alma-Ata as reaffirmed in Astana. Aimed at public policy makers, health authorities, service managers, academics, cooperation agencies, and civil society at large, this publication provides a consistent proposal to move toward integrated, resilient, person-, family-, and community-centered health systems.Item Hospitals in Integrated Health Service Delivery Networks: Strategic Recommendations(PAHO, 2021)In 2007, PAHO launched the Integrated Health Service Delivery Network (IHSDN) initiative to address the problems derived from the fragmentation of health services and to overcome the structural problems stemming from the widespread segmentation of health systems in the countries of the Region. In the IHSDN initiative, hospitals are an aggregate of specialized institutions that support a highly effective first level of care. Hospitals themselves are defragmented, which is theoretically correct, innovative, and even visionary. However, the IHSDN initiative does not seek to diminish the influence of hospitals in the health system or the importance of their role, but to integrate these institutions so that all their efforts are aligned with the needs of the people and communities they serve through the development of IHSDNs. It is obvious that without hospitals there can be no IHSDNs; however, it should also be recognized that without effective networks, hospitals cannot do their job. The IHSDN initiative presents a change in the role assigned to hospitals, in which they are no longer considered the apex of a pyramid in which the hierarchy is based on specialization to successfully treat disease. Instead, the hospital becomes a very important participant in a service organized as a network, performing specific tasks in a series of processes that cut repeatedly across the health service delivery network and include the participation of individuals and communities. The product of an intense debate and joint effort, this work contains a series of proposals in the six areas considered a priority for developing the new role of hospitals in IHSDNs: governance, resource allocation and incentives, the model of care, technology and infrastructure, human resources, and organization and management.Item Integración de redes de servicios de salud en Honduras: valoración comparativa del planteamiento teórico y de la aplicación práctica en cinco redes del país(2018)[RESUMEN]. Objetivo. En la Región de las Américas se han realizado pocas evaluaciones de redes integradas de servicios de salud (RISS). Honduras ha avanzado en la implementación de herramientas y estrategias basadas en los atributos esenciales de las RISS. Este estudio tiene como objetivo valorar y comparar el desarrollo de RISS en su planteamiento teórico-documental y en su aplicación práctica, por tipo de gestión, en cinco redes de Honduras. Métodos. El estudio se realizó en dos etapas: 1) valoración teórico-documental, mediante la revisión y síntesis de seis documentos oficiales de RISS publicados entre 2012 y 2017, y 2) valoración práctica con los equipos de coordinación de cinco redes, dos descentralizadas y tres mixtas, usando la Herramienta de Valoración de RISS de la Organización Panamericana de la Salud. Resultados. La valoración teórica global alcanzó 55 puntos de desarrollo comparada con la valoración práctica de las cinco redes, que alcanzó 42,8. Según el análisis por ámbitos, el Modelo asistencial obtuvo mejores resultados en ambas valoraciones, mayor en la valoración teórica (62,5). Gobernanza y estrategia fue el ámbito que recibió la valoración más baja (41,7). Entre la valoración teórica y la práctica las diferencias en el análisis de ámbitos y de atributos fueron estadísticamente significativas (p = 0,007 y p < 0,001, respectivamente). Las redes con gestión descentralizada alcanzaron mejores valoraciones que las mixtas (p = 0,017). Conclusiones. Existe una brecha entre la valoración teórica y la práctica que sugiere que la aplicación de las herramientas y las estrategias definidas en los documentos son incompletas. El componente provisional sigue siendo el que genera mayor interés e importancia. En las redes mixtas se observó mayor dificultad de integración, probablemente debido a la doble gobernanza. Es necesario seguir evaluando las RISS.Item Framework for the Response of Integrated Health Service Delivery Networks to COVID-19, 10 May 2020(PAHO, 2020)Introduction: In response to the emergency generated by the new coronavirus (COVID-19), which emerged in Wuhan, Hubei Province in the People's Republic of China during December 2019 and the WHO Director-General statement on 11 March 2020 characterizing the COVID-19 outbreak as a pandemic, Dr. Carissa Etienne, Director of the Pan American Health Organization (PAHO), has instructed to raise the level of preparedness of health services in the Region of the Americas. Given this situation, the PAHO Emergency Operations Center (EOC) been activated to ensure that health delivery services in the countries of the Americas are prepared to respond to sustained community transmission of COVID-19. PAHO’s Department of Health Systems and Services (HSS) has defined these general guidelines for the response to the emergency of COVID-19 based on the Primary health care strategic approach and the transformation toward integrated health service delivery...Item G20’s commitment to telehealth for reducing global health disparities: from a global commitment to regional actions(2024)[ABSTRACT]. The G20, representing the world’s largest economies, plays a critical role in shaping global health policies, initiatives and innovative solutions. As these nations navigate the complexities of digital transformation in the health sector, engagement with the Global Initiative on Digital Health (2), aligned with the Pan American Health Organization ́s (PAHO) eight guiding principles for the digital transformation of the health sector (3), becomes imperative not only for advancing technology adoption but also for promoting health equity and universal access to health and universal health coverage. The inclusion of telehealth in the G20 agenda, championed by Brazil’s presidency, underscores the group’s commitment to leveraging digital innovations to improve health outcomes in G20 countries and globally, as telehealth is a key area of the digital transformation of the health sector. Because countries worldwide vary widely in the capacity of their digital health infrastructure and their development stages, there lies a unique opportunity to foster international collaboration, share knowledge and drive global standards that support the widespread adoption of telehealth solutions for leaving no one behind. This strategic focus is predicated on the understand- ing that telehealth serves as both a catalyst for health equity and a critical tool for reinforcing health systems grounded in primary health care (PHC). The scientific rationale behind this concerted effort is clear: by enhancing digital infrastructure and fostering the adoption of telehealth solutions, there is potential to bridge the global digital divide and democratize access to health services. The G20, representing the world’s largest economies, plays a critical role in shaping global health policies, initiatives and innovative solutions (1). As these nations navigate the complexities of digital transformation in the health sector, engagement with the Global Initiative on Digital Health (2), aligned with the Pan American Health Organization ́s (PAHO) eight guiding principles for the digital transformation of the health sector (3), becomes imperative not only for advancing technology adoption but also for promoting health equity and universal access to health and universal health coverage. The inclusion of telehealth in the G20 agenda, championed by Brazil’s presidency, underscores the group’s commitment to leveraging digital innovations to improve health outcomes in G20 countries and globally, as telehealth is a key area of the digital transformation of the health sector. Because countries worldwide vary widely in the capacity of their digital health infrastructure and their development stages, there lies a unique opportunity to foster international collaboration, share knowledge and drive global standards that support the widespread adoption of telehealth solutions for leaving no one behind. This strategic focus is predicated on the understand- ing that telehealth serves as both a catalyst for health equity and a critical tool for reinforcing health systems grounded in primary health care (PHC). The scientific rationale behind this concerted effort is clear: by enhancing digital infrastructure and fostering the adoption of telehealth solutions, there is potential to bridge the global digital divide and democratize access to health services. In envisioning the future of global health, the fourth pillar of the vision of PAHO’s Director emerges with critical importance: the construction of resilient national health systems is firmly rooted in the implementation of the PHC strategy. This vision is not just an aspiration but a necessary evolution, with PAHO standing ready to guide countries towards achieving this goal. PAHO’s commitment involves supporting countries in the organization of health services networks based on PHC, targeting public financing to foster universal access and coverage, and bolstering governance in health under the leadership of health ministries. Moreover, it calls for the rapid deployment of technological innovations such as telehealth and also broader digital transformation initiatives (4). Digital transformation, emerging as a key innovative strategy, offers significant improvements to the strengthening of PHC. Through the adoption of inclusive digital health solutions, it is possible to enhance the delivery of health services, ensuring they become more accessible, efficient and equitable for everyone, everywhere (5, 6). Among the priorities leading this transformation, telehealth emerged at the G20 as a key opportunity in the mission to leave no one behind and as a cornerstone of the digital transformation of the health sector. Telehealth improves access to care and health information, thereby empowering individuals and communities (7). It effectively extends health services to underserved populations, encourages collaborative practices among health professionals, and broadens access to health for the wider community. It can support reduced waiting times and costs through efficiencies in care management. Through telehealth, the transition to a new era of PHC can be accelerated through technological advancements that drive us towards a more inclusive and accessible health care system for all. Concrete efforts should be focused on modernizing normative and legislative frameworks, investment in digital infrastructure, prioritizing the development of robust digital health infrastructures while ensuring that reliable internet access and digital tools are available across urban and rural areas alike. Enhancing digital literacy and telehealth competencies among health professionals and the population will maximize the utilization and effectiveness of digital health services. However, the lack of standardized policies and frameworks for telehealth is a significant barrier to its global adoption and, therefore, G20 nations can lead by example, working towards (a) developing international telehealth guidelines that consider ethical, privacy and security standards for telehealth services to facilitate cross-border healthcare delivery and secure data exchange; and (b) promoting interoperable telehealth platforms that can seamlessly exchange information, thus enhancing the continuity and quality of care. The G20’s leadership and commitment to integrating telehealth into the global health agenda can set an unprecedented opportunity for international cooperation in digital health. G20 countries can significantly impact global health outcomes by integrating telehealth at all levels of care and health service delivery networks, impacting the lives of billions around the world. Equity must remain central to our efforts as telehealth services are integrated into the model of care. This means ensuring the adoption of differentiated approaches in digital health based on (a) the characteristics of a territory (geographical dis- persion, status of infrastructure), (b) the beneficiary population to be served (their health needs, and cultural, racial and ethnic considerations) and (c) the health system capacities and organization (the health services network, coverage capacity and availability of multiprofessional teams). Health outcomes can be significantly positively impacted by undertaking bottom-up planning processes that take into account the latter considerations and by adapting the model of care to leverage the capacity of digital health. Embracing the Regional Roadmap for the Digital Transformation of the Health Sector in the Region of the Americas is imperative for countries aiming to develop expansive, resilient and inclusive health systems based on PHC (8,9). This comprehensive framework, backed by lessons learned and suc- cessful experiences, underscores the significant potential that digital transformation holds for improving health outcomes. Brazil's commitment to the consolidation of the Unified Health System (the Sistema Único de Saúde, or SUS) and its well-established Family Health Strategy as the foundation for the health and well-being of its population is being expressed through the rapid deployment of telehealth, and serves as a model of innovation and effectiveness, showcasing the transformative impact of digital health solutions on accessibility, efficiency and quality of care (10). This editorial, jointly prepared by rep- resentatives of the government of Brazil and PAHO advocates for global standardization of telehealth practices that ensures the scalability and sustainability of health interventions while addressing the core determinants of health equity.