Integration

Community health and wellbeing depend on a variety of interrelated needs. Access to appropriate health information, supplies, and care is essential, but so are water and sanitation and education. Communities also need more productive agricultural systems, stronger value chains, reliable roads and access to communications, and a stronger voice in how they are governed. From its beginning, IRD has strived to view the needs of communities from the perspective of the people who live in them, and to take a holistic view of strategies to address them. In so doing, we improve our collaboration with community stakeholders to identify and prioritize most the urgent needs. IRD’s integrated development strategies seek to address these interrelated needs and challenges simultaneously. This means more effective engagement with local governments and vulnerable community members, better use of resources, and longer lasting results.

More and more, multisectoral approaches are requested by the communities we serve. Such approaches can be easier and more cost efficient for understaffed and underfunded local governments to implement. IRD agrees: integration—whole and complete interventions that satisfy a diversity of community needs—is the most promising approach to improving community health and development. IRD mainstreams health considerations into most of our projects and programs. In so doing, we:

• optimize resources and achieve more sustainable and broader health outcomes
• help rebuild strong and sustainable social systems
• address inequalities and advance human rights
• remain relevant to the broad spectrum of communities’ needs

IRD has accumulated valuable experience in approaching development from a multisectorial perspective. For example, the USAID-funded Women First program in Mozambique combines HIV/AIDS education with entrepreneurial training and the creation of sustainable businesses for rural women. IRD designed the program to increase knowledge of healthy behaviors in the community and strengthen women’s economic wellbeing. The project has also increased access in rural communities to basic household products such as soap, oil, pasta, and candles, at reduced prices.

In Southern Sudan, thousands of people have returned home after years of civil war to find few clinics, schools, or government services. IRD’s Community Health and Water and Sanitation project is increasing access to basic services by constructing health clinics, a health center, and latrines; rehabilitating boreholes; and providing intense hygiene promotion and education. In collaboration with the John Dau Foundation, IRD is training community health workers, home health providers, midwives, nurses, and clinic management staff. County-wide health education and vaccination campaigns are also underway, including a mass deworming campaign for school-aged children. Adult education system instructors trained under a previous IRD project are now receiving further training to provide health and hygiene education. In addition, IRD is working with local authorities to make health and hygiene a part of all government service delivery. IRD is integrating health and community stabilization services for both refugees and internally displaced persons into the national health systems in Jordan. The Health Linkages and National Networks (HLNN) project aims to increase the use of maternal, child, and reproductive healthcare services in Ministry of Health clinics by Iraqi women and youth. The program is also supporting a community building effort to help participants address violent and unhealthy situations. Finally the HLNN is engaging at-risk youth to improve their decision making around reproductive health and gender-based violence.

In Cambodia, IRD used an integrated, community-based approach to improve child nutrition in Teuk Phos, an isolated rural district with higher than average levels of undernutrition. The USAID-funded project increased survival rates for children under age 5 through improved nutrition and access to safe, clean water. IRD provided training, technical assistance, logistical support, and advocacy, employing a range of strategies, including behavior change communication (BCC), capacity building, and community mobilization. Activities were implemented at the community level in partnership with local NGOs, and included multichannel BCC conducted by village health volunteers. The follow-on Nutrition to Reinforce Infant, Child and Maternal Health in Cambodia (ENRICH) builds on these successes and is introducing improved nutrition during pregnancy, nutrition counseling during prenatal visits, and hemoglobin measurement as part of prenatal care. The project is also continuing to support nutrition, water, and sanitation programs. Two of IRD’s earliest projects, the USAID-funded CRDA and CRDA-E in Serbia and Montenegro, offered holistic programming through cluster projects designed to unite different age, ethnic, and gender groups to outline priority needs and address regional issues. Men, women, youth, and Roma were provided computer training, health and education awareness, counseling, prevention of substance abuse, and improved economic opportunity through shepherd projects. Medical equipment was provided and physicians were certified in ultrasound, laparoscopy, breast cancer screenings, and more. In Serbia and Montenegro, IRD implemented 1,613 projects, reaching 6.1 million people and generating sustainable income of over $53 million. In our US programs, YouthBuild helps at-risk youth in Mississippi obtain their high school equivalency diplomas. We also strengthen their minds and bodies through an exercise program, life skills training, and a program to help them improve decision making.

Integration is an effective and cost-efficient means to achieving relevant, culturally appropriate, and lasting community health improvements. The multiple and interrelated effects of integrated interventions bring enormous economies of scale. IRD is actively gathering evidence to help planners and decision makers better design, implement, and learn from development integration efforts.