Health system characteristics | |
 Insufficient resources and financial infrastructure | • Weak disease-specific and antenatal care program links |
• Weak health systems | |
• Financing of health services may be required to change to fit integration of previously separate services | |
 Inadequate physical and technical infrastructure | • Services provided at different locations |
• Services not provided on same day | |
 Ineffective procurement and distribution systems | • Patient drug procurement/administration at different locations |
• Inadequate and irregular supplies of essential drugs and interventions | |
 Inadequate information systems | • Weak monitoring and evaluation systems |
 Insufficient human resources | • Staff shortages and overburdened staff |
• Frequently reallocated workforce | |
Adoption system | |
 Insufficient buy-in from healthcare implementers | Buy in can be affected by: |
• Limited human resource capacity, time, training and financing for extra | |
• Service delivery tasks | |
• Lack of supervision | |
• Poor motivation | |
 Inconsistent leadership and governance | • Inconsistent national policies |
• Inconsistent guidelines and training documents | |
• Poor adherence to guidelines | |
Broader context | |
 Patient-centred barriers to service delivery | • Attending multiple clinics on separate occasions/locations |
• Time away from work/parenting obligations | |
• Costly and timely transport options | |
• Lack of partner support | |
 Cultural and social barriers | • Fear and stigma, lack of trust in interventions |
• Societal attitudes towards HIV, tuberculosis, malaria | |
 Funding structures | • Historical focus on donor funding to specific diseases |
• Siloed and disease-specific funding models | |
• Complexities of different levels of government funding |