23 June 2026
Dr Wendy Harrison, CEO, Unlimit Health
At a recent International Society of Neglected Tropical Diseases (ISNTD) webinar on the impacts of schistosomiasis on early childhood development, one message came through consistently across discussions and country experiences: integration matters.
Yet, as is often the case with widely used terms, “integration” risks becoming a catch-all, invoked frequently, but not always clearly understood. Taking a moment to step back, I found myself reflecting not just on why integration is important, but on what we truly mean by it, and what it requires of us if we are serious about improving outcomes for young children.
Integration begins with clarity
A useful starting point is to recognise what integration is not. It is not simply about doing more activities together or layering additional interventions onto existing programmes. Rather, integration is more deliberate: it is the delivery of multiple services through a unified system, where planning, implementation, and evaluation are aligned around shared goals.
This distinction matters because not all forms of working together are equal. Coordination, for instance, allows programmes to collaborate while maintaining separate structures. Linkages may bring services into the same space, but without shared systems or accountability. Integration, at its fullest, involves the merging of functions, shared management, joint financing, unified monitoring, and multidisciplinary delivery.
At Unlimit Health, we are clear that integration is one tool among several. It is not universally appropriate, nor automatically beneficial. It should only be pursued where it responds to the needs of communities, improves efficiency, and strengthens systems in the long-term.
Why integration reflects peoples lived experience
The rationale for integration becomes clear when we consider the realities of the children and communities we serve.
People do not experience schistosomiasis, or any health issue, in isolation. Their lives are shaped by complex and overlapping factors: water and sanitation access, livelihoods, environmental exposures, cultural practices, and daily behaviours. These influences intersect constantly, shaping both risk and resilience.
For young children, particularly in the first 1,000 days of life, these interactions are even more consequential. Exposure to infection, nutrition, caregiving environments, and access to services all combine to influence development trajectories. Addressing schistosomiasis in this context therefore requires more than a single intervention.
If our goal is elimination, not just control, then we must think differently. We must reach all at-risk populations, including those historically overlooked: pre-school-aged children, adults, and communities that are harder and more costly to access. We must also address the broader system: water, sanitation, environment, and behaviour, not simply the disease itself.
This is why a One Health and systems perspective is so central. Integration, in this sense, is not an abstract ideal, it is an attempt to ensure that our delivery systems mirror the complexity of real life.
A changing context demands a different approach
The urgency of integration today is also shaped by how much the global health landscape has evolved.
During the Millennium Development Goal era, the priority was scale. Vertical programmes often supported by significant external funding, enabled rapid expansion of treatment, achieving impressive coverage of praziquantel, particularly among school-aged children.
Over time, reliance on vertical delivery models contributed to fragmented systems, often weakening existing health structures and reducing the ability of countries to adapt responses to their own contexts.
Today, the environment looks markedly different. Financial constraints are tightening, geopolitical pressures are increasing, and health threats—from climate change to conflict, are becoming more complex and interconnected.
At the same time, the remaining burden of disease is harder to reach and more expensive to address. As incidence falls, the so-called “elimination paradox” can also emerge, where success reduces urgency, and with it, political commitment and investment.
In this context, vertical approaches alone are no longer sufficient or sustainable. Encouragingly, funding models are beginning to shift. Integration is no longer simply a strategic preference; it is becoming a practical necessity.
Integration as a return to strong systems
It is important to stress that integration is not an innovation. In many ways, it represents a return to fundamentals.
Strong health systems, particularly those rooted in primary health care, have always been inherently integrated. They are designed to respond to multiple needs through coordinated delivery, centred on people rather than programmes.
What we are calling for today is not a reinvention of the system, but a restoration of sound system design, adapted to contemporary challenges and opportunities.
The reality: integration is complex
Our experience from Uganda, where schistosomiasis treatment has been integrated into child health platforms, highlights the many dimensions involved, from early planning and clear operational guidance to workforce training, community engagement, and ensuring adequate resources.
Integration requires alignment across policy, financing, service delivery, and governance. It involves navigating real constraints including workforce shortages, supply chain challenges, and legacy systems shaped by years of vertical programming
This complexity should not be underestimated. Integration is resource-intensive and rarely linear. But importantly, it is also system-strengthening, building more resilient and adaptable health systems over time.
What makes integration work
From Unlimit Health’s perspective, successful integration shares several defining characteristics:
When these principles are in place, integration can deliver not only better outcomes for children, but also stronger, more sustainable systems.
Final thoughts
Integration is not about adding layers of complexity to already burdened systems. It is about aligning how we deliver services with how people live, particularly for the youngest and most vulnerable.
In the context of schistosomiasis and early childhood development, this shift is essential. If we are serious about achieving elimination and giving every child the best possible start in life, then our systems must reflect the realities they face.
Watch the webinar here:
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