Fragmentation of health services is a major cause of poor performance of health services, and thus of the underperformance of health systems in general. Fragmentation can generate, on its own, or combined with others factors, difficulties in access to services, delivery of services of poor technical quality, irrational and inefficient use of available resources, unnecessary increases in production costs, and low user satisfaction with services received.

In response to the challenges posed by health services fragmentation and to various international mandates and commitments, PAHO/WHO is developing the initiative on Integrated Delivery Networks (IDN) with a view to contribute to the strengthening of Health Systems based on Primary Health Care (PHC), and thus to the delivery of more accessible, equitable, efficient, and quality health services that better meet the expectations of the population.

The objective of this section is to support policy makers, managers and health services providers in the development and implementation of Integrated Delivery Networks through the dissemination of documents, lessons learned, and tools.

 Documents, publications, and tools

pdf Redes Integradas de Servicios de Salud - Conceptos, Opciones de Politica, Hoja de Ruta para su implementación en las Américas. (2010)

pdf  Integrated Health Service Delivery Networks: Concepts, Policy Options and a Road Map for Implementation in the Americas (2011)

pdf Construcción del Sistema Nacional Integrado de Salud 2005-2009 - Uruguay

iconMethodological Guidelines for Applied Research on Decentralization of Health Systems in Latin America

icon Orientaciones para promover la descentralización de los sistemas de salud en Latinoamérica

icon Descentralización de los Servicios de Salud en Bolivia

icon Applied research on decentralization of health systems in Latin America: Bolivia

icon Descentralización de sistemas de salud en Latinoamérica: Análisis comparativo de Chile, Colombia

icon Applied research on decentralization of health systems in Latin America: Chile

icon Applied research on decentralization of health systems in Latin America: Colombia

icon Decentralization of health systems in Latina America: Comparative analysis of Chile, Colombia, and Bolivia

icon Decentralization of health systems: Decision space, innovation and performance


Hernán Montenegro, Reynaldo Holder, Caroline Ramagem, Soledad Urrutia, Ricardo Fabrega, Renato Tasca, Osvaldo Salgado, Gerardo Alfaro, Maria Angélica Gomes.Combating Health Care Fragmentation through Integrated Health Service Delivery Networks in the Americas: Lessons Learned (2011)