Embrace integrated health services to transform public health security

In recent years, the world has witnessed an increase in public health emergencies, with their complexity intensifying due to climate change and social inequality. One of the most glaring lessons from the Covid-19 pandemic is the critical need for a cohesive, integrated approach to health service delivery. 'Panic and forget' cycle, where society reacts only in the face of an immediate crisis and then forgets to prepare for future risks, has shown us the consequences of fragmented health systems. To break this cycle, we must embrace integrated health services as a comprehensive solution to enhance resilience and response. Integration means breaking down traditional silos and fostering collaboration across sectors-public health, healthcare, water and sanitation, education, and even the environment. This collaborative approach ensures resources are used effectively, reduces redundancy and improves the quality of care for vulnerable populations. This becomes even more critical in the context of climate change, which poses a growing threat to global health security. Extreme weather events such as floods, droughts and heatwaves are becoming more frequent and severe. These events disrupt essential health services, damage infrastructure and lead to health crises that disproportionately affect vulnerable populations. The impacts are far-reaching, with increasing rates of malnutrition, mental health challenges and infectious diseases like cholera, malaria and tuberculosis. Last year, flooding during the March-April-May rainy season resulted in widespread displacement, property destruction and the marooning of 13 health facilities in Tana River County. Health and well-being of over 21,000 households were affected. The situation worsened when cholera outbreaks occurred, infecting 160 people and causing three deaths. What happened next is a lesson in healthcare services integration. Stakeholders came together to address the immediate health crisis and long-term resilience building. The partnership had three objectives: To control the cholera outbreak and reduce the spread, ensure continuity of essential healthcare services for displaced and isolated populations, and to enhance resilient, preventive campaigns through risk communication and community engagement. Community-based outreach services ensured preventive and curative healthcare to populations in IDP camps and isolated villages. Mobile clinics providing a wide range of services, including nutritional screening for under-five children and pregnant women, curative services for minor and major illnesses, psychosocial support, HIV testing and other laboratory services, screening for noncommunicable diseases, and family planning services were deployed. Community health promoters helped deliver critical education on prevention measures, proper hygiene, and sanitation improvement. These efforts helped communities to understand the risks they faced, how to prevent further disease outbreaks, and how to protect themselves and their families. Additionally, the outreach programme incorporated the One Health approach. People were treated and their animals received veterinary care. To counter the risk of infections due to the disruption to sanitation systems, contaminated water sources and open defecation among the displaced populations, distribution of water, sanitation and hygiene commodities, including chlorine and water purification tablets, was done. The experience was a proof that by combining preventive, curative and promotive services, we can flatten the curve of disease outbreaks, restore essential healthcare services, and strengthen communities' ability to withstand future shocks. However, integration must go beyond just health services. It requires a multi-sectoral approach that involves policymakers, community leaders and local organisations. To be truly effective, integrated health systems must address the root causes and the immediate effects of public health emergencies. Mr Mwaniki is Public Health Security Project Manager. Matheka works for Building Resilience Against Climate Effects (BRACE) Project, Amref Health Africa

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