despite existing initiatives to integrate health services in the americas health care fragmentation remains a significant challenge .
excessive fragmentation leads to difficulties in access to services , delivery of services of poor technical quality , inefficient use of resources , increases in production costs , and low user satisfaction . to address this problem ,
the pan american health organization ( paho ) has launched the integrated health services delivery networks ( ihsdn ) initiative to support the development of more accessible , equitable and efficient health care models in the region .
ihsdn are defined as a network of organizations that provides , or makes arrangements to provide , equitable , comprehensive , and integrated health services to a defined population and is willing to be held accountable for its clinical and economic outcomes and the health status of the population served .
ihsdn require 14 essential attributes for their adequate operation grouped according to four principal domains : model of care , governance and strategy , organization and management , and financial allocation and incentives .
an extensive literature review , expert meetings and country consultations ( national , subregional and regional ) in the americas resulted in a set of consensus - based essential attributes and policy options for implementing ihsdn .
the research and evidence on health services integration remains limited ; however , several studies suggest that ihsdn could improve health systems performance .
principal lessons learned include : i ) integration processes are difficult , complex and long term ; ii ) integration requires extensive systemic changes and a commitment by health workers , health service managers and policymakers ; and iii ) multiple modalities and degrees of integration can coexist within a single system .
the public policy objective is to propose a design that meets each system s specific organizational needs .
 introductiondespite existing initiatives to integrate health services in the americas health care fragmentation remains a significant challenge . 
 excessive fragmentation leads to difficulties in access to services , delivery of services of poor technical quality , inefficient use of resources , increases in production costs , and low user satisfaction . to address this problem , 
 the pan american health organization ( paho ) has launched the integrated health services delivery networks ( ihsdn ) initiative to support the development of more accessible , equitable and efficient health care models in the region [ 1].theory / conceptual frameworkihsdn are defined as a network of organizations that provides , or makes arrangements to provide , equitable , comprehensive , and integrated health services to a defined population and is willing to be held accountable for its clinical and economic outcomes and the health status of the population served . 
 ihsdn require 14 essential attributes for their adequate operation grouped according to four principal domains : model of care , governance and strategy , organization and management , and financial allocation and incentives [ 1].methodsan extensive literature review , expert meetings and country consultations ( national , subregional and regional ) in the americas resulted in a set of consensus - based essential attributes and policy options for implementing ihsdn.results and conclusionsthe research and evidence on health services integration remains limited ; however , several studies suggest that ihsdn could improve health systems performance . 
 principal lessons learned include : i ) integration processes are difficult , complex and long term ; ii ) integration requires extensive systemic changes and a commitment by health workers , health service managers and policymakers ; and iii ) multiple modalities and degrees of integration can coexist within a single system . 
 the public policy objective is to propose a design that meets each system s specific organizational needs [ 1 ] . 
Introduction
Theory/conceptual framework
Methods
Results and conclusions