Enhancing integration for greater sustainability of HIV, TB and malaria responses: insights and lessons from African community-led monitoring programs

Global HIV, TB and malaria responses have achieved substantial gains, largely through vertical programs and parallel systems. With shrinking external funding, integration is a strategic process that supports sustainability by replacing fragmented approaches with unified models, embedded in public health systems. Community-led monitoring (CLM) provides community-generated evidence that can inform efforts to advance the integration agenda. This community case study synthesizes evidence and lessons from secondary CLM reports covering more than 4,000 health facilities in 16 African countries, according to integration focus areas for the Global Fund to Fight AIDS, Tuberculosis and Malaria. At the service level, CLM identifies persistent fragmentation, including gaps in TB/HIV co-infection services, weak coordination between programs, and patient pathways requiring multiple visits. CLM data have been used to advocate for integrated solutions, including same-day service delivery and stronger linkages between HIV, sexual and reproductive health, gender-based violence, and mental health services. CLM also provides insights into the integration of vertical programs into primary health care, particularly during donor transitions. At the systems level, CLM is being used within efforts to strengthen integration, including through unified monitoring frameworks, incorporation of community data into national systems, and improvements in supply chains, laboratories and workforce capacity. CLM data have been used to inform advocacy and decision-making related to integrated sample transportations systems, and expansion of social health insurance coverage. Key lessons highlight the importance of integrated monitoring tools, the role of community actors in facilitating integration, and the potential for CLM to contribute to broader health system reform processes.