***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Improvements in the constellation of services in the African context are largely addressed through attaining better measures of service integration , which can be achieved through improved referral across categories of health programs . The use of an unobtrusive referral message that linked family planning and the Exp and ed Program of Immunizations ( EPI ) services was tested in an operations research study in Togo . The introduction of the referral message was accompanied by an 18-percent increase in awareness of available family planning services and an increase in the average monthly number of new family planning clients of 54 percent . These positive results indicate that the use of referral can have a significant and dramatic impact on family planning services in a relatively short time . In Togo , no evidence existed of a negative impact on EPI services , and a majority of the EPI providers reported satisfaction with the effect of the referral message at the close of the study R and omised controlled trials are widely accepted as the most reliable method of determining effectiveness , but most trials have evaluated the effects of a single intervention such as a drug . Recognition is increasing that other , non-pharmacological interventions should also be rigorously evaluated.1 - 3 This paper examines the design and execution of research required to address the additional problems result ing from evaluation of complex interventions —that is , those “ made up of various interconnecting parts.”4 The issues dealt with are discussed in a longer Medical Research Council paper ( www.mrc.ac.uk/complex_packages.html ) . We focus on r and omised trials but believe that this approach could be adapted to other design s when they are more appropriate . # # # # Summary points Complex interventions are those that include several components The evaluation of complex interventions is difficult because of problems of developing , identifying , documenting , and reproducing the intervention A phased approach to the development and evaluation of complex interventions is proposed to help research ers define clearly where they are in the research process Evaluation of complex interventions requires use of qualitative and quantitative evidence There are specific difficulties in defining , developing , documenting , and reproducing complex interventions that are subject to more variation than a drug . A typical example would be the design of a trial to evaluate the  benefits of specialist stroke units .  Such a trial would have to consider the expertise of various health professionals as well as investigations , drugs , treatment guidelines , and arrangements for discharge and follow up . Stroke units may also vary in terms of organisation , management , and skill mix . The active components of the stroke unit may be difficult to specify , making it difficult to replicate the intervention . The box gives other examples of complex interventions . # # # # Examples of complex interventions Service delivery and organisation : Stroke units Hospital at home Interventions directed at health professionals ' behaviour : Strategies for implementing guidelines Computerised decision support Community interventions : Community An integrated postpartum health-care program was established by the Consultorio San Luis de Huechuraba ( CSLH ) , a nongovernmental organization in a neighborhood of extreme poverty in Santiago , Chile . The main components were education , maternal and infant health care , support for the mothers , and active participation of women from the community served . The program was evaluated through indicators of contraceptive use , breastfeeding performance , infant growth and health , and a qualitative assessment of women 's satisfaction .  Controls were women of similar characteristics attending the nearby public clinic .  Acceptability of contraceptive methods was similar but contraceptive options differed between clinics . The total number of pregnancies and of respondents lost to follow-up was significantly higher for the public clinic than for the CSLH . Breastfeeding duration was significantly longer and infant growth and health were found to be significantly better at the CSLH than at the public clinic . Women valued being treated with respect , receiving education and support , and being offered timesaving services and wider contraceptive choices at the CSLH . This study demonstrates that such interventions are possible for poor communities , providing significant advantages for women and children 
    Output:
    
There was no consistent pattern of benefit .
In the other two studies integration result ed in negative outputs in comparison with vertical programmes , although in one of these integration performed better than the control group .
In fact , some studies found greater effects for vertical health care delivery .