Does evidence tell us that integrated development approaches work? It depends!

When we tackle complex, global challenges and their many root causes, intuition tells us that development initiatives need to be more holistic — the approaches may need to be as interconnected as the problems. Even the Sustainable Development Goals (SDGs) agenda states its aims are integrated and indivisible. Yet, the critically important question, “What evidence supports integrated development in practice?” can best be answered through the saying “context is king.”

Integration is an umbrella phrase that can describe thousands of different cross-sector approaches — from health and microfinance, to nutrition and education, to conservation and livelihoods. Consider how evidence showing huge impacts in the integration of savings groups with girls’ education would be relevant for people trying to decide whether to integrate agriculture and environmental conservation. Context matters. A lot. What is being integrated with what? How? For what purpose?

Global development decisionmakers must resist the temptation for a simple, universal answer to whether integration works. The notion that any one gold-standard study on its own will answer the integrated development hypothesis is false. Evidence for cross-sector approaches will always depend on the specific sectors, geography and people in question.

FHI 360 has been digging into the evidence base on integrated development to uncover what it tells us about different approaches. In our first targeted literature review in 2014, we found nearly 60 research articles on various integrated models, which seemed low compared to the volume of integration underway globally. In a second, broader literature review, we identified more than 500 impact evaluations of integrated, multisector programs. Encouragingly, a significant number of these produced proven, positive impacts. Our new, interactive Integrated Development Evidence Map shows the research trends and enables customized searches of the studies.

Among the types of models studied, conditional cash transfers (CCTs) are illustrative of an integrated program model with a large volume of evidence. In contrast to unconditional transfers, which simply provide income support to households, CCTs combine monetary support with health, nutrition and education objectives for the family. Because the cash transfers are tied to certain cross-sector conditions, they qualify as a deliberately integrated approach.

Decades of research on Mexico’s CCT program indicate clear, positive impacts. Although a handful of studies on the model show a mostly neutral effect, many dozens more show a verifiable impact of CCTs on outcomes across multiple goals beyond measures of income. Moreover, the evaluated programs come from multiple regions of the world, are generally large scale and include long-term analyses that confirm some lasting effects. Some additional integrated approaches with promising evidence include: linking economic strengthening and health efforts; incorporating water, sanitation and hygiene (WASH), health or nutritional support into schools; combining nutrition and agriculture initiatives; and integrating family planning with environmental programming.

There is enough evidence that integration can work in a wide variety of settings to justify routinely considering it when undertaking complex, interrelated challenges. Most proven models are still underutilized, however, and many others remain innovations or hypotheses that require further exploration.

To advance evidence-informed integrated development in the SDG era, we need:

• Investment in the scale-up of existing, promising integrated models
• Additional research to fill the gaps about other strategies to show which combinations of approaches yield amplified impact or efficiencies; whether an integrated or a targeted approach will be better in specific contexts; and what the cost/benefits of different options are as they relate to particular problem sets
• Methodological recommendations for conducting strong evaluations of integrated efforts
• Agreement among sector experts trying to work better together on what will constitute sufficient evidence for their context
• Access, understanding and use of the available evidence to inform funding, policy and program design