"Integration may be the only feasible option to address mental health problems in the context of a weak health system, and doing so can contribute to systems strengthening more generally"

I wonder if the above excerpt presents a circular logic because....

1. The failure of the efficacious studies of integration methods to sale up has long been attributed to weakness of health systems. So the premise in this would be that if systems were not weak efficacious interventions could scale up smoothly.
2. Now does the excerpt imply that even if systems are weak, integration could still be attempted with the hope that it will lead to system strengthening..

It may not if the integration model is just task shifting based on educating the primary care providers. A collaborative model where the specialist is also involved may only offer that extra benefit of system strengthening.

Weakness of health systems have been originally precipitated and perpetuated by donor preferences for vertical programs than horizontal programs because for the greater "bang for buck" in vertical disease based programs. Reference 40 rightly points to the balanced approach of vertical+horizontal primary care. Among the various components of health-system listed, the "'health workforce"' component appear to be the crucial agent in the scheme of things. The service,wage and relative professional standing of the formal and informal workforce in primary care will be the key determinant. Primary- care-doctory which is at its historical low will have to be revived. That will be a different task altogether, probably we might need to start from scratch.