Horizontal, vertical, or diagonal?
by Victor Roy on September 8, 2008
Debates about the design and financing of public health programs can be heated. Do vertical, disease-specific programs, such as TB, malaria or HIV/AIDS interventions, miss the point? The development of "horizontal" health systems and infrastructure, capable of addressing a broader spectrum of diseases, many say, should be the goal. A disease-specific emphasis, however, has been more effective at bringing billions of new $$$ to the table for global health, through schemes such as the Global Fund for HIV, TB, and Malaria and President Bush's AIDS program, PEPFAR.
More and more, people are seeing both sides of the argument. That's why the "diagonal" is in. Partners in Health's Dr. Joia Mukherjee puts this emerging perspective clearly:
"Interest in and money for AIDS allowed us to rehabilitate basic health infrastructure in Haiti's central department. Our philosophy was that we could not find AIDS cases or treat them if clinics stood understaffed, empty and without essential medicines. Thus, the investment in AIDS became our Chwal Batay, or battle horse-a tool to bring us into a larger battle against poverty, inequality and poor health."
If HIV/AIDS gets more funders involved and interested than "building primary care systems", then why not use the funding for AIDS programs to do more, as Dr. Mukherjee describes? The effective treatment of these specific diseases will rely on this anyways. What do you think? Will the debates about vertical vs. horizontal go away? Is the "diagonal" approach here to stay? Or should we be creating new visuals in our head?
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