Recommended readings
When do vertical (stand-alone) programmes have a place in health systems?
Vertical versus systemic health care delivery
Authors:
R.A. Atun; S. Bennett; A. Duran; European Observatory on Health Systems and Policies
Publisher:
World Health Organization , 2008
This policy brief by the WHO considers the comparative effectiveness of vertical versus more systemic approaches to health service delivery. The authors unpack what is meant by a vertical programme versus an integrated one and assess the available evidence. The brief then indicates under what circumstances vertical programmes have a role to play in health systems and notes the factors policymakers need to take into account when considering implementing vertical programmes.
It is shown that the available evidence on the relative benefits of vertical versus integrated delivery of health services is limited and too weak to allow for clear conclusions about when vertical approaches are desirable. Evidence available suggests that integrated approaches to delivering health services, compared with vertical approaches, improve outcomes in selected areas including HIV, mental health and certain communicable diseases. The authors show that political economy within a particular context and technical factors related to the health system will influence the extent of integration. Where vertical governance, funding and service delivery systems exist, integration will be difficult and changes in service delivery must be underpinned by legal and regulatory adjustments aimed at linking the governance, organisation and funding of vertical programmes with mainstream health systems. The authors conclude that both approaches have strengths and weaknesses, which vary depending on the conditions addressed and the particular context.
