The natural links between the “vertical” and “horizontal” approaches
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There has been a long debate about which strategy, i.e. the “vertical” or “horizontal” approach, would provide health care services more effectively and efficiently in developing countries.
For example, see a review of the debate here and here. In addition, the effects of one approach on another have also been discussed intensively. Most recently, the “diagonal” and “fabric” approaches have been proposed as new concepts to harmonize the development of both vertical and horizontal health care systems. However, this proposal of integration needs to be rooted in the natural links between these two approaches.
For example, in a TB control program, most TB patients, without knowing their status as infected, will have a first contact with service providers in an health facility within the “horizontal” health system. If the “horizontal” health system functions well, patients will benefit from it in terms of early diagnosis, effective treatment, long-term cost saving, and better outcomes. However, if the horizontal health system does not function well, patients will very likely suffer from a high financial burden and a bad health outcome.
Another example of the natural links between "vertical” and “horizontal” approaches I would like to raise here is in a HIV/AIDS control program. Although antiretroviral treatment is one of the central pieces of a comprehensive HIV/AIDS program, the incidence and prevalence of opportunistic infections (OI) in the area that affect the HIV+ patients’ outcomes while on treatment are highly connected to the proper functioning of “horizontal” health system. The diagnosis and treatment of OIs in the general ‘horizontal’ population will have direct impacts on the success of “vertical” HIV/AIDS control program.
Clearly other natural links exist which can be capitalized on by this new "diagonal" thinking within the global HIV/AIDS community. At Healthsystems 20/20, we are interested in identifying these natural links between “vertical" and “horizontal” approaches so that we can all translate these new concepts into practice.
From Emily Moonze on 5 August 2008, 02:47
The only way a "horizontal" system will only function well if the natural links at community level are also strengthened. The patient comes from a community which is the natural horizontal link, and strengthening that natural link will result in early diagnosis and initiation of treatment which is not only beneficial to the client but also to the health system and especially in resource constrained countries.