When do vertical (stand-alone) programmes have a place in health systems?

Abstract

Few issues related to the organization of health systems and service delivery have attracted as much attention as the debate on vertical versus integrated health programmes. The literature has focused on the comparative effectiveness of vertical (‎disease- or service-specific)‎ versus more systemic approaches since the 1960s, and both approaches have been widely implemented in low- and middle-income countries and in high-income countries. In vertical approaches (‎also referred to as stand-alone, categorical, disease management or disease control programmes)‎, interventions are provided through delivery systems that typically have separate administration and budgets, with varied structural, funding and operational integration with the wider health system. In the integrated model (‎also known as horizontal approaches or programmes)‎, services do not have separate administration orbudgets and are typically delivered through health facilities that provide routine or general health services. This policy brief has three objectives and is structured accordingly: to unpack what is meant by a vertical programme versus an integrated one; to assess the available evidence and lessons on when vertical programmes have a role to play in health systems; and to indicate under what circumstances vertical programmes have a role to play in health systems and to note the factors policy-makers need to take into account when considering implementing vertical programmes.