Overview:

There is a longstanding debate on how to address the poor health status of many low and middle income countries.  Should the focus be on a single disease entity in which substantial improvement can be demonstrated, such as vaccination programs, or should attention be directed to strengthening a country’s health care delivery system?  This has been described as the conflict between vertical (single disease) programs and horizontal (system building) programs.

PEPFAR (the President’s Emergency Plan for AIDS Relief) is an example of a vertical program, which has focused on HIV and made a real difference in reducing mortality from AIDS. This positive contribution, however, has to be contrasted to its effect on the often fragile health system in many developing countries.  For example, in countries where there is a health professional shortage, vertical programs which pay doctors and nurses more and provide more generous infrastructure support, may under undermine the existing health care system by attracting physicians and nurses away from government-sponsored health centers.  Recently, the goal of universal access to health care has been projected as a perspective that has the potential to reduce, if not eliminate the tension between vertical and horizontal approaches to improving the health status of nations. 

This session will provide an overview of four models of health system organization and finance.  Attention will be directed on approaches to health care delivery systems in low and middle income countries.  Country cases will be presented to illustrate how health system and financing reform have impacted health outcomes.

Key objectives:

·         To critically assess the differences between vertical and horizontal programs in addressing the health status of a nation and their effect on building the health care system.

·         To explore universal access to health care as a way of bridging the conflict between vertical and horizontal programs.

·         To demonstrate an understanding of the differences among the four models of health system organization and finance and their implications for the health of individuals and populations.