Many have pointed to the fact that vertical programs, those focused on a specific disease, may be diverting funds away from horizontal programs [5], those interventions that strengthen the entire health system [6].
Duplication occurs when different numerators and denominators are used and there is separation between vertical and horizontal programs.
Achieving an appropriate balance between vertical and horizontal programming and between prevention and treatment strategies are issues to be resolved by the GFATM and other institutions at the programming level.
This paper sets out the case for global leadership to support health systems investments and help ensure the synergies between vertical and horizontal programs that are essential for effective functioning of health systems.
This diagonal approach to curriculum design is similar to a diagonal strategy for health programming and intervention, combining the use of vertical programs targeted to specific diseases and horizontal programs applying to general, broader health systems strengthening, and common risks and associations for disease (34).
Where health systems are extremely weak, vertical programs can play an important role, but they need to be designed in ways that act as a catalyst for wider system change (as is being attempted by the GFATM and GAVI), becoming interwoven in a matrix with horizontal programs [ 2].
The often polarised debates around verticalised programming versus horizontal programming and health systems strengthening will hopefully develop into more nuanced debates around, for example, "diagonal" approaches that both strike a balance between disease and systems priorities as well as use disease-specific interventions to leverage improvements in the broader health systems [ 32, 33].
Investing in horizontal programs for developing health systems would not only provide much-needed basic services for individuals suffering from these and other diseases at present, but would also lay essential groundwork for the future delivery of targeted interventions such as medications and immunizations, once they become available.
The MoHP of Nepal has a national plan that prioritizes horizontal health programs that cover the most important health needs of the Nepali people [ 12- 14].
When it looked at figures from 2010, it found natural gas volumes grew dramatically thanks in part to horizontal drilling programs.
