BOX 6-1
Some Theoretical Advantages of Integrated and Vertical Programs

Integrated Programs

  • Minimize duplication in administration staffing, infrastructure, logistical, and procurement systems.

  • Often are more cost-effective.

  • Can be more efficient for patients through consolidation of care in a few places.

  • Involve less chance of gaps in care because of fewer referrals out of the program.

  • Are more responsive to local, decentralized management.

  • Foster the building of government capacity as opposed to management by donors.

  • Lower transaction costs between governments and donors as a result of harmonized administrative methods.

  • Unify government and donor priorities and funding targets.

  • Foster programmatic fiscal security through pooled funding.

  • May help avert resource imbalances and negative collateral effects that can occur with well-funded vertical programs.

Vertical Programs

  • May be easier to maintain quality and effectiveness with a narrower focus.

  • Require less complex operational planning and thus potentially less time-consuming.

  • Make use of more readily mobilized funding, which can be used more easily, reliably, and quickly.

  • Make it easier to protect key interventions (e.g., a TB program) where political commitment is weak.

  • May provide more comprehensive and linked monitoring and management response to problems.

  • Make it easier to target interventions specifically to places or populations with greatest needs.

  • Make it easier to maintain the technical quality of services.

SOURCE: Adapted with modifications from Brown, 2001.

And time is in particularly short supply under the stated President’s Emergency Plan for AIDS Relief (PEPFAR) and World Health Organization (WHO) imperatives of placing millions of people under treatment over the next several years. Thus a focus of operations research must clearly be on how models of HIV/AIDS care in settings characterized by different underlying infrastructures can be rapidly established without seriously disrupting

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