When do vertical programmes strengthen health systems? A comparative assessment of disease-specific interventions in India

Abstract

Disease-specific programmes in India are widely regarded as having made a substantial contribution in disease control. They can have both positive and negative effects on health systems. Certain conditions are necessary for them to have a positive influence on health systems—the programme needs to have an explicit policy to strengthen local health systems, and should also be embedded within the health system administration.

The impact of introducing new vaccines on the health system: Case studies from six low- and middle-income countries

“…Some studies have reported a perceived increase in health service use following the introduction of services or new vaccines [3,16], however, others found no change [6,12]. Our results suggest that findings based on perceptions of increased service use should be treated with caution.…”

“…Research on the health system impact of other vertical health programmes, including vaccination campaigns, have identified both positive and negative effects [6,[13][14][15][16]. It has also been noted that these impacts varied depending on the strength of the health system [6,15].…”

Association Between HIV Programs and Quality of Maternal Health Inputs and Processes in Kenya

“…22,23 Additional gains may be possible if services are more closely integrated, as is currently pursued. 24–26 Prospective evaluation research is needed to elucidate how to most efficiently harness HIV investments to benefit all people seeking health care.…”

Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-Eastern Nigeria

“…Health systems factors that strengthened TB control include effective national strategies [5][6][7]; strong stewardship from district government [8]; donor funding [5,[8][9][10][11][12][13]; inclusion of TB in social health insurance schemes [14,15]; earmarked funding for TB [16]; medical vouchers and subsidies [17,18]; providers' satisfaction with directly observed treatment short course [19]; incentives to programme staff [20]; patient-centred approaches and intersectoral collaboration [6,16,19]; motivated and dedicated healthcare workers [16,19]; effective supply and drug management system [8,21]; use of dedicated logistics agency to distribute TB drugs [9,22]; and electronic reminders to improve treatment adherence [17].…”

“…Constraints to TB control include perception that TB control is less important than other public health programs [20,23]; weak accountability relationship between provincial/regional and district TB programme management [7,12,24]; insufficient community involvement [25]; and low public spending on TB [5][6][7][9][10][11][12][13]. TB control have been limited by lack of skilled staff [4,10,11,19,22]; lack of incentives for service providers [4,5,10]; lack of utilization of various levels of health staff and health facilities [25]; poor attitude and weak commitment of health workers towards deployment to TB services [22,23], inadequate training [10,11,19], and lack of laboratory staff [5,22,23].…”