Non-governmental actors and vertical programs in global health

In many cases, non-governmental actors recognize a gap human health relating to a disease or location, and then use funding to act on it.  While at one level this kind of work is necessary and important, it is also imperative to note that their efforts are usually specifically targeted and don’t address the broader determinants of health.  It raises the question, does this NGO Band-Aid approach of patching holes in global health detrimental to the formation of adequate health systems? Furthermore, how can aid approach health from the bottom-up while health emergencies prevail?     

There are vertical strategies of tackling public health issues (disease-focused), and horizontal strategies (more broad and health system-focused).  Non-governmental actors commonly take the vertical approach for several reasons.  Donor wishes or agendas and the measurability of having specific goals play a large part in this.  From a political economy standpoint, a problem with vertical programs is that they allow inefficiencies in health systems to persist.  NGOs have become an important branch of development aid, but are not meant to take over government roles for extended periods.  At the same time, how are developing countries supposed to develop solutions and systems to deal with public health problems if the problems are taken into the hands of outside influences?        

In developing countries where poor health is initiated by poverty and worsened by the lack of access to care, attempts to improve health starting from the source are extremely difficult.  Poverty reduction and health system construction take a lot of time, money, and planning.  Those kinds of goals are also more subjectively achieved.  More concrete goals, for example, the eradication of polio, are more concrete and have a greater sense of urgency.  Here we get back to the problem with donors and the agendas that determine public health priorities.  Solutions to this aren’t easy, but one idea is to develop better ways to combine horizontal and vertical approaches in order to address both immediate and long-term public health problems.