An Opportunity for Diagonal Development in Global Surgery: Cleft Lip and Palate Care in Resource-Limited Settings

Table 1

The vertical-horizontal debate: benefits and limitations of each approach.

Approach	Description	Examples	Advantages	Disadvantages
Vertical	(i) Disease specific; (ii) Narrowly focused; (iii) Operates outside the existing healthcare structures and systems; (iv) Often privately funded	(i) Polioimmunization program; (ii) HIV/AIDS treatment programs; (iii) Male circumcision programs; (iv) DOTS	(i) Demonstrated effectiveness (HIV/AIDS); (ii) May have a limited, positive impact on other areas of healthcare delivery (“spill over”); (iii) Fast implementation; (iv) Scalable; (v) Donor attractiveness; (vi) Efficient delivery of disease, specific equipment and supplies	(i) May not address other diseases, healthcare needs, and health determinants; (ii) May yield redundant and poorly coordinated efforts; (iii) May divert funds from other diseases and medical priorities
Horizontal	(i) Not disease specific; (ii) Focuses on broadly applicable healthcare infrastructure; (iii) Long-term interventions and investments	(i) Strengthening primary care systems; (ii) Healthcare provider education and training; (iii) Human resources for health (HRH)	(i) Strengthens health systems as a whole; (ii) Benefits all patients, regardless of disease or diagnosis; (iii) May facilitate disease, specific treatments; (iv) Builds capacity for long-term change	(i) Long-term interventions; (ii) Large, unwieldy projects; (iii) Often less attractive to donors, funders; (iv) Require functional state and local governments; (v) More difficult to measure impact of horizontal interventions