By: Rifat A. Atun, Sara Bennett and Antonio Duran (World Health Organization)

The terms vertical and integrated are widely used in health service delivery, but each describes a range of phenomena. In practice, the dichotomy between them is not rigid, and the extent of verticality or integration varies between programmes – including (1) a vertically funded, managed, delivered and monitored programme; (2) one with integrated funding, organization and management but separate delivery; and (3) a fully integrated approach comprising comprehensive primary health care services. Most health services combine vertical and integrated elements, but the balance between programmes in these elements varies considerably. Hence, when vertical and horizontal and programme design are being discussed, clarity is needed on the programme element being referred to: (1) governance arrangements, (2) organization, (3) funding and (4) service delivery.