Question:

The world is currently experiencing a shift in the global health agenda from an emphasis on
disease-specific approaches to a focus on health system strengthening. These two approaches are
often called the “vertical” and “horizontal” approaches to health improvement. Discuss the
factors that have contributed to the growing attention to health systems.

Introduction:

The shift from disease-specific approaches (vertical) to health system strengthening (horizontal)
reflects a recognition of the interconnectedness of various health challenges and the need for
comprehensive, sustainable solutions. Several factors have contributed to this growing attention
to health systems:

These are;

1. Rising Burden of Non-Communicable Diseases (NCDs): Non-communicable diseases

such as cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases have
become leading causes of morbidity and mortality worldwide. Addressing NCDs requires
a holistic approach that includes preventive measures, early detection, and ongoing
management, which are best delivered through strengthened health systems.
2. Globalization and Urbanization: Globalization and urbanization have led to increased
mobility, changing lifestyles, and rapid urbanization, which in turn have contributed to
the spread of infectious diseases, environmental health risks, and lifestyle-related
diseases. Health systems need to be robust and adaptable to effectively respond to these
complex health challenges.
3. Health Security Concerns: Events such as the Ebola outbreak in West Africa and the
emergence of novel infectious diseases like Zika and COVID-19 have highlighted the
importance of resilient health systems for epidemic preparedness and response. Health
system strengthening is essential for early detection, rapid response, and effective
containment of disease outbreaks.
4. Health Inequities and Universal Health Coverage (UHC): Disparities in access to
healthcare and health outcomes persist within and between countries. Achieving UHC
requires not only expanding access to essential health services but also addressing
 underlying health system weaknesses such as inadequate infrastructure, health workforce
shortages, and insufficient financing. Health system strengthening is therefore central to
achieving equitable health outcomes for all populations.
5. Increasing Recognition of the Social Determinants of Health: There is growing
recognition that health outcomes are influenced by social, economic, and environmental
factors beyond the healthcare sector. Addressing these social determinants of health
requires a multi-sectoral approach that goes beyond disease-specific interventions and
encompasses broader health system strengthening efforts to improve living conditions,
education, employment, and social support systems.
6. Health System Resilience: The ability of health systems to withstand and recover from
shocks, whether they are natural disasters, conflicts, or pandemics, has become a critical
consideration in global health agendas. Strengthening health systems to enhance their
resilience and adaptive capacity is essential for ensuring continuity of essential health
services during crises.

Conclusion

The growing attention to health system strengthening reflects a recognition of the need for
comprehensive, integrated approaches to address the complex health challenges facing societies
today, from infectious diseases and NCDs to health inequities and health system resilience. By
investing in health systems, countries can build the foundation for achieving better health
outcomes and greater health equity for all.