The Integration of Vertical and Horizontal Programmes for Health Systems Strengthening in Malawi: a case study

Joseph J. Sakala1, Chancy S. Chimatiro1,2, Racheal Salima1, Arnold Kapachika1, Josephine Kalepa1, William Stones1,3

1 School of Public Health and Family Medicine, College of Medicine, University of Malawi.
2 Africa Center of Excellence in Public Health (ACEPHEM), University of Malawi, College of Medicine, Blantyre, Malawi.
3 Centre for Reproductive Health, College of Medicine, University of Malawi.
*Corresponding Author: Joseph J. Sakala; E-mail:

A challenge for the health system in Malawi is that funding allocation is heavily influenced by donor priorities. As a result, mandated routine elements of service delivery may not be fully offered owing to lack of resources or programmatic priority. Integration of currently active ‘vertical’ programmes (those focused on a specific priority disease entity) into existing ‘horizontal’ services (meaning provision across the range of clinical and public health need) has potential to improve access and quality of service delivery for Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) in Malawi.
We identified and tabulated the main vertical funding streams currently available in Malawi and identified where these could intersect with existing horizontal health sector programmes in order to strengthen RMNCAH. We have indicated how each of the main vertical programmatic components can be adapted and integrated to support broader system strengthening within RMNCAH focusing especially on drug and commodity procurement, supply chain logistics, health facility and equipment maintenance/upgrading, health service activity data systems, human resources for ‘front line’ RMNCAH provision, as well as community engagement and mobilization.
By circumventing the various limitations of vertical programmes in the delivery of health services in the country, they would complement existing funding streams rather than operating in a vacuum as independent activities. We therefore recommend the integration of horizontal and existing vertical programmes in order to improve RMNCAH in Malawi.

Keywords: health financing, horizontal programmes, RMNCAH, vertical programmes, health systems strengthening

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