Getting Out of the Vertical Vs. Horizontal Box

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The November issue of the Journal of Acquired Immune Deficiency Syndromes offers something of a roadmap for how best to move forward, more productively and less bitterly, in the decades-old debate that pits diseases-specific health initiatives against broader efforts to strengthen health systems. With nearly 20 articles exploring the relationship between HIV scale up and global health systems, JAIDS is weighing in on the hottest topic du jour in Washington and various academic circles.

But the opening piece, an introduction by Drs. Wafaa El-Sadr and Kevin De Cock, reminds us that this should not be an esoteric debate, disconnected from the health care realities on the ground in the developing world. “Health systems exist to provide services for real people to prevent and treat diseases that have names,” they write. Failure to recognize that could have devastating consequences.

“Perhaps most seriously, the debate fails to take account of the lives saved through PEPFAR and the Global Fund, and the implications for countries and systems if those advances are not sustained or extended,” Drs. El-Sadr and De Cock say. “We cannot forget that it was the unparalleled impact of untreated HIV/AIDS in Africa that launched these major initiatives and that the prevention of death remains a core public health function. At the same time, criticisms such as that HIV/AIDS programs steal health care workers or are sometimes ivory tower initiatives amidst a sea of misery need to be examined seriously.”

Instead of a polarizing and theoretical debate, these questions need to be addressed with strong “global health leadership, clarity of thought, pragmatism, and sound understanding of disease epidemiology.”

And that’s just the JAIDS opener on the topic. Click here to see the table of contents and read the rest.

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