Vertical, horizontal, even diagonal. These are all directions that international institutions, NGOs, and/or local governments try to impose upon local health systems.
The vertical direction may cure a strain of a disease, but what happens if the disease forms new strains, such tuberculosis, which has become resist many of the treatment. The horizontal path may try to improve an entire health system, but may not have a clear path for implementation. The diagonal approach looks at bringing in certain innovations to improve the overall health system. Diagonal system clearly moves the global health system in a more efficient direction, but there are a lot of elements to consider in terms of when it comes to what diseases are considered important and what diseases go untreated.
Who is driving the car when it comes to the direction that healthcare is moving? It is often organizations or leaders that have the power and influence to determine what is included in a certain direction and what needs to be left in the back seat. A government may prioritize malaria vaccinations, but not have enough funding for oral rehydration treatment for diarrhea patients.
The direction that the system goes in can impact entire communities or nations. This chosen path can also impact other countries or the entire global, especially when it comes to the spread of contiguous diseases. For example, the weak health systems of West Africa in post-war Liberia and Sierra Leone have led to the current state of the Ebola epidemic. When no one driving is the health care agenda for these countries cared about implementing strong health systems, because it was not a priority issue for them. Therefore, the outbreak is cycle of draining resources and not being eradicated, because health systems are far too weak to start with.
Now, since Ebola has become a global issue, there is a possibility that someone else will be placed in the driver’s seat when it comes to determining the next direction for West Africa’s health system. Possible candidates include the WHO, the UN, NGOs, etc. But it is unknown who will be the best candidate to make an impact.
There are certain things that may be off the map, such as increasing education levels or access to healthy food. These determinants may a role when it comes predicting health outcomes for a nation or community. Culture attitudes, for example, can play a critical role in determining health outcomes for women and girls in terms of access to family planning services. Education for girls and healthy food for community members be to taken into account when determining health policy.
The direction that global leaders chose can impact the world. It is ultimately up to the major actors to choose the right path, but that is not enough to help every individual receive access to healthcare. For individuals to have the best care possible, they must be able to have a seat in the car.