Building ladders to success: connecting vertical and horizontal programmes.

In many countries the demand for family planning (FP) programs is increasing a demand that could be met by increasing resources and making more effective use of existing resources. A vertical national and regional FP program must be sensitive to the needs of women. Vertical means a single-purpose program; while horizontal programs are multi-purpose. Local reproductive health services must be integrated to meet the needs of the local community. The national-vertical aspect requires that program leaders: 1) discern the unmet need for services in their area; 2) maintain an optimal mix of contraceptive and sterilization services; 3) have funds available for FP; and 4) design programs that are sensitive to the needs of clients. Evaluation should also be conducted vertically by means of an effective information system period surveys and operations research. Traditional evaluations have counted the number of new and continuing acceptors and couple-years of protection. These indicators have been supplemented by periodic population-based surveys at the national or regional level. Well-planned surveys spanning several vertical programs can assess common goals e.g. in Ecuador FP and child survival program collaborated on a FP survey and realized a 40% reduction in cost. When a FP program is sensitive to womens needs it may also appeal to health care workers focusing on child survival safe motherhood primary health and womens health and development. Vertical programs can collaborate to manage a horizontal structure for service delivery by sharing service personnel and information systems at the local levels. Decentralization would lead to efficiency with cost savings responsiveness to local needs and improved service. The criticisms of vertical programs include reduced long-term impact because of inefficiency reduced consumer satisfaction and loss of opportunity to discuss FP. Concerns about integrated programs concern the lessened impact of FP resources ministerial inefficiency and the absence of primary health care.