Date of Award
Spring 5-18-2026
Document Type
Thesis
Degree Name
Master of Public Policy (MPP)
First Advisor
Cara Fallon
Subject Area(s)
African studies, Biostatistics, Economics, Epidemiology, Health care management, International relations, Management, Public health, Public policy, Sub Saharan Africa studies, Statistics
Abstract
Background: Global health financing has historically prioritized disease-specific “vertical” programs over broader “horizontal” strengthening of general health systems. Vertical programs in HIV have led to unprecedented reductions in mortality worldwide, but HIV remains a significant public health threat in sub-Saharan Africa, where vertical strategies have long been criticized for creating fragmented health systems. In response, global health strategies have shifted towards combining vertical investments with broader horizontal activities, commonly referred to as “diagonal” programming. While evidence suggests that diagonal programming has the potential to create more resilient and sustainable health systems, evaluating its value for money is challenging due to the difficulties associated with measuring the costs and benefits of horizontal interventions.
Objectives: We aim to synthesize existing literature on economic evaluations of HIV programs integrated with health systems strengthening activities and describe common considerations and lessons learned to inform future research and policymaking.
Methods: We conducted a rapid review of peer-reviewed literature by searching the PubMed electronic database for studies assessing the economic impacts of integrated HIV and HSS interventions in sub-Saharan Africa. The search strategy identified 1,009 unique English-language records published between January 1, 2015 and January 1, 2026. Records were screened by abstract and title for relevance, then selected for inclusion after full-text review. Data were extracted from 24 studies on study design, type of HSS platform, costing methodology, and reported outcomes. Study conclusions were summarized using qualitative synthesis and analysis.
Results: Diagonal programs integrating HIV and HSS activities were generally found to be cost-effective and result in improved effectiveness measures compared with status quo or no comparator alternatives. The most frequent integration strategies were integration of multiple health services, point-of-care testing, and implementation of mobile-based interventions.
Conclusion: Leveraging the existing HIV infrastructure to implement diagonal interventions is economically feasible, but costs are sensitive to factors such as intervention uptake. This review can help policymakers make nuanced decisions in countries considering similar interventions.
Recommended Citation
Kim, Lucy, "Global Health Financing of Diagonal Interventions: Building Resilient and Sustainable Health Systems In Sub-Saharan Africa" (2026). Master in Public Policy Theses. 8.
https://elischolar.library.yale.edu/publicpolicy_theses/8
This Article is Open Access
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