The health system is further plagued by an over emphasis of vertical programs and numerical targets, with little emphasis on quality and outcome of services. The basic philosophy of the vertical approach is that the state can make the most visible impact on health by aiming at a clearly defined target with one or two technological bullets through a chain of command that extends back to the central ministry. Vertical approaches usually care little for local specificities or community participation. Even when successful, they are dramatic but seldom sustainable.
The worst example is the family welfare program, which has been de–humanized to targets and figures sterilizations and contraceptive use by eligible couples. The notorious use of unfair means and incentives is worse compounded by neglect of other health services, even of mother and child health. Despite this sledgehammer approach to the great neglect of general health care, actual achievements in reducing population growth rate fall well short of what is targeted. Better health services, child survival, and female education would have achieved much better results in family planning, even an important programme like Universal immunization programme is sought to be implemented by a vertical chain of command with out building infrastructural and technical capacities to sustain the cold chain. The resultant pathologies are false reporting of figures and reliance on vaccines of damaged potency.
Likewise, a PHC is considered established only when buildings are constructed and staff positions created, or a CHC is ‘Upgraded’ again when staff positions are created. Therefore, figures may show a not insubstantial coverage of rural populations by PHCs and CHCs whereas in practice the languish without staff equipment or consumables or exist only on paper.
Today, there are numerous fragmented vertical programmes. Thus there are separate programmes for leprosy, TB, malaria, filaria, AIDS, and so on frequently with separate establishments and personnel for the same target population. This approach needs to be replaced by horizontal and integrated programmes, with a convergence of health personnel for general health goals. The success of programmes should be assessed not by conventional numerical targets (e.g. number of children immunized, amount of DDT sprayed etc.) but by impact and outcomes (e.g. decline in IMR and disability, and decline in number of cases of malaria respectively). The ability to sustain an achievement must be considered a major criteria of success as typically, targets fulfilled by vertical programmes are seldom sustained.
