Reforms to the health sector must retain vertical programmes like those for tuberculosis

EDITOR—Health sector reform has become the policy urged on poor countries in the developing world. Basically it entails transferring responsibility for health services and health budgets to local communities. I am sympathetic to this approach. But its uncritical application by governments has a dangerous obverse.

Vertical programmes—for instance, central coordination and monitoring of the World Health Organization's DOTS (directly observed treatment short course) programme for control of tuberculosis—may be discouraged. The programme may be suddenly abolished. The economy of scale …