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You are here: Home Symposium Cutting Edge Research and Cross-Cutting Themes in Vertical/Horizontal Integration
Cutting Edge Research and Cross-Cutting Themes in Vertical/Horizontal Integration Print E-mail

Speakers: Erica DiRuggiero, Elizabeth Gyorfi-Dyke, Christine Kurtz-Landy

The second session of the symposium highlighted cutting edge research in vertical and horizontal integration by graduate students. Doctoral student Erica Di Ruggiero opened the session describing her research interest related to processes leading to vertical and horizontal integration in the context of policy implementation. Early research suggests that intersectoral action is strongest and outcomes best achieved when collaborations are both vertical and horizontal, occur at several levels simultaneously, and are integrated or supported through policy legislation. Di Ruggiero proposed a need to question how vertical and horizontal integration are conceptualized in different policy contexts and how to best understand the processes for integration.

Switching from her PhD student lens to her research funding hat, Di Ruggiero offered suggestions to encourage knowledge development in this area. Enabling conditions include support for natural policy experiments, unconventional programs of research and knowledge exchange (i.e., nested and inter-connected studies, comparative studies, fleeting ‘policy window’ opportunities), basic and applied research, and within and cross-country collaborations. Targeted funding and training and mentorship across career trajectories are additional supports Di Ruggiero believes are necessary to encourage research in this area.

Elizabeth Gyorfi-Dyke continued the session by introducing her innovative PhD research exploring factors that influence International Non-Governmental Organizations’ (INGO) implementation of equity principles in their HIV/AIDS work. Gyorfi-Dyke believes a gap exists between the intent of INGOs to ensure equity in their HIV/AIDS work and actual practice. She suggested that global donor funding may be a contributing factor. According to Gyorfi-Dyke there has been a shift from the funding of horizontal programs to vertical programs. Relying on donor funding, INGOs are influenced by the focus of the donors that tend to be disease specific and vertically oriented. Advantageous to vertical funding is targeting of diseases, monitoring successes, (i.e., reduced enteric disease), and enhancing the awareness and thus support to combat diseases. On the other hand, vertical funding contributes to lack of donor coordination, poses challenges for sustainable programs, and hinders the development of comprehensive approaches required to address wider determinants and social inequity.

For Gyorfi-Dyke, the question is how do we integrate vertical or horizontal approaches, or in the case of HIV/AIDS, is one approach better suited than the other? Arguing that HIV/AIDS shares common underlying structural issues with other health concerns such as poverty, gender inequity, and lack of human resources and infrastructure, Gyorfi-Dyke believes there needs to be a shift in funding arrangements that allows targeting upstream sources of problems. She suggested that perhaps it is through a ‘diagonal approach’ that opportunities from vertical approaches can be retained yet address gaps through horizontal approaches.

Adding to the horizontal and vertical integration dialogue, Christine Kurtz-Landy began by introducing her doctoral and post doctoral research interests concerned with health inequities experienced by those in early motherhood. Kurtz-Landy argued that commitments to address inequities and ensure basic human rights for children and mothers living in poverty are not being met. Government policies as well as societal rhetoric and ideologies contribute to the disadvantage of these women who experience poorer health, lack essential supports, and resources and are stigmatized and discriminated by the very service providers put in place to help. Addressing these concerns requires combined vertical hierarchical and horizontal integration and collaboration. Kurtz-Landy cautioned the linear thinking that may accompany vertical and horizontal approaches. She suggested the relationships involved with vertical and horizontal integration are complex and chaotic, requiring communication at every level and across levels.

Discussants: Marjorie MacDonald and Beth Jackson

Discussants Marjorie MacDonald and Beth Jackson provoked additional theoretical and methodological considerations in their responses to the three presentations. MacDonald noted that all presenters identified theoretical and methodological challenges for gaining knowledge about horizontal and vertical integration in MIPs. Pulling together various theoretical perspectives to guide research for programs that focus on multiple aspects of a problem, involve complex interventions, cross sectors and jurisdictions, and play out differently in different contexts remains an important area for investigation and innovation.

Picking up on Kurtz-Landy’s idea, MacDonald suggested that moving away from linear ways of thinking and grappling with complexities may be facilitated through network theories. We also need to think very differently about how we research complex interventions within complex systems. MacDonald argued that the kinds of methodologies and designs that get funded and with which we are most familiar will not begin to take us down that path. Methodological development is critical and fortunately, people are now starting to come together to discuss these issues.

Adding to the themes of theoretical and methodological issues, Beth Jackson proposed that feminist epistemologies, science and technology studies, and intersectional analysis are important tools that can help to advance knowledge in health and social justice. Jackson shared ideas from her paper (recently accepted for publication), which describes the complementary and productive cross-fertilization of these approaches in research. Feminist epistemologies and science and technology studies draw attention to the social, political, historical, and material contexts in which knowledge is produced, while intersectional analysis guides inquiry into the production of meaning, systems of inequality, and social justice. Value added through such approaches is the provision of responsible accounts of how and what we know and questioning of the assumptions upon which those knowledge claims are based.

Jackson suggested there is an addiction to developing tools, but we may be well served to shift our thinking to developing critical methods of inquiry. We have lots of work to do in terms of developing and implementing these theoretical and methodological frames. Fortunately we have a rich set of concepts and practices with which to do this work across disciplines. Jackson ended the session by reminding participants that we may not always recognize each other’s language but we are all very much engaged in the same project.

Last Updated on Sunday, 11 October 2009 22:08