The eradication of smallpox, with the last natural case recorded in 1977, was transformative for global health in ways no one could have imagined at the time. This feat demonstrated that a single-disease focus, pursued at scale, could work, thus eradication became the frame through which donors concentrated a considerable portion of their investments. This architecture drove dramatic gains in areas like HIV treatment and coverage of critical vaccines such as polio and rotavirus. Since disease-specific programs produced visible, quantifiable results on timelines that matched political funding cycles, the vertical approach suited donors and was subsequently adopted by countries and implementers as the organizing logic of their own health systems.  

 An eradication agenda pursued through disease-specific programs presumes dedicated resources will be available and sustained, but over the last two years, the global health financing landscape has experienced significant shocks. Bilateral and multilateral agencies have cut budgets, and fragile health systems in low- and middle-income countries must sustain services across a growing number of disease areas with fewer resources. Under funding pressures, the vertical disease silos that once enabled major health gains are proving difficult to sustain. The downstream effects are already visible, with some countries experiencing up to a 70% reduction in critical services.

Integration has long been discussed as an approach to improving the impact of services and the quality of the patient experience. Now, countries and implementers facing shrinking budgets and steady demand are turning to integration not as a design choice but as a financial necessity—even though the power to align siloed financing mechanisms sits with the funders above them.

Integration pursued as a cost-cutting reflex can produce fragile and ineffective systems. The outcome depends on whether there is genuine overlap in patients’ needs, compatible delivery infrastructure, established clinical co-benefit, and aligned financing. These conditions, however, are not all within countries’ power to create. Countries bear the burden of integrating delivery, but the donors and multilaterals above them control the financing architecture that plays a major role in determining whether integration can hold. 

In Camber’s new report, “Shifting from Siloes: Where Integration Can Create Value”, our team explores what governments and funders alike can do to make integration an effective reality in public health programming.