Chagas Disease Control in El Salvador and the Diagonal Approach to Health Interventions: a case study of health systems strengthening, integration, and community participation

Toke Andersson Dalsgaard Nielsen & Peter Røpke

Studenteropgave: Speciale


In our thesis we are investigating the Chagas disease control program, which was carried out in El Salvador in collaboration between the national Ministry of Health, the Japanese International Cooperation Agency (JICA), and the Pan American Health Organization (PAHO) during the period of 2003-2011. We are investigating the program through the lens of a long-standing debate in the field of global health about the respective merits of ”vertical” and ”horizontal” health interventions, a debate which we have used as a point of entry to bring in the conceptual frameworks of ”Health systems strengthening”, ”Integration”, and ”Community participation”. We argue that the Chagas program was neither vertical nor horizontal but rather a ”diagonal” health intervention because it was both disease-specific but also strengthened the ”building blocks” of the national health system in a number of ways. Furthermore, we argue that the extent of integration of the Chagas program into the different ”critical functions” of the national health system varied significantly, meaning that the program was neither fully nor non-integrated. In addition, we argue that the program’s strategy of community participation was closest to an approach of ”mobilization” in most of its ”process indicators” as it was the health authorities who took the lead, decided its focus and priorities and evaluated the strategy. Finally, we argue that the specific contextual circumstances of El Salvador’s health reform; the situation of gang crime and violence; and the political will related to Chagas all affect the disease control efforts, while housing improvements have significant potential to mitigate the Chagas problem, although it is a complicated approach to carry out.

UddannelserGlobal Studies, (Bachelor/kandidatuddannelse) Kandidat
Udgivelsesdato29 apr. 2016
VejledereJohanna Hood


  • Chagas Disease
  • health systems
  • Global Health
  • community participation