“A Fundamental Schism and a Problem”: The Debate Between Vertical and Horizontal Approaches in the Somalia–Finland Tuberculosis Control Project, 1980–1990

Abstract The Somalia–Finland Tuberculosis Control Project started in 1980 as a vertical, expatriate-led, and technology-oriented initiative focused on developing specialised tuberculosis care. In 1984, the Project was transformed into a massive capacity-building programme that prioritised training and PHC integration. This article investigates the difficulties in reconciling the vertical and horizontal approaches from the perspective of the different Project participants on the level of different institutional actors and organisations. By mapping how different views were argued for and negotiated and how they influenced the Project, the article contributes to a more comprehensive understanding of how global health policies were adopted and modified in bilateral development assistance settings. The article shows that while a horizontal PHC approach pushed the Project towards more broad-based capacity-building, the difficult treatment environment, inner tensions, competing agendas and miscommunication between bilateral project parties hindered the creation of a commonly shared consensus on PHC in meso-level decision making and hampered the integration.