Hybrid service configurations fall somewhere between these two extremes. Many of the
activities with a large potential impact on outcomes (shown in Table 3.1) are implemented
in this form. Programmes to control infectious diseases such as malaria, tuberculosis and
HIV/AIDS benefit from the planned coordination of some of their strategic elements at the
national level. Yet their implementation can sometimes be more effective when carried out
under contractual relationships with local providers than when implemented as vertical
programmes isolated from other ambulatory services. For example, the implementation of
the integrated management of childhood illness in Egypt requires close national coordination
of activities such as immunization, malaria control and iron supplementation, but implementation
would be impossible without local providers with the broad range of skills
needed, for example, to treat acute respiratory infections, diarrhoea, and childhood illnesses.