There are basically three types of public health interventions: vertically targeted interventions (focused immunization or disease eradication campaigns, for example), horizontally targeted interventions (universal access to a basic medical care package including vaccination, for example), and sector-wide interventions such as capacity building for improved infrastructure and administration. For many years, donors and health officials in low-and middle-income countries gave emphasis to vertical interventions financed by 'earmarked' funds. Problems with this approach include duplication and lack of coordination among projects, 'recipient fatigue' in health ministries forced to administer multiple grants, distortions in local resource allocation such as poaching skilled personnel, and "crowding out" (of which more below) [19] . All donors and the partner countries have committed themselves, through the 2005 Paris Declaration, to pursue harmonisation of practices, standards, and criteria in foreign assistance. Yet the urge to compete rather than cooperate is strong, and well-entrenched donor practices and protocols disappear only stubbornly.