Most primary health centers merely provide limited, disease-specific curative services. The current emphasis on vertical disease control programs, such as tuberculosis and leprosy, contributes to the need for comprehensive, integrated service delivery. The vertical disease program structure identifies a clear flow of funds and delineates activities at various levels of health care. Vertical programs efficiently manage healthcare delivery, usually driven from the 'top'. People are at the receiving end of such arrangements rather than at the center of planning or delivery as envisaged in primary health care. The underlying distinction between vertical and horizontal approaches is the contradiction of power. The horizontal approach responds to patients' needs, and the vertical approach is more suited to the state's requirements. The vertical arrangement of services becomes a challenge because it impedes the integration of services and a person-centered approach that are the hallmarks of primary health care. Further, it restricts participatory approaches to designing and delivering healthcare in a bottom-up approach central to primary healthcare.