the vertical nature of their approach creates a new type of frontline healthcare worker with very specific skills which may not correspond to the overall needs of the country in general people living in remote areas urban slums or particular geographical areas with high concentrations of ethnic minorities depend heavily on such basic primary care services as observed elsewhere there is a serious risk that weak human resource and systems capacity at central and local levels can be overwhelmed by the growing proliferation of ghp and other hivaids initiatives with separate demands even if vertical funds invest resources in strengthening national capacities or improving their harmonization and alignment difficulties will persist because each initiative has its own governance structures and decisionmaking process the united states president s emergency plan for aids relief pepfar for instance has indicated that it targets children and orphans particularly the share of children receiving pepfarsupported treatment grew from per cent of total beneficiaries in fiscal year fy to per cent in fy