One of the most prominent questions on the global health policy agenda has been whether disease-specific programs, such as those oriented to prevent and treat HIV/AIDS, malaria, TB, and vaccine-preventable diseases, are supportive of or damaging to broader health system functions. After more than a decade of experience with large-scale disease-specific programs, there is still relatively little hard data on the effects of such efforts on sector management, quantity and quality of delivery, health information systems, supply chain, and other health system elements. However, some guidance can be drawn from experience about how to orient the use of disease-specific resources so they are most likely to yield positive spillover benefits. This presentation will highlight the “systems vs disease” tension; examine current trends and debates in development assistance for health; and summarize research on the topic. Recommendations for disease-specific programs will be offered.