Service Delivery

Many low and middle-income countries have pluralistic health systems with a variety of providers of health-related goods and services in terms of their level of training, their ownership (public or private) and their relationship with the regulatory system. The development of institutional arrangements to influence their performance has lagged behind the spread of these markets. This paper presents a framework for analysing a pluralistic health system. [adapted from introduction]

This study helps government and donors to understand how local government and service delivery work and to assess whether the return of local councils is likely to improve their functioning. [from introduction]

External challenges to health systems have received little attention in recent years, including the increase of prices for petroleum-based products. Health systems are significant consumers of fossil fuels in the form of petroleum-based medical supplies; transportation of goods, personnel and patients; and fuel for lighting, heating, cooling and medical equipment. Long-term increases in petroleum prices in the global market will have potentially devastating effects on health sectors who already struggle to deliver services to remote parts of their catchment areas. [adapted from abstract]

The purpose of this study was to investigate recent changes in the geographic distribution of pediatricians and the factors underlying this change. [from abstract]

It has been more than 20 years since the 1988 Constitution formally established the Brazilian Unified Health System (Sistema Único de Saúde, SUS), which established health as a fundamental right and duty of the state and started a process of fundamentally transforming Brazil’s health system. The report assesses whether the SUS reforms have transformed the health system as envisaged more than 20 years ago and whether the reforms have led to improved outcomes with regard to access to services, financial protection, and health status. [adapted from introduction]

The objective of this study is to compare measures of cost and quality of care (in-hospital mortality, 30-day same-facility readmission, and length of stay) of hospitalists vs. traditional physician providers in a large Canadian community hospital setting. [from abstract]

This report launches a new program of activities to tackle health inequalities through action by health professionals on the social determinants of health. [from summary]

This study used covert observers to determine health worker adherence to hand hygiene compliance for hospital infection control.

This update describes the development of a platform for delivery of essential health services in a post-conflict setting using integrated mobile teams of health workers consisting of MOH doctors, nurses, midwives, community health workers, and technicians, as well as community nutrition volunteers. [adapted from author]

The paper develops a framework for designing and implementing healthcare delivery innovations aimed at making markets work better for poor people. Focusing on the social contract between providers and users, it reviews several arrangements that have emerged, with a particular focus on the providers largely used by the poor. [from publisher]

Drawing on livelihood studies in health and sociological theory of capitals, this study develops and evaluates the new concept of workhood. As an analytical device the concept aims at understanding health workers’ capacities to access resources (human, financial, physical, social, cultural and symbolic capital) and transfer them to the community from an individual perspective. [from abstract]

This paper examined the association of the family planning service delivery environment with contraceptive outcomes among males and females in five states of Nigeria, including the impact of health worker training in family planning, and the effect of the provider-client interaction on uptake of modern methods. [adapted from abstract]

This report presents an overview of outreach services provided by health workers to remote and rural populations in different countries and contexts. It highlights the potential for alternative health service delivery models, such as mobile clinics and telemedicine, to enhance the attraction and retention of health workers in underserved areas. [from preface]

The impact of HIV-specific funds and programmes on non-HIV-related health services and health systems in genera has been debated extensively. Drawing on evidence from Malawi and Ethiopia, this article analyses the effects of ART scale-up interventions on human resources policies, service delivery and general health outcomes, and explores how synergies can be maximized. [from abstract]

This brief outlines a study from rural Tanzania that shows that there is a huge potential for improving service quality with the existing workforce, by reducing the large gap between knowledge and practice. [adapted from author]

The research detailed in this paper aimed to understand which health system factors constrained the delivery of the Essential Health Package (EHP) in Malawi, namely two areas factors - human resources and drug supply. [adapted from author]

The aim of this paper is to show that present provider-centred models of chronic care are not adequate and to propose full self-management as an alternative for low-income countries, facilitated by expert patient networks and smart phone technology. [from abstract]

This study seeks to assess the role of private health facilities and pharmacies in HIV/AIDS service delivery in Ethiopia, and specifically to identify factors that could enable greater involvement of this sector in addressing the HIV epidemic.

The provision of eye care in the developing world has been constrained by the limited number of trained personnel and by professional cultures. This paper presents a highly flexible competencies-based multiple entry and exit training system that matches and adapts training to the prevailing population and service needs and demands, while lifting overall standards over time and highlighting the areas of potential benefit. [from abstract]

In recent years, some efforts have been made at developing systems for assessing performance and generating information to assist in the distribution of resources in the health sector. However, most of these measurements have focused on the implementation of services and the intermediate steps that determine how inputs are transformed into outputs. This document uses available information to estimate the cost of providing service and workload analysis in order to provide a picture of efficiency in the delivery of services. [from introduction]

This is the first study to systematically review the available published literature describing innovative models of comprehensive primary health care (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993-2006). The study aimed to describe what health service models were reported to work, where they worked and why. [from abstract]

The theme of this edition is primary health care in South Africa. It includes national and international perpescitves on primary health care and focuses on areas such as policy and legislation, infectious diseases, maternal and child health and human resources. Chapter 11 discusses strengthening human resources for primary care. [adapted from summary]

Prior to implementing male circumcision as a public health measure against the spread of HIV, the feasibility, safety and costs of the procedure within target countries should be evaluated to understand what measures need to be taken to ensure access to safe, affordable voluntary circumcision services. The aims of this study were to assess variation and safety of male circumcision practices, as well as resource and training needs related to the procedure, in a community that has been practicing circumcision traditionally for many generations. [from introduction]

Most children undergoing surgery in Kenya are anaesthetised by clinical officers or anaesthetists with minimal training in paediatric anaesthesia. This article details the statistics of how this personnel shortage impacts anaesthesia delivery. [from introduction]

In South Africa, first-contact primary care is delivered by nurses in small clinics and larger community health centres (CHC). CHCs also employ doctors, who often work in isolation from the nurses, with poor differentiation of roles and little effective teamwork or communication. Worcester CHC, a typical public sector CHC in rural South Africa, decided to explore how to create more successful practice teams of doctors and nurses.

A study of private-sector immunization services was undertaken to assess scope of practice and quality of care and to identify opportunities for the development of models of collaboration between the public and the private health sector. A questionnaire survey was conducted with health providers at 127 private facili¬ties; clinical practices were directly observed; and a policy forum was held for government representatives, private healthcare providers, and international partners. [from abstract]

The community score card process is a community-based monitoring tool that is a hybrid of the techniques of social audits and citizen report cards.The CSC is an instrument to exact social and public accountability and responsiveness from service providers. By linking service providers to the community, citizens are empowered to provide immediate feedback to service providers. [from author]

Improving service delivery for the poor is an important way to help the poor lift themselves out of poverty. This resource presents and evaluates tools and techniques to measure service delivery and increase quality in health and education.

This article outlines the challenges facing the surgical workforce in Africa. Funding priorities in Africa typically favor infectious diseases, and surgery and perioperative care have been neglected, even though essential surgical care at district hospitals is more cost effective than some other highly prioritized interventions, such as antiretroviral therapy for HIV. There is a need to integrate surgical and anesthetic training programs so health personnel, particularly in rural areas, can treat the full range of diseases appropriate to that level of care. [adapted from author]

In an initiative to collate experiences on management development in low resource settings, WHO carried out case studies to explore management development approaches and how these impacted managerial and service delivery performance. [adapted from author]