This World Health Organization study describes various activities aimed towards strengthening the management of health service delivery in three countries: South Africa, Togo and Uganda. The paper considers factors that affect management capacity: the number of managers at all levels; opportunities for building existing managers’ own competences; improving management support systems; and creating a more supportive work environment. It also identifies several ways to help managers do their jobs better. These include clarity about their responsibilities; practical reference handbooks; and a regular forum for managers to identify their needs, discuss problems and share ideas. On-the-job support is perceived by many managers as key to improving their performance – this can include technical assistance, mentoring, coaching and learning networks. In terms of management strengthening activities, the study reveals that a range of approaches have been used in recent years, but countries and external development agencies have concentrated mainly on training and some management systems (planning and monitoring) to the detriment of other key conditions for facilitating good management. Medium- to long-term sector-wide budgets and plans for management strengthening are required if good management is to play its appropriate role in scaling up health services.
Equitable health services
A descriptive, non-interventive, observational study design was used to audit all public and private sector ICUs and HCUs in South Africa to evaluate the distribution and functioning of South African intensive care units (ICUs) and high care units (HCUs), in particular the extent to which units were ‘closed units'. In the face of already limited resources (financial and human) and given the emphasis on primary care medicine (with consequent limited capacity for further ICU development), it is crucial that existing facilities are maximally utilised.
A descriptive, non-interventive, observational study design was used to audit all public and private sector ICUs and HCUs in South Africa to establish the efficacy of the current system of referral of critical care patients: (i) from public hospitals with no ICU or HCU facilities to hospitals with appropriate facilities; and (ii) from public and private sector hospitals with ICU or HCU facilities to hospitals with appropriate facilities. There was considerable variation (less than 1 hour - 6 hours) in time to collect between provinces and between public hospitals that have or do not have ICU/HCU facilities. A combination of current resource constraints, the vast distances in some regions of the country and the historical disparities of health resource distribution represent a unique challenge which demands a novel approach to equitable health care appropriation.
A descriptive, non-interventive, observational study design was used to audit of all public and private sector ICU and high care units in South Africa to determine the national distribution of intensive care unit (ICU)/high care (HC) units and beds. The most compelling conclusion from this study is the need for regionalisation of ICU services in SA.
There is some evidence from refugees that health care services in South Africa are not responsive to their perceived needs. Using quantitative and qualitative approaches to evaluate the perceptions and opinions of refugees about health care services in South Africa, the authors find that major issues affecting refugees include: discrimination and xenophobic attitudes of health service providers; language barriers leading to inappropriate treatments due to misunderstanding; exclusion from public hospitals due to lack of valid permits or delay in the delivery of such permits. Based on these findings, the authors suggest that refugees should have at least a baseline health related interview and check-up preferably done in a primary health care (PHC) centre dedicated to refugees. Refugee support systems should be established and health care workers should be informed about issues such as refugee permits and policies regarding referral systems. Also, public hospitals should employ qualified translators to help in cases that are referred from PHC centres for refugees.
The researchers analysed the experiences of different countries affected by conflict, including Afghanistan, Cambodia, East Timor, Kosovo, Uganda and Mozambique. They began by looking at the impacts of conflict on public health. They then presented a framework for understanding how programmes for rehabilitating health systems might work in post-conflict countries. The authors suggest three interrelated approaches to health sector rehabilitation: an initial response to immediate health needs (through humanitarian assistance and relief); restoration or establishment of a package of essential health services including immunisation and obstetric care; and restoration of the health system itself. The authors highlight the lack of co-ordination between donor organisations, whose competing needs and projects distract health officials. Non-governmental organisations (NGOs) may also delay progress by continuing to focus on relief when the country has moved on to the next stage.
This report uses the examples of the health and education sectors to consider South Africa's compliance with the various standards and best practices laid down in relation to the functioning of the public service -- including the African Union Convention on Preventing and Combating Corruption, and the Charter for the Public Service in Africa. While South Africa has many examples of best practice on paper, it is struggling to ensure that these policies are fulfilled in practice: this report offers analysis and suggestions on critical problems for attention.
This study assesses the evidence regarding strategies used to attain universal coverage and draws out a list of lessons for policy makers, donors and civil society groups. It focuses mainly on middle-income countries that have recently gained, or are close to gaining, universal coverage. It looks at the extent to which various strategies promote equity in terms of financing, access to and use of services. Key financing priorities are to gradually increase risk pooling arrangements over time, and to focus on protecting the poorest and most socially disadvantaged against the costs of health care.
This study investigates contextual factors associated with treatment-seeking behaviour and higher-risk sexual conduct of men symptomatic of sexually transmitted infections (STIs) in Botswana. At the heart of Botswana's epidemic lies men's reluctance to seek medical treatment, engaging in unprotected sex, and having sex with multiple partners while symptomatic of an STI. The odds of engaging in unprotected sex while symptomatic of an STI were significantly higher among teenage males, males in urban households, where age differences between partners was higher, in married men and men with more than one sexual partner. Having sought medical treatment from hospitals, clinics and health workers, as opposed to consulting traditional healers, significantly reduced the odds of having had unprotected sex while infected with an STI. The results indicate the need to encourage men to utilise public healthcare services. The public health sector in Botswana needs to provide healthcare services that are user-friendly for men. Special attention needs to be paid to boys' socialisation towards gender norms, and men are to be encouraged to play a responsible role in HIV prevention.
This paper assesses strategies to promote child development and to prevent or limit the loss of development potential. The programmes reviewed have been implemented in developing countries since 1990. Thirty-five such studies were identified of which 20 met the researchers’ criteria. They fell into three groups: centre-based early learning, parenting and parent-child programmes, and comprehensive programmes that include health and nutrition interventions. The researchers identify factors that are consistently associated with effective programmes and identify a need to establish globally accepted monitoring indicators for child development and for more evaluation. They conclude with a discussion of priorities and crucial issues for future programmes.