Reforming health service delivery at district level in Ghana: the perspective of a district medical officer
Reforming health service delivery at district level in Ghana: the perspective of a district medical officer
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DOI：
10.1093/heapol/14.1.59
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发表时间：
1999-03-01
影响因子：
3.2
通讯作者：
Agyepong, IA
中科院分区：
文献类型：
--
作者：
Agyepong, IA
在经济衰退和资源有限的背景下，撒哈拉以南非洲的许多国家面临着以向其民众提供足够质量和覆盖范围的医疗服务的方式来组织医疗服务提供的问题。为应对这些挑战，包括加纳在内的不同政府一直在考虑或正在实施不同程度的卫生部门改革。本文从地区卫生管理者的角度，利用加纳大阿克拉地区当梅西区随时间推移的常规数据，审视了医疗服务提供的各个方面以及利用和覆盖范围的趋势。文中提出了可以改善地区层面医疗服务提供和利用的具体干预措施。这些建议包括提高医疗服务提供者和卫生管理者的认识，即资源可用性的增加只有在导致覆盖范围、利用和质量提高的情况下才算是成功；制定绩效指标，以评估和奖励地方层面资源的使用，从而提高覆盖范围、利用和质量。还需要中央政府在资源分配和使用规定方面更加灵活；将地区层面的服务提供与更分散的规划相结合，使服务更好地适应当地需求；改变基础和在职培训策略；探索公共和私营部门如何有效合作，在现有资源范围内实现最大程度的覆盖和医疗质量。
Many countries in sub-Saharan Africa face the problem of organizing health service delivery in a manner that provides adequate quality and coverage of health care to their populations against a background of economic recession and limited resources. In response to these challenges, different governments, including that of Ghana, have been considering or are in the process of implementing varying degrees of reform in the health sector. This paper examines aspects of health services delivery, and trends in utilization and coverage, using routine data over time in the Dangme West district of the Greater Accra region of Ghana, from the perspective of a district health manager. Specific interventions through which health services delivery and utilization at district level could be improved are suggested. Suggestions include raising awareness among care providers and health managers that increased resource availability is only a success in so far as it leads to improvements in coverage, utilization and quality; and developing indicators of performance which assess and reward use of resources at the local level to im prove coverage, utilization a nd quality. Also needed are more flexibility in Central Government regulations for resource allocation and use; integration of service delivery at district level with more decentralized planning to make services better responsive to local needs; changes in basic and inservice training strategies; and exploration of how the public and private sectors can effectively collaborate to achieve maximum coverage and quality of care within available resources.