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Service delivery

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In any health system, good health services are those that deliver effective, safe, good-quality personal and non-personal care to those that need it, when needed, with minimum waste. Services – be they prevention, treatment or rehabilitation – may be delivered in the home, the community, the workplace or in health facilities.[1]

Although there are no universal models for good service delivery, there are some well-established requirements. Effective provision requires trained staff working with the right medicines and equipment, and with adequate financing. Success also requires an organizational environment that provides the right incentives to providers and users. The service delivery building block is concerned with how inputs and services are organized and managed, to ensure access, quality, safety and continuity of care across health conditions, across different locations and over time.

Primary care as a hub of coordination: networking within the community served and with outside partners[2]

Attention should be given to the following:

  • Demand for services. Raising demand, appropriately, requires understanding the user’s perspective, raising public knowledge and reducing barriers to care – cultural, social, financial or gender barriers.
  • Package of integrated services. This should be based on a picture of population health needs; of barriers to the equitable expansion of access to services; and available resources such as money, staff, medicines and supplies.
  • Organization of the provider network. This means considering the whole network of providers, private as well as public; the package of services (personal, non-personal); whether there is oversupply or undersupply; functioning referral systems; the responsibilities of and linkages between different levels and types of provider, including hospitals.
  • Management. Whatever the unit of management (programme, facility, district, etc.) any autonomy, which can encourage innovation, must be balanced by policy and programme consistency and accountability. Supervision and other performance incentives are also key.
  • Infrastructure and logistics. This includes buildings, their plant and equipment; utilities such as power and water supply; waste management; and transport and communication. It also involves investment decisions, with issues of specification, price and procurement and considering the implications of investment in facilities, transport or technologies for recurrent costs, staffing levels, skill needs and maintenance systems.

This section of the health system profile is structured as follows:

Contents

Résumé analytique

The English content will be available soon.

La couverture géographique du pays en formations sanitaires est relativement bonne. Mais si l’offre de soins est, en terme quantitatif, globalement satisfaisante (à quelques exceptions près, comme la Région Sanitaire Nord), le véritable problème se situe au niveau de la qualité des soins et des prestations offertes dans les structures, que ce soit au niveau des structures de base ou des établissements hospitaliers.

Toutes les analyses de situation relèvent des dysfonctionnements liés, selon les cas, à un défaut d’équipement de base (thermomètre, tensiomètre…), à un manque de médicaments dû à de fréquentes ruptures de stock, aux délais interminables de livraison, à l’inadéquation entre les besoins formulés et les produits livrés par l’Office Pharmaceutique National. A cela s’ajoutent les mauvaises conditions de travail (ni eau, ni électricité dans certaines structures, délabrement des locaux), une mauvaise répartition et une démotivation des personnels de santé, concentrés dans les structures urbaines au détriment des structures rurales.

Le défaut avéré de la qualité des prestations est aussi lié à l’absence de Référentiel qualité nationale, de programme d’assurance qualité, au défaut ou insuffisance de contrôle des performances des structures sanitaires ainsi qu’à l’inadéquation des programmes de formation.


Organisation et gestion des services de santé

Paquets d'activités (services)

Prestataires de soins de santé publics et privés

Approche centrée sur la personne et autres caractéristiques des services de soins de santé primaires

Pratiques parallèles

Qualité des services de santé

Priorités et pistes pour l'avenir

Autres

Notes de fin: sources, méthodes, abréviations, etc.

References

  1. Everybody’s business. Strengthening health systems to improve health outcomes. WHO’s framework for action (pdf 843.33kb). Geneva, World Health Organization, 2007
  2. Framework and standards for country health information systems, 2nd ed (pdf 1.87Mb). Geneva, World Health Organization and Health Metrics Network, 2008