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.
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.
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 on Service delivery is structured as follows:
Service delivery is largely dominated by the public sector that controls 90% of health facilities, either directly, or through agreements with Churches Health Association of Zambia (CHAZ). Yet the private sector is getting increasingly developed particularly in urban areas. The packages of health services are defined along a combination of paradigms: the need to identify limited priority cost-effective services through the definition of the Basic Health Care Package, population-based approach, through decentralisation of health care delivery to the districts and communities, disease-centred services, and life-cycle approach to health service delivery.
Organization and management of health services
Package of services
Elaboration process of packages of services
Primary care services
Table 2.2 summarized the Basic Package of Services as it has been defined for the primary level.
Secondary and tertiary care services
Public and private health care providers
Person-centredness and characteristics of primary health care services
Quality of health services
Priorities and ways forward
Endnotes: References, sources, methods, abbreviations, etc.
- ↑ Everybody’s business. Strengthening health systems to improve health outcomes. WHO’s framework for action (pdf 843.33kb). Geneva, World Health Organization, 2007
- ↑ Framework and standards for country health information systems, 2nd ed (pdf 1.87Mb). Geneva, World Health Organization and Health Metrics Network, 2008