The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa: Achieving better Health for Africa in the New Millennium

The Ouagadougou Declaration on Primary Health Care and Health Systems in Africa focuses on nine major priority areas: 1) leadership and governance for health; 2) health services delivery; 3) human resources for health; 4) health financing; 5) health information systems; 6) health technologies; 7) community ownership and participation; 8) partnerships for health development; and 9) research for health. This paper describes a framework constructed for implementing the necessary activities in each of these priority areas; and proposes recommendations for consideration by Member States in the development of their own country frameworks. The frameworkfor implementing activities related to health information and research for health which have been taken into account in the Algiers Framework are discussed separately elsewhere in this issue

A World Bank country study: Zimbabwe Financing Health Services

The main objectives of the report are to identify options for improving efficiency and in the provision of health services in Zimbabwe. The context for the report is one of rising personal incomes (and demand for health care); increasingly severe budgetary constraints; and an epidemiological pattern that includes both traditional childhood and communicable diseases and new challenges in the form of adult chronic disease and AIDS. The authors conclude that much remains to be done to: make services accessible to all segments of the preventive health care such as child immunizations; safe motherhood activities; family planning; and rural water and sanitaition; and increase technical efficiency (especially in hospitals) by controlling length of patient stay; staff deployment; drug consumption; and vehicle usage. The report also concludes that; with the cash-strapped public sector now providing more than half the health services and heath financing in Zimbabwe; non-governmental actors will need to play an increasingly important role in the future. This means that the Government will have to find ways to permit and encourage non-governmental institutions (including church missions; private doctors; and nurses; commercial enterprises; and traditional practitioners) to extend service coverage. Moreover; a wide range of existing but under-exploited sources of health financing in Zimbabwe -- including user fees; private insurance; and municipal and local government revenues -- need to be tapped more fully; in order to stretch scarce central government funding