How operational are district health systems? Estimation of available resources

RESUMO

A study to assess the operationality of district health systems was carried out between February and May 2001. Operationality is defined as the state of the existing and functional structures and managerial processes that enable the provision of essential health care to the population. This was not an assessment of the performance of the district; but rather the availability of functional inputs required for health care delivery. A health care system is assessed in terms of the structures/inputs it has for health care provision; the processes used to convert these inputs into favorable products; and the outcomes that are achieved as a result of the actions of the system. The performance of a health system is a function of the available inputs; and the efficiency with which these inputs are utilized. We need to first determine the presence of inputs; before determining how these are used. The level of inputs into the health care system has not been determined. Different programs have some ideas as to the amount of input they have; but no study has ever comprehensively looked at inputs into te district system. This study quantifies the inputs into a score that can be compared over time and whithin districts for inter district comparisons. The study was very comprehensive; and this paper is a condensation of the findings. We explored thestructures/inputs that avail the users with an opportunity to receive adequate care. These features do not tel us whether the users are receiving quality care; but rather; they tell us whether there is an increased / decreased likelihood of receiving quality care. We do not explore the level of functioning of the inputs analysed; but rather the presence or absence of these inputs. Efficiency with which these inputs are utilized is a second stage of this analysis: