Health sector reform in sub-Saharan Africa: a synthesis of country experiences.

Health sector reform is 'a sustained process of fundamental changes in national health policy, institutional arrangements, etc. guided by government and designed to improve the functioning and performance of the health sector and, ultimately, the health status of the population'. All the forty six countries in the African Region of the World Health Organisation have embarked on one form of health sector reform or the other. The contexts and contents of their health reform programmes have varied from one country to another. Health reforms in the region have been influenced largely by the poor performance of the health systems, particularly with regard to the quality of health services. Most countries have taken due congnizance of the deficiencies on their health systems in the design of their health reform programmes and they have made some progress in the implementation of such programmes. Indeed, some countries have adopted sector-wide approaches (SWAps) in developing and implementing their health reform programmes. Since countries are at various stages of implementing their health reform programmes, there is a lot of potential for countries to learn from one another. This paper is a synthesis of the experiences of the countries of the Region in the development and implementation of their health sector reform programmes. It also highlights the future perspectives in this important area.

How to develop an operational plan for health.

BACKGROUND: About 88%, 8%, 36% and 28% of the ministries of health in African countries do not have long-term health plans (LTHPs), health policies (HPs), strategic plans (SPs), and operational plans (OPs), respectively. Eight per cent, 38% and 54% of the countries with OPs rated their formulation as 'excellent', 'satisfactory' and 'needs improvement', respectively. OBJECTIVE(S): To provide a rationale for an OP; to describe its contents; and to explain the process of developing it. DESIGN: Descriptive study. SETTING: Operational plans in the WHO African Region. INTERVENTIONS: Non-intervention descriptive study. MAIN OUTCOME MEASURES: Operational plan (OP) for health. RESULTS: An OP framework and process that could be adapted by countries is proposed. CONCLUSION: An adequately formulated OP will contain objectives, targets, expected results, activities, required resources, and a monitoring and evaluation plan (consisting of responsibilities, monitoring indicators, evaluation indicators, data sources - for verifying indicators, and periodicity). In the next two decades, we envision that all the UN agencies and other health partners working in Africa will cooperate with individual countries to develop (or strengthen) LTHPs, HPs, SPs, and OPs of the Ministries of Health (national, provincial and district level).

Are public hospitals in Kwazulu-Natal Province of South Africa technically efficient?

Generally, policy-makers and researchers in South Africa acknowledge that hospitals absorb a disproportionate share of health sector resources. The latter, to a certain extent, have failed to provide evidence needed to guide the former's decisions. Albeit in an ad hoc manner, the post-apartheid policy-makers have been reducing hospital budgets to avail the resources needed to strengthen the hitherto neglected primary health care system. Since political will exists to reduce (if not eliminate) wastage of resources within the hospitals, micro-efficiency analyses (like the one reported here) are needed to guide the policy-makers. This study employs Data Envelopment Analysis (DEA) methodology to identify and measure individual hospital's inefficiencies. The key results are as follows. Forty percent of the hospitals had some degree of technical inefficiency. Fifty eight percent were scale-inefficient. In total, the following inputs are currently wasted and not utilized in the production of hospital outputs in Kwazulu-Natal public hospitals: 117.4 doctors (8.0%); 2709 nurses (11.9%); 61 paramedics (11.5% ); 58 Technician (13.1%); 295 Administrative staff (11.1%); 835 General staff (11.3%); 1,193 Labour provisioning staff (14.3%); 38 Other staff (10.7 %); and 1,752 Beds (7.1%). Those are the specific input reductions required to make inefficient hospitals become technically efficient. In conclusion, the DEA results constitute a strong guide to health care decision making, especially with regard to practical always of increasing efficiency and rational use of health care resources.

Demand for antenatal care in South Africa.

On May,24 1994, the then South African president, Mr. Nelson Mandela, declared that all health care for children under the age of 6 years, and pregnant women would be free. Unfortunately, there has been no significant decrease in maternal, perinatal and infant mortality. Thus, there is a need of research into the factors that influence the demand for antenatal services. The objectives of this paper are to (a) establish the determinants of individual pregnant women's choice to seek antenatal care; and (b) deal with potential endogeneity bias in the relationship between the decision to seek pre-natal care and perceived health status. The joint determination of consumption of antenatal care and pregnant woman's health status requires estimation of a simultaneous system. To help mitigate the simultaneity bias and avoid the inconsistency inherent in the application of Ordinary least Squares (OLS) method to simultaneous equations systems, we used Two-Stage Probit Maximum Likelihood Estimator Method. In the antenatal structural-form equation, the coefficients for TOILET, AGE, OCCUPATION, EMPLOYMENT, SMOKER, METHODS and QUALITY were statistically significant at P

The economy and health.

The interrelationships between sectors in an economy (especially between the health sector, on one hand, and the rest of the economy, on the other hand) are often ignored when many developing countries strive to achieve some general socioeconomic as well as specific sectoral goals. Macroeconomic policies adopted in developing countries, especially in Sub-Sahara Africa, to deal with the economic crisis failed to take adequate measures to protect the health of the people. Policy makers and the planners have contributed to the problems of the health sector by not devising necessary built-in measures to mitigate the negative impact of macroeconomic and sectoral policies on health. The paper attempts to bring into focus the linkages between the economy and the health sector and to proffer to policy makers and planners, especially in Sub-Sahara Africa, what should be done in future to minimize the negative impact of macro and sectoral policies on health.

Health for all Nigerians: some revolutionary management dimensions.

Health For All by the Year 2000, usually referred to as HFA/2000, is a goal that has been accepted by most nations of the world. PHC is the strategy designed to achieve this laudable goal. In Nigeria, there is no doubt that remarkable strides have been made to achieve the goal of HFA/2000 in recent years. However, in order to fully realise this goal, some further revolutionary management steps are needed. This article first examines the progress on HFA made so far in Nigeria; and then, discusses some management initiatives that need to be taken or accelerated to be able to reach that desirable destination.