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a raPid assEssMENt oF distriCt HEaltH sYstEMs iN siX CoUNtriEs oF tHE wHo aFriCaN rEGioN

S.P. Barry, S. Bakeera, J.M. Kirigia, L.G. Sambo


Objectives: this paper reviews the adequacy of inputs and processes at district level to support
outputs and outcomes of service delivery at district level using a rapid assessment. the outputs
included in this study are those considered essential for the attainment of the Health related
Millennium development Goals(MdGs).
Data sources: a questionnaire based rapid district Health systems assessment was conducted
among six african countries during the year 2007.
Study selections: the study took place in a random sample of six out of 19 English speaking countries
of the wHo african region. these countries are Ghana, liberia, Namibia, Nigeria, sierra leone
and Uganda.
Data extraction: the data was extracted from the questionnaires, entered and analysed in Excel
Data synthesis: in spite of the variability in quality and completeness of reporting on the selected
parameters, this paper does indicate that according to country norms and standards, the inputs
and processes are insufficient to lead to acceptable outputs and outcomes, especially those related
to the MdGs. an important point to note is that comparability across countries is made on the
basis of individual country norms and standards. implicit in this assessment is that country norms
and standards are reasonable and are appropriate for the attainment of the MdGs. However
reasonable the country norms and standard are, it is unlikely that the low resource base as well
as weak organisational and managerial capacities in most countries will support effectively the
attainment of the MdGs.
Conclusion: Most countries manage to offer the essential health services at all levels of care despite
the relatively low level of inputs. However, their level of quality and equity is debatable. the
general trend is that provision of the essential health services is more at the higher levels of care
prompting concerns for the populations served at lower levels of care. there is also a tendency
to have wide variations in the performance of service delivery geographically as well as at the
different levels of the health systems. this paper recommends further exploration of the impact
of focusing on improving quality of existing health services while increasing quantity of service
delivery points to achieve higher coverage of essential health services.

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