A COVERAGE PLAN FOR HEALTH CENTERS IN MUREWA DISTRICT IN ZIMBABWE - AN EXAMPLE OF ACTION RESEARCH

Good access to health facilities providing good first-level health car e remains problematic in many developing countries. It is a hindrance to effective and efficient functioning of the hospital, as outpatient departments become overcrowded with patients from areas without health centres. In many cases the quality of care delivered to these patient s is poor because within the district health system the hospital is no t the best place for the supply of comprehensive, integrated and conti nuous care. Eventually, high hospital involvement in first-level care can jeopardize the delivery of adequate referral care for those patien ts who desperately need the hospital's technology and expertise. This paper provides an account of the way this problem was investigated and managed by the district health management team in the Murewa district in north-east Zimbabwe. The design of a comprehensive 'master plan' o r 'coverage plan' is presented as well as the problems and difficultie s encountered. The Murewa experience highlights the relevance of a cov erage plan for rational and coherent health infrastructure planning at district level. The approach followed by the Murewa team illustrates the use of action research as an integral part of the management of di strict health systems.