THE IMPACT OF HEALTH SECTOR REFORM ON COUNTY HOSPITALS

County hospitals are important providers of inpatient and outpatient s ervices in poor rural areas. They have a higher proportion of well-qua lified personnel than township health centres and they are better equi pped. They provide specialist services for patients referred by lower level facilities and they deal with the mure complex inpatient cases. In addition, those who can afford to pay use them as a First point of contact with the health care system. in 1992, 16 per cent of outpatien t visits in rural areas were at the county level, and in poor rural ar eas the proportion was slightly higher (MoPH 1994). This article descr ibes ho iv the economic and institutional reforms of the 1980s have in fluenced the management of county hospitals. It uses one county hospit al to illustrate how this has led to unnecessary increases in the cost of services. The aim is to identify measures that can be taken to imp rove the performance of county hospitals in the future.