Reforming health service delivery at district level in Ghana: the perspective of a district medical officer

Many countries in sub-Saharan Africa face the problem of organizing health service delivery in a manner that provides adequate quality and coverage of health care to their populations against a background of economic recessio n and limited resources. In response to these challenges, different governm ents, including that of Ghana, have been considering or are in the process of implementing varying degrees of reform in the health sector. This paper examines aspects of health services delivery, and trends in utilization and coverage, using routine data over time in the Dangme West district of the Greater Accra region of Ghana, from the perspective of a district health ma nager. Specific interventions through which health services delivery and ut ilization at district level could be improved are suggested. Suggestions in clude raising awareness among care providers and health managers that incre ased resource availability is only a success in so far as it leads to impro vements in coverage, utilization and quality; and developing indicators of performance which assess and reward use of resources at the local level to im prove coverage, utilization a nd quality. Also needed are more flexibili ty in Central Government regulations for resource allocation and use; integ ration of service delivery at district level with more decentralized planni ng to make services better responsive to local needs; changes in basic and inservice training strategies; and exploration of how the public and privat e sectors can effectively collaborate to achieve maximum coverage and quali ty of care within available resources.