Ia. Agyepong, Reforming health service delivery at district level in Ghana: the perspective of a district medical officer, HEAL POL PL, 14(1), 1999, pp. 59-69
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.