Published by Service Resource Africa
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Copyright Š 2018 Prosper Tumusiime, Jennifer Nyoni, Martins Ovberedjo
All rights reserved. No part of this book may be reproduced, stored, or transmitted by any meansâwhether auditory, graphic, mechanical, or electronicâwithout written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.
ISBN: 978-0-9980857-0-8 (Hardback, color)
ISBN: 978-0-9980857-4-6 (Hardback, black and white)
ISBN: 978-0-9980857-1-5 (Paperback, color)
ISBN: 978-0-9980857-5-3 (Paperback, black and white)
ISBN: 978-0-9980857-2-2 (e-Book: e-Pub)
ISBN: 978-0-9980857-3-9 (e-Book: Kindle/Mobi)
WHO/AFRO Library Cataloguing-in-Publication Data
Managing health in Africa: the health system perspective
1. Health services â organization and administration â economics
2. Delivery of health care â organization and administration
3. Health status
4. Health planning â organization and administration
5. National health programmes â organization and administration â economics
6. Health personnel
7. Pharmaceutical preparations
(NLM Classification: WA 540 HA1)
Printed in the U.S.A.
Editing and Publishing Assistance: Service Resource Africa (+1 940 231-2314;
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[email protected])
Contents
Foreword
Preface
Chapter 1: Status of health in Africa
Introduction
Epidemics in Africa
Double burden of disease
Social determinants of health
Opportunities for improving the current situation
Experiences, good practices, lessons learnt and proposed approaches
Summary
Exercises and assignments
For further reading
References
Endnotes
Chapter 2: Developing and implementing comprehensive national health policies and plans
Introduction
Status of national health policies and strategic plans in Africa
Development of national health policies and national health sector strategic plans
Important observations in the development process
Implementation of national health policies and national health strategic plans
Monitoring and evaluating implementation of strategic plans
Summary
Exercises and assignments
For further reading
References
Endnote
Chapter 3: Towards client-centred and integrated service delivery
Introduction
Definitions
Service delivery models
The nature of integrated health services delivery
The situation in Africa
Review of experiences
Summary
Exercises and assignments
For further reading
References
Chapter 4: Community involvement in health services organization and delivery
Introduction
Definitions
Rationale
Evidence-based community approach
Some strategies
Some tools and resources to consider
Summary
Exercises and assignments
References, and for further reading
Chapter 5: How to improve the performance of district health systems
Introduction
What performance of a health system entails
A district health system and its functions
Situation in Africa
Experiences, challenges, and lessons learnt
Summary
Exercises and assignments
For further reading
References
Endnotes
Chapter 6: Prerequisites for improving resources for the health agenda
Introduction
The problem with resources in sub-Saharan Africa
Prerequisite 1: Effective leadership and governance at all levels
Prerequisite 2: Coordinated partnerships
Prerequisite 3: Access to health care and health services
Estimating resource requirements
Making the case for a health agenda
Summary
Exercises and assignments
For further reading
Endnotes
Chapter 7: Production, recruitment and retention of an efficient workforce
Introduction
Availability of the health workforce in sub-Saharan Africa
The reality on the ground in general
Health workforce training
A ready and performing health workforce
Good practices in workforce motivation and retention
Health workers who stay and those who wonât
Options at the district or local level
Summary
Exercises and assignments
For further reading
Endnotes
Chapter 8: Increasing the availability of essential medicines and medical supplies
Introduction
Definitions
Situation of essential medicines and supplies in sub-Saharan Africa
Experiences, good practices, and lessons learnt
Proposed approaches
Summary
Exercises and assignments
For further reading
References
Endnotes
Chapter 9: The role of health technologies in improving care and service delivery
Introduction
Blood transfusion safety
Diagnostic and laboratory technology
Organ transplants
Emergency and essential surgical care
Injection safety
Diagnostic imaging
Medical devices and equipment
E-health for health care delivery
Overview of health technologies in sub-Saharan Africa
The way forward for health technologies
Summary
Exercises and assignments
For further reading
Endnotes
Chapter 10: Financing and resource mobilization for efficient and affordable health services
Introduction
Status of health financing in sub-Saharan Africa
Health financing reforms and strategies
Financing, allocation, and health outcomes
Health financing approaches
Accountability
Experiences, good practices, lessons learnt, and proposed approaches
The way to universal health coverage
Resource mobilization
Summary
Exercises and assignments
For further reading
References
Endnotes
Chapter 11: Managing health beyond the health sector
Introduction
Managing health in sub-Saharan Africa
Experiences, good practices, lessons learnt, and proposed approaches
Summary
Exercises and assignments
For further reading
References
Endnote
Chaprter 12: Monitoring and evaluating progress
Introduction
Importance of performance monitoring and evaluation
The issue being addressed in sub-Saharan Africa
Experiences, good practices, lessons learnt, and proposed approaches
Summary
Exercises and assignments
For further reading
References
Chapter 13: Conclusion
About the Authors
List of Tables
Table 1.1: Estimated life expectancy in selected countries with and without AIDS
Table 1.2: Annual number of deaths by cause for children under five years of age in WHO regions: estimates for 2013
Table 1.3: Cumulative EVD cases and deaths as of 18 October 2015
Table 1.4: Countries in the WHO African Region likely to attain their health MDGs
Table 2.1: Key contents of a national health policy and a national health strategic plan
Table 5.1: Autonomy-resource triangulation
Table 10.1: Trends in total health expenditure per capita in current US dollars
Table 12.1: Logical framework: the âifâthenâ approach
List of Figures
Figure 1.1: The link between health and socio-economic development
Figure 1.2: Life expectancy at birth for the world and other UN regions
Figure 1.3: Reforms for Primary health care renewal
Figure 1.4: Health system building blocks and the role of leadership and governance
Figure 2.1: Transforming data into information and evidence
Figure 3.1: Service production and delivery
Figure 3.2: Relevance of integration by level of the organization
Figure 4.1: The health map
Figure 5.1: Relation between the functions and objectives of a health system
Figure 5.2: The performance chain of a health system
Figure 5.3: A district health system and its linkage with other structures in the district (Hypothetical model)
Figure 7.1: Countries with a critical shortage of doctors, nurses and midwives
Figure 7.2: Health worker density and health outcomes
Figure 8.1: Availability and update of essential medicines lists among countries over a five-year period ending in 2003
Figure 8.2: Effects of generic medicines competition*
Figure 10.1: Government health financing as a percentage of government expenditure in some African countries for 2000 and 2010
Figure 10.2: Reversing the trend in child mortality: interventions in two districts of Tanzania
Figure 10.3: Maternal mortality ratio and total health expenditure per capita, 2010
Figure 10.4: Three things a country considering universal coverage should do
Figure 11.1: Spheres of influence on health
Figure 11.2: Women with access to delivery assistance by richest and poorest wealth quintiles
Figure 12.1: Monitoring and evaluating health systems strengthening
List of Boxes
Box 3.1: Community at work in the Democratic Republic of Congo
Box 3.2: Example of integrated support supervision from Uganda
Box 3.3: Example of HAST committees from South Africa
Box 3.4: Example of initiatives on integrated service delivery
Box 3.5: Integrating mental health into primary health care in Uganda
Box 3.6: The joint LLIN and immunization programme campaign in Rwanda
Box 3.7: Ghanaâs integrated child health campaign
Box 3.8: Integrating HIV services in Zambia
Box 3.9: Strategic directions for global people-centred and integrated health services
Box 6.1: Public-private partnership in health service delivery in Botswana
Box 6.2: Good partnerships that address peopleâs priorities and make resources available
Box 8.1: WHO-recommended interventions for promotion of rational use of medicines
Box 9.1: Typical story of a motherâs everyday experience with health technology
Box 9.2: First blood transfusions
Box 9.3: The Millennium village project
Box 9.4: Experiences with e-health in Rwanda
Box 9.5: E-health workshop for the East African Community, November 2010
Box 10.1: Mixed-effects model analysis for health expenditures and health outcomes
Box 10.2: Performance-based financing in Burundi
Box 10.3: Example of an AIDS levy from Zimbabwe
Box 10.4: Case study: les Mutuelles de santÊ in the Thiès Region of Senegal
Box 10.5: Effect of user fee abolition in Burkina Faso
Box 11.1: Main recommendations of the Commission on social determinants of health
Box 11.2: Sustainable development goals
Foreword
Global concern over the deplorable state of weak health management systems in sub-Saharan Africa has deepened profoundly, and despite recorded improvements, the health of the vast majority of people in the region remains unacceptably poor. Millions of people in Africa are still suffering from diseases that are relatively simple to prevent or treat. As health managers in the region struggle to meet basic standards of care, many experts have come to the conclusion that system-wide barriers linked to existing weak health management systems remain a major obstacle to progress.
Yet, better management of health systems in Africa presents an unprecedented opportunity to deliver quality health services to all people in the continent. It is also clear that a comprehensive approach is required to overcome the health-system-wide barriers. Managing health in Africa: the health systems perspective is a most welcome and candid attempt to address these growing health system management weaknesses. This book will complement ongoing efforts by health managers, health service providers and training institutions to help...
