A rapid assessment of district health systems in six countries of the WHO African Region.
OBJECTIVE
This paper reviews the adequacy of inputs and processes at district level to support outputs and outcomes of service delivery at district level using a rapid assessment. The outputs included in this study are those considered essential for the attainment of the Health related Millennium Development Goals (MDGs).


METHODS
A questionnaire based rapid District Health Systems assessment was conducted among six African countries during the year 2007.


METHODS
The study took place in a random sample of six out of 19 English speaking countries of the WHO African region. These countries are Ghana, Liberia, Namibia, Nigeria, Sierra Leone and Uganda.


METHODS
The data was extracted from the questionnaires, entered and analysed in Excel spreadsheet.


RESULTS
In spite of the variability in quality and completeness of reporting on the selected parameters, this paper does indicate that according to country norms and standards, the inputs and processes are insufficient to lead to acceptable outputs and outcomes, especially those related to the MDGs. An important point to note is that comparability across countries is made on the basis of individual country norms and standards. Implicit in this assessment is that country norms and standards are reasonable and are appropriate for the attainment of the MDGs. However reasonable the country norms and standard are, it is unlikely that the low resource base as well as weak organisational and managerial capacities in most countries will support effectively the attainment of the MDGs.


CONCLUSIONS
Most countries manage to offer the essential health services at all levels of care despite the relatively low level of inputs. However, their level of quality and equity is debatable. The general trend is that provision of the essential health services is more at the higher levels of care prompting concerns for the populations served at lower levels of care. There is also a tendency to have wide variations in the performance of service delivery geographically as well as at the different levels of the health systems. This paper recommends further exploration of the impact of focusing on improving quality of existing health services while increasing quantity of service delivery points to achieve higher coverage of essential health services.
Barry
S P
SP
Health Policies and Services Delivery Programme, Division of Health Systems and Services Development, WHO Regional Office for Africa, BP 06, Brazzaville, Congo.
Bakeera
S
S
Kirigia
J M
JM
Sambo
L G
LG
D000349:Africa; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D006285:Health Planning / Q000458:organization & administration* / Q000592:standards; D006296:Health Services / Q000592:standards*; D006801:Humans; D007391:International Cooperation; D011634:Public Health; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D011795:Surveys and Questionnaires; D013997:Time Factors; D014944:World Health Organization