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 recession and limited resources. In response to these challenges, different governments, 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 manager. Specific interventions through which health services delivery and utilization at district level could be improved are suggested. Suggestions include raising awareness among care providers and health managers that increased resource availability is only a success in so far as it leads to improvements in coverage, utilization and quality; and developing indicators of performance which assess and reward use of resources at the local level to improve coverage, utilization and quality. Also needed are more flexibility in Central Government regulations for resource allocation and use; integration of service delivery at district level with more decentralized planning to make services better responsive to local needs; changes in basic and inservice training strategies; and exploration of how the public and private sectors can effectively collaborate to achieve maximum coverage and quality of care within available resources.
PIP: Many countries in sub-Saharan Africa are challenged to provide adequate health services to their populations in the context of economic recession and limited resources. In response to such challenges, a number of governments, including Ghana, are either considering or implementing health sector reforms. The authors examine aspects of health services delivery and trends in utilization and coverage, using routine data over time for the Dangme West district of the Greater Accra region of Ghana, from the perspective of a district health manager. Specific interventions through which health services delivery and use at the district level could be improved are suggested. Suggestions include explaining to care providers and health managers that increased resource availability is only successful insofar as it leads to improvements in coverage, use, and quality; and developing indicators of performance which assess and reward use of resources at the local level to improve service coverage, use, and quality. Central government regulations also need to be more flexible with regard to resource allocation and use, the integration of service delivery at the district level with more decentralized planning to make services more responsive to local needs, changes in basic and in-service training strategies, and research into how the public and private sectors can effectively collaborate to achieve maximum coverage and quality of care using available resources.