Supporting Local Health Care in a Chronic Crisis Management and Financing Approaches in the Eastern Democratic Republic of the Congo (2006) / Chapter Skim
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4 Discussion
4 Discussion
Pages 67-75
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From page 67... ...
In fact, the measures taken by nongovernmental organizations (NGOs) to ensure adequate drug supplies and supervision of those supplies contribute to higher utilization, but they also lead to a higher overall financial burden on the health system.
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From page 68... ...
closely followed the reclassification of age groups, meaning that fees were lowered for 5-15 year olds. Studies have shown that while utilization rates for children under age 5 increased when fees were dropped, the rates increased even more for those over age 5 -- suggesting that health care for young children is the priority in a household even when there are fees to pay (Burnham et al., 2004)
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From page 69... ...
In chronic crises, knowledge of recent developments in health care is minimal, meaning that health personnel usually lack skills and capacity. Any program with an aim to decrease morbidity and mortality must, as a prerequisite, ensure that health teams are capable of delivering the care required.
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From page 70... ...
Fees should also be advertised to ensure that the population knows what it can expect at a health facility and also to ensure that staff do not try to impose additional or increased costs. Poor knowledge of the health center fees along with weaker supervision can lead to under-the-counter takings by health staff.
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From page 71... ...
· Train staff (zone bureau, reference health centers, health centers, or hospitals) and health committees to build capacity through local participation and the promotion of preventive health care.1 · Subsidize preventive services and provincial health inspection and zone bureaus to help build capacity.
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From page 72... ...
The hard part is determining which structures are appropriate and capable enough to work with. Although working through local structures ensures some cohesion and prevents parallel networks from being set up, the problem of how to hold local management accountable requires ongoing attention.2 This research suggests such accountability can be enhanced by intensive supervision, as a form of evaluation with capacity building, and a participatory contract approach.
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From page 73... ...
Measuring utilization, for example, or incidence of disease is difficult when the population figures are unknown and changing. Revenues: · Develop a mechanism with local management and donors whereby health care is declared free during epidemic outbreaks.
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From page 74... ...
Ideally, such a follow-up public health study would include checking health records and quantitative questionnaires, such as patient exit and household surveys, to study in depth the local health needs, actual activities in the health centers, and the local management structures. A number of research topics could thus be elucidated: Donor Management: · The impact of the different donors, in particular the Humanitarian Aid Office of the European Union and the Office of U.S.
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From page 75... ...
Local Management: · Cooperation with the private sector, for example with private pharmacies or traditional healers, merits more attention. Similarly, a better understanding of local coping mechanisms, for both patients and health staff, may provide interesting opportunities for providing health care, for example, to extended families or with accepting payments in kind.
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