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Management and health care reform in sub-Saharan Africa

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  • Gilson, Lucy

Abstract

Recent discussions of health care reform in sub-Saharan Africa have centred on the potential of alternatives to public financing and provision of health care to address efficiency and resource weaknesses. This paper informs these discussions by reporting an overview of the findings of a detailed evaluation of the efficiency and quality of public and non government primary level health services in Tanzania, a sub-Saharan leader in health policy development since the 1960s and used here as an exemplar country for the region. The paper discusses the management actions necessary to address the performance weaknesses identified and considers the possible contribution alternative financing strategies might make in addressing the weaknesses. However, financing reforms will not by themselves address the performance failures; health care reform packages must allow for financing, organizational and management development.

Suggested Citation

  • Gilson, Lucy, 1995. "Management and health care reform in sub-Saharan Africa," Social Science & Medicine, Elsevier, vol. 40(5), pages 695-710, March.
    • Handle: RePEc:eee:socmed:v:40:y:1995:i:5:p:695-710
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    Citations

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    Cited by:

    1. Ardeshir Sepehri & Robert Chernomas, 2001. "Are user charges efficiency- and equity-enhancing? A critical review of economic literature with particular reference to experience from developing countries," Journal of International Development, John Wiley & Sons, Ltd., vol. 13(2), pages 183-209.
    2. Jitta, Jessica & Whyte, Susan Reynolds & Nshakira, Nathan, 2003. "The availability of drugs: what does it mean in Ugandan primary care," Health Policy, Elsevier, vol. 65(2), pages 167-179, August.
    3. Valeria Oliveira-Cruz & Kara Hanson & Anne Mills, 2003. "Approaches to overcoming constraints to effective health service delivery: a review of the evidence," Journal of International Development, John Wiley & Sons, Ltd., vol. 15(1), pages 41-65.
    4. Xu, Ke & Evans, David B. & Kadama, Patrick & Nabyonga, Juliet & Ogwal, Peter Ogwang & Nabukhonzo, Pamela & Aguilar, Ana Mylena, 2006. "Understanding the impact of eliminating user fees: Utilization and catastrophic health expenditures in Uganda," Social Science & Medicine, Elsevier, vol. 62(4), pages 866-876, February.
    5. Kara Hanson & M. Kent Ranson & Valeria Oliveira-Cruz & Anne Mills, 2003. "Expanding access to priority health interventions: a framework for understanding the constraints to scaling-up," Journal of International Development, John Wiley & Sons, Ltd., vol. 15(1), pages 1-14.
    6. Gilson, Lucy & Mills, Anne, 1995. "Health sector reforms in sub-Saharan Africa: lessons of the last 10 years," Health Policy, Elsevier, vol. 32(1-3), pages 215-243.
    7. Rishworth, Andrea & Dixon, Jenna & Luginaah, Isaac & Mkandawire, Paul & Tampah Prince, Caesar, 2016. "“I was on the way to the hospital but delivered in the bush”: Maternal health in Ghana's Upper West Region in the context of a traditional birth attendants' ban," Social Science & Medicine, Elsevier, vol. 148(C), pages 8-17.

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