Improving Equity in the Provision of Primary Health Care: Lessons from Decentralized Planning and Management in Namibia

By Bell, Ruth; Ithindi, Taathi et al. | Bulletin of the World Health Organization, August 2002 | Go to article overview

Improving Equity in the Provision of Primary Health Care: Lessons from Decentralized Planning and Management in Namibia


Bell, Ruth, Ithindi, Taathi, Low, Anne, Bulletin of the World Health Organization


Voir page 680 le resume en francais. En la pagina 680 figura un resumen en espanol.

Introduction

Health sector reform in developing countries, including the decentralization of management and the provision of primary health care, is expected to produce changes in the pattern of health service delivery and improvements in the equity of provision (1-4). In particular, first-level services may require strengthening in order to improve local access to basic primary health care. This requires that local health management teams develop the skills to assess the adequacy of provision and to identify and implement ways of improving services.

This paper describes how the Khomas Regional Health Management Team undertook a review of primary health care services in urban Windhoek, Namibia, in order to obtain evidence that would underpin local planning decisions. The review led to changes in resource allocation and enabled the team to influence central planning decisions.

Background

Health sector reform in Namibia

When Namibia gained its independence in 1990 it inherited a state health system typical of colonial Africa: centrally planned, largely based on hospitals and in urban areas, and fragmented on ethnic lines (5-7). Subsequently, the Ministry of Health and Social Services adopted the primary health care approach (8). Thirteen regional health management teams were created in 1994 to decentralize responsibility for the planning and management of local primary health care services from four directorates, which were being phased out in 1997-98 when the work described in this paper was being carried out. The role of regional health management teams was to support and supervise district health management teams in their role of operationalizing the primary health care strategy at the local level. There were between one and three districts per region. During the transitional period, assistance with finance and training was provided from programmes funded by donors. This help included the provision of technical advisers who were involved in the development of management and planning capacity in the regional and district health management teams.

At the time of this work, key decision-making on resource allocation had not been decentralized to regional health management teams. The directorates retained responsibility for setting official staff establishments for all primary health care facilities, while decisions on capital developments, such as the extension of clinics and the construction of new facilities, were taken centrally by planners in the Ministry of Health and Social Services.

Windhoek: population and primary health care services

Before Namibia attained independence from South Africa in 1990, Windhoek was racially segregated: the areas of Katutura and Khomasdal were designated for the Black and Coloured populations, respectively, while the rest of the urban area was designated for the White population. In 1995, urban Windhoek had an estimated population of 181 000 and an annual population growth rate of about 5.4%, resulting mainly from migration from rural areas (9). The urban area expanded to accommodate the migrant population, largely in informal settlements of shacks spreading outwards from Katutura. Such communities suffer high levels of poverty and ill-health (10). In 1995 a survey revealed wide geographical variations in the levels of poverty in the urban area of Windhoek (Table 1) (9).

For the purposes of primary health care management, urban Windhoek is covered by a region and a district, both of which have the same boundaries. The overall planning and management of primary health care services are undertaken by the regional health management team, while district staff are responsible for delivering services in the clinics.

There are seven clinics in the urban area. At the time of the review, four were staffed by nurses only and three had doctors on site (Table 2). …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Improving Equity in the Provision of Primary Health Care: Lessons from Decentralized Planning and Management in Namibia
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.