District health care between quality assurance and crisis management. Possibilities within the limits, Mporokoso and Kaputa District, Zambia
Van Bergen, J.E.
Tropical and Geographical Medicine 47(1): 23-29
1995
ISSN/ISBN: 0041-3232 PMID: 7747327 Document Number: 309410
A tension exists between the aim of health policy-makers to achieve high quality standards of care on the one hand and the district multi-crisis reality in sub-Saharan Africa on the other. Disintegrating health services together with deteriorating living conditions adversely affect the population's health status and contribute to an increase in health inequalities both nationally and internationally. Constraints and some examples of achievements in district health management in Mporokoso and Kaputa districts in Northern Province, Zambia, are presented. A strong focus should be given to community-based health care, partnership with communities, and accelerated health system support through the strengthening of on-site supervision. Decentralization and self-reliance can help in flexible crisis management, but demand continuity in human resource development and appropriate care for carers. To increase operational efficiency, there is a need to conceptualize a practical approach of minimum primary health care.