Health Systems in Africa - World Health Organization

[Pages:97]Health Systems in Africa

Community Perceptions and Perspectives

The Report of a Multi-Country Study

ll

Africa REGIONAL OFFICE FOR

Health Systems in Africa

Community Perceptions and Perspectives

The Report of a Multi-Country Study June 2012

This publication contains the report of an international study team on the perceptions and perspectives of populations on the health systems in ten African countries and does not necessarily represent the decisions or the policies of the World Health Organization nor those of the governments concerned

Health Systems in Africa

Community Perceptions and Perspectives

The Report of a Multi-Country Study June 2012

Published by The World Health Organization Regional Office for Africa Brazzaville Republic of Congo

? WHO Regional Office for Africa, 2012

Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. Copies of this publication may be obtained from the Library,WHO Regional Office for Africa, P.O. Box 6, Brazzaville, Republic of Congo (Tel: +47 241 39100; Fax: +47 241 39507; E-mail: afrobooks@afro.who.int). Requests for permission to reproduce or translate this publication ? whether for sale or for non-commercial distribution ? should be sent to the same address.

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or or certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied.The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use.

WHO/AFRO Library Cataloguing ? in ? Publication Data

Health Systems in Africa: Community Perceptions and Perspectives

1. Health systems plans ? organization and administration 2. Delivery of health care ? organization and administration ? trends 3. Socioeconomic factors 4. Community Health Planning ? trends 5. Community Health Workers ? utilization 6. mAfrica I. World Health Organization. Regional Office for Africa

ISBN: 978 929 023 2018

(NLM Classification:WA 540 HA1)

Typeset by AMA DataSet Limited, Preston, Lancashire, UK Printed and bound by Charlesworth Press,Wakefield, UK

iv

Contents

List of abbreviations

vii

Report writing team

viii

Foreword

ix

Acknowledgements

x

Executive summary

xi

Chapter 1 Introduction

1

Chapter 2 Research Questions and Objectives

3

2.1 Overall research questions

3

2.2 Research objectives

3

Chapter 3 Methodology

5

3.1 Study design and methods

5

3.2 Study sites and population

5

3.3 Sampling

5

3.4 Research instruments

6

3.5 Data analysis

7

3.6 Ethical considerations

7

3.7 The study process

8

3.8 Study limitations

8

Chapter 4 Results

9

4.1 Socio-demographic information

9

4.2 Community perceptions of health and health care delivery

12

4.3 Experience with health services

30

4.4 Community perceptions of health care financing

36

4.5 Health system goals and social capital

43

Chapter 5 Discussion

49

Chapter 6 Conclusions

57

Chapter 7 Recommendations

59

Chapter 8 References

61

v

Health Systems in Africa: Community Perceptions and Perspectives

Annexes

65

Annex 1: Definitions of terms

65

Annex 2: Distribution of mean age by site

67

Annex 3: Distribution of respondents who had ever attended school by sex

67

Annex 4: Proportion reporting diabetes as a common health problem per site

68

Annex 5: Common health problems of older persons by locality

68

Annex 6: Rating of involvement of communities in decision making by locality

68

Annex 7: Households needing health care by locality

69

Annex 8: Households needing health care by performance of district

69

Annex 9: Most common reasons why health care was sought by sub-region

70

Annex 10: Reimbursement of money paid for drugs in sub-region

70

Annex 11: Freedom of expression by loacility

71

Annex 12: Freedom of expression on health matters by sub-region

71

Annex 13: Location of the study sites

71

Annex 14: Research Team

72

vi

List of abbreviations

AFRO ANC APOC ARVs BCC BCG CAR CBHI CBO CDTI CSO DHS DPT3 DRC FGD HHH HIV/AIDS IDI IGA IRB LGA MDGR MDG MOU NCD NGO NID PHC PMTCT RC SPSS SSA TB TDR

UN UNDP UNICEF WHO

WHO Regional Office for Africa Antenatal Care African Programme for Onchocerciasis Control Antiretrovirals Behaviour Change Communication Bacille-Calmette-Gu?rin Central African Republic Community-Based Health Insurance Community-Based Organization Community-Directed Treatment with Ivermectin Civil Society Organization Demographic and Health Survey Diphtheria Pertussis Tetanus (three doses) Democratic Republic of the Congo Focus Group Discussion Head of Household Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome In-depth Interview Income-generating Activity Institutional Review Board Local Government Area Millennium Development Goals Report Millennium Development Goal Memorandum of Understanding Noncommunicable Disease Non-governmental Organization National Immunization Day Primary Health Care Prevention of Mother-to-Child Transmission Regional Committee Statistical Package for Social Sciences Sub-Saharan Africa Tuberculosis UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases United Nations United Nations Development Programme United Nations Children's Fund World Health Organization

vii

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download