There has been a clear shift in the policy of many donors in the health sector-away from discrete project assistance towards more broad-based sectoral support. This paper, based on interviews with officials in a number of bilateral and multilateral agencies, explores whether this shift in policy has been matched by similar changes in the form or range of aid instruments. The paper develops a framework for examining current practice in relation to the different objectives that donors seek to promote through technical and financial assistance. In particular, it looks in some detail at the advantages and disadvantages of budgetary support compared to more traditional forms of project assistance. It concludes that the debate should not be about whether one form of aid is better than another. Ideally, they should be complementary and the forms, channels and systems used for managing aid need to be assessed in relation to how they help to achieve the mix of development objectives that are most appropriate to the country concerned. The review demonstrates that this is a complex task and that to achieve an effective balance is not easy. The final section summarizes the main themes emerging from the discussion and suggests some preliminary conclusions and proposals for future action.

Delivery of Health Care↗

PubMed1990

Training managers for primary health care: teaching about community involvement.

Community involvement is a key element of the Primary Health Care (PHC) approach, and thus an essential topic on a course for managers of Primary Health Care programmes. This paper describes the teaching approach adopted on the Management for Primary Health Care course-a 3-month programme for PHC managers from developing countries, offered by the Liverpool School of Tropical Medicine, which attempts to overcome the difficulty of discussing this subject without a common reference point. Following a series of visits to community organizations in Liverpool, participants analyse factors which have influenced the formation and operation of these groups. Whilst preparing a report on key issues facing the community groups, and developing an analytic framework based on the Liverpool experience, participants are encouraged to draw parallels with their own working situation. Several advantages of this approach have been identified in the paper, but course organizers will have to balance these potential benefits with the investment of time and resources required to make it a success.

Administrative Personnel↗

PubMed1983

Drug supply in rural Nepal. Bhojpur Drug Scheme.

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Developing Countries↗

PubMed1982

Tuberculosis case-finding in Eastern Nepal.

Two methods of case-finding used in Eastern Nepal have been compared. The differences in terms of outcome and patient compliance in one district have been examined in detail and compared with results in 4 other neighbouring districts. The 2 methods compared were active case-finding (ACF) carried out by mobile teams and self referral (SR) of patients to the existing services. The results can be summarised thus: 1 In a district with established tuberculosis services an active case-finding campaign revealed patients that had not presented for treatment of their own accord. 2 These patients tended to be older than self-referred patients and there was a higher proportion of women. 3 ACF patients defaulted from treatment more than SR patients and older women were more likely to default than older men. 4 Proximity to a health facility or treatment at a health post (HP) did not decrease the proportion defaulting in the ACF group but both these factors positively influenced the default rate in SR patients. 5 Over 90% of ACF patients had their first period of default within 6 months of starting treatment and if they returned they were more likely than SR patients to default again. 6 The number of ACF patients completing 1 year's treatment with sputum conversion was significantly lower than SR patients in this and 3 other districts. 7 In a district where no separate tuberculosis services existed the cure rate among ACF patients was significantly lower than in 4 districts where separate services had been established.

Adolescent↗

PubMedDate not supplied

Management development for primary health care: a framework for analysis.

Strengthening management has been widely promoted as a critical component of any strategy concerned with improving the implementation of primary health care (PHC). Management development programmes are, however, subject to conflicting demands and differing expectations. The situation is confounded by the wide diversity of strategies subsumed under the heading of management development, and the confusing nature of much of the terminology currently in use. This article presents a simple conceptual framework that can guide analysis and help programme planners review the options, opportunities and limitations of management development programmes. The framework presented examines management development from three different perspectives: the approach adopted; the outcomes expected; and the process of expansion, extension and adaptation. Our analysis of management development strategies allows us to reach some conclusions in areas where there is a degree of consensus. In countries where there is a mismatch between the strategies of PHC and the organizational structures through which they are to be implemented, management development has a role to play in effecting change. Its potential to do so is limited by powerful social, political, economic and organizational forces. Therefore, the capacity to critically analyse the context in which change is planned, emerges as a key element in programme design. We argue that there is no one best approach to management development, and the design of strategies will be contingent on a variety of factors. We do, however, reaffirm the view that where organizational structures and conditions do not support the implementation of PHC strategies, intervention through training alone is almost certain to be inadequate. To be effective, a more comprehensive programme will be required. Finally, the article points to a number of unresolved issues in areas where there is either controversy, lack of clarity or limited experience.

Health Planning↗

PubMedDate not supplied

Health sector reform: key issues in less developed countries.

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Delivery of Health Care↗