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Challenges in Reforming the Health Sector in Africa: Reforming Health Systems Under Economic Siege - The Zimbabwean Experience

by Paulinus Lingani Ncube Sikosana

384 pages; quality trade paperback (softcover); catalogue #04-0515; ISBN 1-4120-2687-3; US$33.74, C$42.18, EUR27.42, £19.95

Africa's declining health expenditures and the poor state of public health delivery systems are a serious indictment to the development of the continent. Are health sector reforms the right solution?

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about the book      about the author      excerpts      catalogue info

About the Book The book provides an insight and descriptive analyses of health sector reforms that are being implemented in African countries, with particular application to Zimbabwe. In some cases the Zimbabwean experience is blended with those of other countries in Africa. The book elaborates on the various elements of health sector reforms which include; health financing options, organizational restructuring, core health service packages, the introduction of market forces, hospital autonomy and the Sector Wide Approach to health development. These reform elements are described from a theoretical perspective; the rationale, implications, implementation modalities, their potential impact which the author provocatively links to the practical experiences of the selected country. The book highlights the fact that reforms in African countries have a different thrust to those in developing countries, though in both cases the ultimate objectives are the same. Whilst each chapter is dedicated to an element of the reform process, other chapters provide the background to reforms, the interactions between reforms and the notion of equity and the monitoring and evaluation of health reforms. The last chapter attempts to consolidate the experiences of the reforms in Zimbabwe and their impact and propose a possible way forward for the troubled health sector. The targeted readership includes students in community medicine, nursing programs, public health medicine students and practitioners, professional health managers and administrators and development workers in the health field in Africa.

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About the Author Dr. Sikosana is married with 3 children and his educational qualifications include a Medical Degree (MD) from the University of Dar es Salaam in Tanzania, a Masters in Public Health (Epidemiology) from the Johns Hopkins University in the USA, and a Masters in Business Administration (MBA, Health Executive) from Keele University in the United Kingdom. Dr. Paulinus L.N. Sikosana has more than 20 years work experience in the public sector in Zimbabwe. He has worked as a District Medical Officer, Medical Superintendent, Provincial Medical Director and Principal Medical Director at the Ministry of Health headquarters. Dr. Sikosana left the Ministry of Health and Child Welfare in 2001 after heading the ministry for 5 years as the Secretary for Health to assume an advisory role to the Ministry of Health and the Public Service Commission as the National Coordinator for Health Sector Reforms in Zimbabwe. In 2002 he joined Liverpool Associates in Tropical Health (LATH) as an independent Consultant assigned to the Ministry of Health of Malawi as a Technical Advisor on the Essential Health Package (EHP) and the development of the country's health Sector Wide Approach (SWAp). Dr. Sikosana has worked on several consultancies with the World Bank, UNFPA, UNICEF, WHO, the University of Zimbabwe, etc. on program development, assessment and health systems development. He has experience in several countries which include, Botswana, Lesotho, Malawi, Zambia, Ethiopia and Mozambique. During the course of his work he has interacted with several bilateral and multilateral organizations and represented his country at several international forums.

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Excerpts

"Some African countries have analyzed the role and impact of foreign aid in health development and demonstrated the evolution of the country's dependence on external resources to maintain their health services. This has resulted in most of these countries gradually losing control over their own doctrines and policies. Policy makers in African countries and the rest of the developing world have complained, from a position of weakness, that they spend more time trying to fulfill donor requirements and coordinating donor actions rather than discussing with their own people the soundness of home grown development strategies. African countries need the freedom to be able to assess their own needs and to design their own development strategies and systems necessary to effectively coordinate development partners.

While accepting the right of donors to impose stringent criteria in the disbursement of development aid, the question is whether it is right for them to force governments to adopt policies and strategies that they do not believe in. This is much more unnerving when different donors impose different conditionality to the same government. The current view is that donors should give up some of their rigid control over development assistance to the governments of developing countries and move more towards partnerships."

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"...the implementation of market-oriented reforms in African countries. These are mainly a result of challenges concerning the role of the state in the provision of health services, the poor performance of government run institutions and in some cases pressure from multinationals and the World Bank who apply an economic approach to health and exercise their dominance over country specific approaches. These moves are also a response to the globalization of public health policies. Although governments retain the primary responsibility for health, health determinants and means to address them transcend health ministries and national governments. It is becoming the norm rather than the exception that in order to develop and adopt national policy objectives governments find themselves having to increasingly turn to international development partners. Ultimately in this model the government's role is confined to policy formulation, monitoring, coordination and regulation.

Traditionally African countries have implemented the integrated model to health provision which combines public financing with public ownership of hospitals and the employment of salaried health professionals. It is through this model that some governments have been able to develop and successfully implement policies that have ensured universal coverage and equitable access to health care in the absence of viable third party payers. However, like any other policy strategy this model has had its share of criticisms which include those of being entrenched bureaucracies, inefficient and non responsive to public demands.

The introduction of market mechanisms in the health systems of African countries has meant that some services previously provided by the public health sector are now delivered by private companies under contract with the public sector. The public contracting model provides services to patients through negotiated contracts between governments and independent providers of care and in some cases with local authorities. The strategy is to use government funds to purchase clinical or non-clinical services from private providers in order to improve the productivity of public resources by purchasing the gains in efficiency perceived to be characteristic of the private sector."

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Catalogue Information

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