|Health Centres: From Responsibility to Accountability (Institut Tropical - Tropical Institute, Antwerp, Belgium, 1997)|
|Accountable health centres: A convergence of expectations|
The expectations of clients go beyond that of technical effectiveness. First and foremost, they expect easy access to effective health care when needed. This requires that services be geographically accessible, consistently available, affordable, and not involve undue waiting times, or psychosocial stress. The client expects the health centre to understand the need for care in a broader sense than simply resolving disease, and to address issues of anxiety, of suffering, and implications for his or her family, social and professional life. "Effective" health care may mean that the health centre has an answer to the client's problem: this may require equipment and drugs, or that the health centre is capable of enabling clients to resolve problems on their own. Or it may mean that the health centre refer the client them to more specialised services for a technical solution. Because clients expect cure and care for all their health problems, not only those judged to be problems by health care providers, health centres must also have the competence to deal with those aspects of care which are not strictly medical.
The client expects the health centre not only to make quality care, preventive and curative services available, but to do so in a way that is convenient, attractive and acceptable. It is interesting to note the different, but converging, experience from the developing and the developed world in this respect. In the developed world, the transition from individual private practices - which traditionally focused exclusively on curative services and the provision of care - to group health centre practices, has increased provider involvement in preventive services. In many developing countries, dispensaries and health centres traditionally have assumed responsibility for preventive services, along with their role of de-congesting the hospital system. Experience, particularly from West Africa, has shown that through providing quality care and curative services, health centres can gain the confidence of the population, and can then be the most effective and efficient way of reaching and sustaining high levels of coverage with preventive activities.
Finally, the health centre is expected to respect the way the client lives and defines his or her problem. This does not mean that the health centre responds unhesitatingly to every irrational demand or request; it does mean, however, that there is a dialogue between the client and provider, to negotiate which of various options would be the most appropriate answer to the problem at hand. The objective is not for the client to hand over his problem to the health centre, but for the health centre to better enable the client to resolve his/her problem. At the end of the road there is no fundamental difference in clients' expectations in an affluent or a poor setting. The level of personnel and technical equipment may differ, and the response may be more or less sophisticated, but whether in London or in Laos, in Kinshasa or Khazakstan, health centres can respond to clients' demands for support in seeking care, cure and prevention.