|Health Centres: From Responsibility to Accountability (Institut Tropical - Tropical Institute, Antwerp, Belgium, 1997)|
Health care systems should provide cost-effective technical interventions, but this cannot be their only aim. Clients require more than just technical resolutions to their health needs. Health services must ensure that clients make effective use of cost-effective interventions, and they must respond to clients' needs for care, that is, relieve their anxiety, help them cope with disease, and enable them to maintain their autonomy - their capacity to care for themselves. Clients expect more than just technical solutions for their disease. The expectations of people with AIDS highlight this fact.
How can this be achieved? This paper suggests that a key resides in the perception by health care providers of their accountability, and that accountability is most important at the health centre level, where the client first makes contact with the system. A system comprising a network of health centres - each of which is accountable to a defined population for the provision of effective health services - may represent the most efficient means for ensuring effective coverage with an essential package of curative and preventive services, while simultaneously responding to clients demands for care.