|Health Centres: From Responsibility to Accountability (Institut Tropical - Tropical Institute, Antwerp, Belgium, 1997)|
The importance of an individual's first point of contact with the formal health care system, its potential to most effectively and efficiently address health problems, and to better enable clients to improve their own health status has brought increasing attention to the role of health centres and to the developed world's equivalent, family practitioners.
The notion of an essential package of preventive and curative health services for reduction of morbidity and mortality has now become main-stream. It cannot achieve its objectives if clients do not receive services, if they receive poor quality services, or if they receive services inefficiently. The majority of health interventions that comprise the essential package, will be most cost-effectively addressed outside hospitals, whether in a developed or developing country. The responsible facility however needs to have sufficient skills and resources. The population served has to be of a size both i) large enough to enable providers to maximise their effectiveness, and to justify the investment in required infrastructure and equipment, and yet ii) small enough to enable them to effectively cover the entire population. And the health centre has to be accountable for living up to its responsibilities.
Accountable health centres offer a cost-effective mechanism for
achieving improvements in health status while responding to the needs of clients
for care, whether they are public or private, serving urban or rural
populations, located in developing or developed countries. Whether systems are
predominately publicly or privately financed, governments have a stake in
ensuring that their constituencies are served by a network of health centres.
The intervention of public policy makers then becomes essential for defining a
national agenda that recognises the role of health centres, establishing
standards for the care that is provided, and developing the environment required
to facilitate and promote