(introduction...)

THOUSANDS of vehicles-and buildings and a wide range of sophisticated equipment (much of it imported) are used each day in Africa for health purposes. As populations grow, new buildings, vehicles, and equipment will be needed. If funds for this infrastructure and equipment are allocated inefficiently or inequitably or are poorly used, the delivery of health services will be severely impaired. The challenge facing the public sector is particularly immense because most African governments are heavily involved in building, operating, and maintaining health facilities. Many Sub-Saharan countries, and especially poorer ones with low population densities, face high infrastructure costs. In the Sahel countries, for example, construction costs are estimated to be double or even more than those in other African countries.

The next section of this chapter discusses the status of Africa's health infrastructure and equipment Three problems dominate: insufficient maintenance, inappropriate and insufficient expansion, and poor planning. This review of the current situation makes it possible to determine what is missing and what health system reforms are needed to improve the planning and management of physical facilities devoted to health purposes.