Prestação de serviços
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In any health system, good health services are those that deliver effective, safe, good-quality personal and non-personal care to those that need it, when needed, with minimum waste. Services – be they prevention, treatment or rehabilitation – may be delivered in the home, the community, the workplace or in health facilities.
Although there are no universal models for good service delivery, there are some well-established requirements. Effective provision requires trained staff working with the right medicines and equipment, and with adequate financing. Success also requires an organizational environment that provides the right incentives to providers and users. The service delivery building block is concerned with how inputs and services are organized and managed, to ensure access, quality, safety and continuity of care across health conditions, across different locations and over time.
Attention should be given to the following:
- Demand for services. Raising demand, appropriately, requires understanding the user’s perspective, raising public knowledge and reducing barriers to care – cultural, social, financial or gender barriers.
- Package of integrated services. This should be based on a picture of population health needs; of barriers to the equitable expansion of access to services; and available resources such as money, staff, medicines and supplies.
- Organization of the provider network. This means considering the whole network of providers, private as well as public; the package of services (personal, non-personal); whether there is oversupply or undersupply; functioning referral systems; the responsibilities of and linkages between different levels and types of provider, including hospitals.
- Management. Whatever the unit of management (programme, facility, district, etc.) any autonomy, which can encourage innovation, must be balanced by policy and programme consistency and accountability. Supervision and other performance incentives are also key.
- Infrastructure and logistics. This includes buildings, their plant and equipment; utilities such as power and water supply; waste management; and transport and communication. It also involves investment decisions, with issues of specification, price and procurement and considering the implications of investment in facilities, transport or technologies for recurrent costs, staffing levels, skill needs and maintenance systems.
Esta seção do perfil do sistema de saúde está estruturado da seguinte forma:
O conteúdo em Portugês estará disponível em breve.
In Botswana, health services are delivered in public, private for-profit, private non-profit and traditional medicine practice settings. The public sector is the main provider of services delivered through a network of health facilities using the primary health care approach. Other health care providers complementing the public sector are faith-based organizations (two district hospitals), mining companies (three hospitals) and a few nongovernmental organizations. The health facilities are spread over 29 health districts operated by the district health management teams.
In 2006, referral and district hospital beds constituted 69% of total bed capacity while primary hospitals and clinics constituted 19% and 15%, respectively. Health services are accessible in both rural and urban areas with 95% of the population living within 8 km radius of a health facility. The private sector mainly provides services to insured clients. However, the uninsured do access private sector service through out-of-pocket payment.
Primary health care facilities are mainly staffed by nurses and midwives. Doctors visit health posts on schedule while some clinics, especially those in urban areas, have doctors and pharmacy personnel on staff. In addition to doctors, nurses and midwives, all hospitals have pharmacy, laboratory and radiology personnel. Referral hospitals have specialized care services. All health facilities have ambulance services for referrals and emergency calls.
The public and private health services in Botswana are regulated by a Public Health Act of 2002 (Chapter 63:01). Health professionals are accredited by professional councils in accordance with the Medical, Dental and Pharmacy Act and the Nurses and Midwives Act. The Ministry of Health assesses and registers private facilities through recognized standards. Regulatory mechanisms for traditional medical practice are yet to be established.
Disparity in access to the services between rural and urban areas still prevails, and shortage of human resources for health is a long-standing challenge. Underutilization and inefficiency in service utilization have also been reported and can be due to factors such as the population’s health-seeking behaviour and an ineffective referral system, among other things.
Organization and management of health services
Package of services
Public and private health care providers
Person-centredness and characteristics of primary health care services
Quality of health services
Priorities and ways forward
Endnotes: sources, methods, abbreviations, etc.
- ↑ Everybody’s business. Strengthening health systems to improve health outcomes. WHO’s framework for action (pdf 843.33kb). Geneva, World Health Organization, 2007
- ↑ Framework and standards for country health information systems, 2nd ed (pdf 1.87Mb). Geneva, World Health Organization and Health Metrics Network, 2008