Service Delivery

Clinical practice guidelines have been developed aiming to improve the quality of care. The implementation of the computerized clinical guidelines (CCG) has been supported by the development of computerized clinical decision support systems. This systematic review assesses the impact of CCG on the process of care compared with non-computerized clinical guidelines. [from abstract]

This study seeks to assess the role of private health facilities and pharmacies in HIV/AIDS service delivery in Ethiopia, and specifically to identify factors that could enable greater involvement of this sector in addressing the HIV epidemic.

The provision of eye care in the developing world has been constrained by the limited number of trained personnel and by professional cultures. This paper presents a highly flexible competencies-based multiple entry and exit training system that matches and adapts training to the prevailing population and service needs and demands, while lifting overall standards over time and highlighting the areas of potential benefit. [from abstract]

This video resource chronicles how after a truce in Nepal's civil war, a mobile reproductive health team is reaching isolated communities that have had no health services for years. [adapted from synopsis]

Given the worrying trends in infant and child mortality rates, there is a clear need to assess current practices in the management of childhood illnesses and to identify opportunities for intervention. The 2004 Kenya Service Provision Assessment Survey (KSPA) findings indicate that most health care providers are not taking care of sick children holistically, but rather are treating children only for the presenting illness.

In recent years, some efforts have been made at developing systems for assessing performance and generating information to assist in the distribution of resources in the health sector. However, most of these measurements have focused on the implementation of services and the intermediate steps that determine how inputs are transformed into outputs. This document uses available information to estimate the cost of providing service and workload analysis in order to provide a picture of efficiency in the delivery of services. [from introduction]

This is the first study to systematically review the available published literature describing innovative models of comprehensive primary health care (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993-2006). The study aimed to describe what health service models were reported to work, where they worked and why. [from abstract]

This presentation from the 2008 Asia-Pacific Action Alliance on Human Resource for Health Conference discusses the potential impact of globalization and the challenges this presents to Sri Lankan health workers.


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This presentation from the 2008 Asia-Pacific Action Alliance on Human Resource for Health Conference discusses the role of primary healthcare (PHC) in the WHO Expanded Program on Immunization (EPI), specifically regarding non-communicable diseases (NCD) [adapted from presentation].


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One of the most significant impacts of globalization on India’s healthcare industry has been the direct trade in health-related goods, services and health professionals. This paper examines the opportunities and challenges for medical tourism in India and attempts to assess its potential impact on the country’s health workforce and health system. [adapted from introduction]

The theme of this edition is primary health care in South Africa. It includes national and international perpescitves on primary health care and focuses on areas such as policy and legislation, infectious diseases, maternal and child health and human resources. Chapter 11 discusses strengthening human resources for primary care. [adapted from summary]

Prior to implementing male circumcision as a public health measure against the spread of HIV, the feasibility, safety and costs of the procedure within target countries should be evaluated to understand what measures need to be taken to ensure access to safe, affordable voluntary circumcision services. The aims of this study were to assess variation and safety of male circumcision practices, as well as resource and training needs related to the procedure, in a community that has been practicing circumcision traditionally for many generations. [from introduction]

Most children undergoing surgery in Kenya are anaesthetised by clinical officers or anaesthetists with minimal training in paediatric anaesthesia. This article details the statistics of how this personnel shortage impacts anaesthesia delivery. [from introduction]

In South Africa, first-contact primary care is delivered by nurses in small clinics and larger community health centres (CHC). CHCs also employ doctors, who often work in isolation from the nurses, with poor differentiation of roles and little effective teamwork or communication. Worcester CHC, a typical public sector CHC in rural South Africa, decided to explore how to create more successful practice teams of doctors and nurses. This paper is based on their experience of both unsuccessful and successful attempts to introduce practice teams and reports on their learning regarding organisational change.

A study of private-sector immunization services was undertaken to assess scope of practice and quality of care and to identify opportunities for the development of models of collaboration between the public and the private health sector. A questionnaire survey was conducted with health providers at 127 private facili¬ties; clinical practices were directly observed; and a policy forum was held for government representatives, private healthcare providers, and international partners. [from abstract]

This study was conducted to identify determinants, benchmarks and indicators of the costs and benefits and distributional impact of the migration of human resources for health on health services in Kenya and to make policy proposals for intervention. [from abstract]

The community score card process is a community-based monitoring tool that is a hybrid of the techniques of social audits and citizen report cards.The CSC is an instrument to exact social and public accountability and responsiveness from service providers. By linking service providers to the community, citizens are empowered to provide immediate feedback to service providers. [from author]

The mapping exercise illustrated in this report was conducted to inform and support the efforts of the Ugandan Ministry of Health to increase the contraceptive prevalence through enhanced community-based distribution (CBD) of family planning. The specific objectives of the exercise were to determine the historical and current coverage of CBD of family planning services in Uganda, by both governmental and nongovernmental programs, and to identify potential districts for scaling up these services. [adapted from summary]

Telemedicine is viewed as a new way of offering medical services. It is seen as a means of overcoming the growing shortage of health practitioners in developing countries. The aim of this paper is to highlight the need for the formulation of guidelines for the ethical practice of telemedicine in South Africa. [from abstract]

Improving service delivery for the poor is an important way to help the poor lift themselves out of poverty. This resource presents and evaluates tools and techniques to measure service delivery and increase quality in health and education.

This article outlines the challenges facing the surgical workforce in Africa. Funding priorities in Africa typically favor infectious diseases, and surgery and perioperative care have been neglected, even though essential surgical care at district hospitals is more cost effective than some other highly prioritized interventions, such as antiretroviral therapy for HIV. There is a need to integrate surgical and anesthetic training programs so health personnel, particularly in rural areas, can treat the full range of diseases appropriate to that level of care. [adapted from author]

In an initiative to collate experiences on management development in low resource settings, WHO carried out case studies to explore management development approaches and how these impacted managerial and service delivery performance. [adapted from author]

Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community settings. The results of this study indicate that implementation of nursing best practice guidelines can result in improved practice and patient outcomes in some settings. [adapted from author]

This article focuses on the field of telemedicine in developing countries and its role in improving health, using examples from the experience of the International Development Resource Centre. [adapted from publisher]

Despite the usefulness of voluntary counselling and testing centres implemented in Africa, their limited capacity does not allow for vast testing of the general population. Therefore, in order to increase the number of individuals tested for HIV with the aim of enhancing the scaling up, we developed a strategy based on bringing the healthcare package much closer to the people, by using mobile HIV testing units. We herein report the Cameroon experience of mobile HIV testing unit strategy, demonstrating its effectiveness in reaching a great number of individuals, including those without usual access to HIV testing facilities. [abstract]

This review was designed to assess how nurse to patient ratios and nurse work hours were associated with patient outcomes in acute care hospitals, factors that influence nurse staffing policies, and nurse staffing strategies that improved patient outcomes. [from abstract]

The main objectives of this study were to assess the quality of the written communication between physicians and to estimate the number of patients that could have been treated at primary care level instead of at a general hospital. [from abstract]

This resulted in a collection of papers with very different viewpoints and formats, reflecting the different professional and geographical backgrounds of the participants. We have grouped them under three headings. First a set of papers describes the performance of health personnel in a number of countries and attempts to improve it. A second part looks more closely at the various coping strategies health care workers, medical and paramedical, clinical and managerial, actually apply to deal with difficult working and living conditions.

This article assesses interventions aimed at improving family planning mechanisms and reviewing the problem-solving processes to build an effective monitoring system of the interventions at the local level of the overall system of the Ministry of Health and Family Welfare of the Government of Bangladesh. [adapted from author]

There are few cost-minimisation studies in telemedicine. We have compared the actual costs of providing the telepaediatric service to the potential costs if patients had travelled to see the specialist in person. In November 2000, we established a novel telepaediatric service for selected regional hospitals in Queensland. Instead of transferring patients to Brisbane, the majority of referrals to specialists in Brisbane have been dealt with via videoconference. Since the service began, 1499 consultations have been conducted for a broad range of paediatric sub-specialities including burns, cardiology, child development, dermatology, diabetes, endocrinology, gastroenterology, nephrology, neurology, oncology, orthopaedics, paediatric surgery and psychiatry.