The District Hospital

Excerpt

Hospitals are major consumers of health budgets. However, there is a paucity of good evidence—even in industrial countries—on their effect (McKee and Healy 2002), whereas the body of theory and opinion on their role is wide. This chapter can serve as only an introduction to topics that include, among others, the political and social value of hospitals and their essential role in integrated health systems (Sachs 2001; Van Leberghe, de Bethune, and de Brouwere 1997; WHO 1999; World Bank 1993). The chapter first introduces basic concepts relevant to district hospitals that may affect their role and performance and a description of possible core services (see figure 65.1). For discussions of the evidence justifying inclusion of an intervention or process as a core service at this level of care, the reader is referred to disease- and service-specific chapters. Although recently attempts have been made to refine definitions of performance (WHO 2000b), the term is used in a general sense, referring to processes and outcomes that contribute to improved levels and distribution of health. The chapter then summarizes currently available economic data on hospital care, focusing where possible on the district level and acknowledging the difficulty in generalizing findings from one setting to another. An illustration follows of some of the factors that threaten district hospitals' performance, indicating the broad range of influences to which they are subject. Finally, possible strategies for improving performance are proposed, focusing on cross-cutting interventions, and highlight areas where current knowledge is inadequate and research is urgently needed.