A code of best practice for disease control programmes to avoid damaging health care services in developing countries

Abstract

SUMMARYHow should we implement disease control programmes so as to strengthen existing health systems? To answer this question, we re-examined the integration of these programmes from a managerial perspective. Based on a literature review, we concluded that integration is essential in the majority of cases. We went on to examine the mechanisms whereby the integration of disease control activities can jeopardize health care delivery, resulting in low service utilization, low detection and cure rates, and patient delays. To do this we clustered disease control programmes into three categories and assessed the impact of each on local health care facilities. From these results, we suggest a series of measures designed to help aid agencies and national governments support local health care infrastructures or, as a minimum, avoid damaging them. Whilst some vertical programmes should never be integrated, two conditions are essential to the integration of others: (1) Disease control needs to be integrated with general health care delivery-which implies the possibility to deliver general practice/family medicine care in publicly oriented health services. (2) Integration of both operational and administrative aspects should take place simultaneously. Any health policies in developing countries tending to allocate disease control programmes to government facilities and general health care to private facilities preclude their integration. They risk unravelling the fabric on which both disease control and health care delivery depend.

Primary health care in Africa: do family physicians fit in?

“…This dialogue between 'programme', professional, and patient is limited to matters of education and information -one-way communication -to promote the campaign objectives. 29 A report prepared for the Swiss Agency for Development and Cooperation identifies other disadvantages of vertical programmes: they create duplication (each single disease control programme requires its own bureaucracy), lead to inefficient facility utilisation by recipients, may lead to gaps in care, are incompatible with decent healthcare delivery and, where funded externally, undermine government capacity by reducing the responsibility of the state to improve health care in its own services. 30 Recently, a new phenomenon is influencing the developments in a negative way: vertical diseaseoriented programmes, funded by international donors, 'extract' the skilled local health personnel out of the local primary healthcare system in order to employ them, in much better financial conditions, in vertical programmes.…”

International health policy and stagnating maternal mortality: is there a causal link?

“…73 International programmes may not, in general, be truly vertical, as their hierarchy and administration are not integrated, even though their operations are. 74 Thereby, they have overlooked the need for unity in the chain of command, one of Henri Fayol's fourteen principles of management and a key one, generally applied in the corporate sector. 75 When each dispensary has to respond to several chiefs (e.g.…”

Quality standards for health care delivery and management in publicly oriented health services

“…Second, organizational structures requiring independent staff for each disease programme are very expensive and difficult to sustain. Third, disease control interventions need to attract general health service users and gain access to patient 'stocks' through the offer of comprehensive care in order to improve (early) detection (Unger et al, 2003). Separating disease control and prevention from curative health care is therefore bound for failure.…”

“…These managers should also supervise both health care and disease control; if these activities are separated to distinct service structures the disease control objectives tend to overwhelm wider health care goals (Unger et al, 2003).…”