Health Systems in Africa - WHO

1 Health Systems in Africa Community Perceptions and Perspectives The Report of a Multi-Country Study l l REGIONAL OFFICE FOR Africa Health Systems in Africa Community Perceptions and Perspectives The Report of a Multi-Country Study June 2012. This publication contains the report of an international study team on the perceptions and perspectives of populations on the Health Systems in ten African countries and does not necessarily represent the decisions or the policies of the World Health Organization nor those of the governments concerned Health Systems in Africa Community Perceptions and Perspectives The Report of a Multi-Country Study June 2012.

2 Published by The World Health Organization Regional Office for Africa Brazzaville republic of congo WHO Regional Of ce for Africa , 2012. Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. Copies of this publication may be obtained from the Library, WHO Regional Of ce for Africa , Box 6, Brazzaville, republic of congo (Tel: +47 241 39100; Fax: +47 241 39507; E-mail: Requests for permission to reproduce or translate this publication whether for sale or for non-commercial distribution should be sent to the same address.)

3 The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of speci c companies or or certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned.

4 Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Of ce for Africa be liable for damages arising from its use.

5 WHO/AFRO Library Cataloguing in Publication Data Health Systems in Africa : Community Perceptions and Perspectives 1. Health Systems plans organization and administration 2. Delivery of Health care organization and administration trends 3. Socioeconomic factors 4. Community Health Planning trends 5. Community Health Workers utilization 6. mAfrica I. World Health Organization. Regional Of ce for Africa ISBN: 978 929 023 2018 (NLM Classi cation: WA 540 HA1). Typeset by AMA DataSet Limited, Preston, Lancashire, UK. Printed and bound by Charlesworth Press, Wake eld, UK.

6 Iv Contents List of abbreviations vii Report writing team viii Foreword ix Acknowledgements x Executive summary xi Chapter 1 Introduction 1. Chapter 2 Research Questions and Objectives 3. Overall research questions 3. Research objectives 3. Chapter 3 Methodology 5. Study design and methods 5. Study sites and population 5. Sampling 5. Research instruments 6. Data analysis 7. Ethical considerations 7. The study process 8. Study limitations 8. Chapter 4 Results 9. Socio-demographic information 9. Community perceptions of Health and Health care delivery 12.

7 Experience with Health services 30. Community perceptions of Health care financing 36. Health system goals and social capital 43. Chapter 5 Discussion 49. Chapter 6 Conclusions 57. Chapter 7 Recommendations 59. Chapter 8 References 61. v Health Systems in Africa : Community Perceptions and Perspectives Annexes 65. Annex 1: Definitions of terms 65. Annex 2: Distribution of mean age by site 67. Annex 3: Distribution of respondents who had ever attended school by sex 67. Annex 4: Proportion reporting diabetes as a common Health problem per site 68.

8 Annex 5: Common Health problems of older persons by locality 68. Annex 6: Rating of involvement of communities in decision making by locality 68. Annex 7: Households needing Health care by locality 69. Annex 8: Households needing Health care by performance of district 69. Annex 9: Most common reasons why Health care was sought by sub-region 70. Annex 10: Reimbursement of money paid for drugs in sub-region 70. Annex 11: Freedom of expression by loacility 71. Annex 12: Freedom of expression on Health matters by sub-region 71.

9 Annex 13: Location of the study sites 71. Annex 14: Research Team 72. vi List of abbreviations AFRO WHO Regional Of ce for Africa ANC Antenatal Care APOC African Programme for Onchocerciasis Control ARVs Antiretrovirals BCC Behaviour Change Communication BCG Bacille-Calmette-Gu rin CAR Central African republic CBHI Community-Based Health Insurance CBO Community-Based Organization CDTI Community-Directed Treatment with Ivermectin CSO Civil Society Organization DHS Demographic and Health Survey DPT3 Diphtheria Pertussis Tetanus (three doses).

10 DRC democratic republic of the congo FGD Focus Group Discussion HHH Head of Household HIV/AIDS Human Immunode ciency Virus/Acquired Immunode ciency Syndrome IDI In-depth Interview IGA Income-generating Activity IRB Institutional Review Board LGA Local Government Area MDGR Millennium Development Goals Report MDG Millennium Development Goal MOU Memorandum of Understanding NCD Noncommunicable Disease NGO Non-governmental Organization NID National Immunization Day PHC Primary Health Care PMTCT Prevention of Mother-to-Child Transmission RC Regional Committee SPSS Statistical Package for Social Sciences SSA Sub-Saharan Africa TB Tuberculosis TDR UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases UN United Nations UNDP United Nations Development Programme UNICEF United Nations Children's Fund WHO World Health Organization vii Report writing team Listed in alphabetical order Dr Uche Amazigo Prof Peter Ndumbe Dr Mary Amuyunzu-Nyamongo Dr Richard Ndyomugyenyi Dr Tieman Diarra Dr Ngozi Njepuome Prof S.