65. The District Hospital

Abstract

In the developing world, district hospitals play an especially critical role in linking communities to the larger health care system. At the apex of the pyramid of primary care, district hospitals have many functions in addition to offering

24–hour diagnostic services, therapeutic care, counseling, and rehabilitation services. They also serve as a coordinating center for information and supplies?whether treatment compliance information that enhances home–based care or supplies for immunization programs. Frequently, they have a direct role in training practitioners and in supplying crucial health care data to national health information systems. Implementing these functions properly can increase the overall cost–effectiveness of health care.

Nevertheless, in developing countries district hospitals face numerous challenges. Hospital efficiency is compromised by a shortage of appropriate professional staff and beds, poor use of resources, nonfunctioning theaters and laboratories, lack of transportation, irregular distribution of drugs and supplies, and frequent breakdowns of medical equipment. In addition, lack of flexibility in reallocating roles between different health worker groups may also prevent hospitals from realizing cost efficiencies.

A number of interventions could help improve the performance of district hospitals. For example, staff members should be appropriate to the tasks they are asked to perform. In practice, this may mean using auxiliary staff members with more limited training because this is more cost–efficient. Other interventions include (1) clinical guidelines and performance reviews to improve staff performance; (2) accreditation to improve quality in hospitals; and (3) programs to reduce the incidence of hospital–acquired disease. A particularly promising avenue for cost savings in developing countries may be the ability to undertake and interpret diagnostic tests remotely, thereby enabling district hospitals to function without a skilled diagnostician on site.