Should health systems in developing countries focus on regularity of service delivery to improve their performances ?

One of the key elements developed in the Alma-Ata Conference was the scientific soudness of Primary Health Care. First consideration would convince the observer that health services delivered on a regular basis would automatically achieved better performance. Nevertheless, careful attention allows researcher to doubt this assumption. The present study was performed by computing health centres monthly data available in Rwanda for the year 1999. By using indicators collected through routine HIS, this paper attempts to argue or even provide evidence that regularity of service delivery tested on BCG immunisation coverage indicator could be considered as a key pointer for better global performance at health centre level.

In order to categorise health centres that are regularly performant or not, vaccination against tuberculosis (BCG) was choosen as reference activity. The monthly regularity of this activity has been measured for each health centre. The health centres were grouped into group I (n=255) and group II (n=68). Performances were then scrutinized for 4 other indicators. In order to validate the first results obtained on the basis of an a priori classification, cluster analysis was also performed (n=254).

The results showed that those health centres that have the better performance for BCG immunisation (Group II) are also those that systematically have better performance for all other selected indicators. The results showed also good similarity between cluster and grouping analyses, especially for well performing health centres.

BCG vaccine coverage is linked to other indicators as a “predictor” for good performance. The argumentation provides medical authorities with relevant elements for influencing strategic policy formulation. Moreover, as an example, the present study reveals that it is conceivable to perform analyses that provide useful information for investigation and reasoning about the way health systems are constructed and about how to improve soundness of decision making for better organisation of service delivery.