Health Service Delivery: a commonly-used term without common definition. Despite searching high and low for a definition that would satisfy me – the WHO, my source of choice, even failed me here – I have been forced to try my hand at crafting one. But let me start with a story from my adopted country, South Africa.
Since I arrived in SA a little over a year ago, the country has experienced a wave of protests. These strikes have typically involved municipal workers, but have also included general protests by civilians and have been tainted by xenophobic attacks and murders, which have driven many foreigners from their homes seeking safe haven from these uprisings. Although many reasons have been posed for these protests, the common theme is dissatisfaction with “service delivery”. Spurred by political promises for access to running water, electricity and toilets, the public has become increasingly frustrated as their expectations have not been met. The frustration has now reached a point of social unrest, with municipal workers refusing to work under current conditions, and a point of violence, as foreigners – who are seen as utilizing services from an already scarce supply – are harassed, attacked and killed.
I tell this story to highlight the importance of service delivery in the public context. South Africa, a country which conceivably has the political will and financial resources to deliver upon promises of equal distribution of public services, has not been able to bridge the gap between expectations and reality. The gap from promise and payment to “service delivery” has not been bridged, and the implications for political and personal security are dire.
So – back to the original intent – a definition for service delivery:
Effective health service delivery is the mobilization, management and distribution of health resources–including staff, commodities, equipment, information, and financing–to serve the health needs of a specific population, contributing to effective and equitable health outcomes.
If not through more money or more promises, how is service delivery improved? I’ll take a crack at this too, with the caveat that it’s easy for me to wax theoretically on a blog, much harder to deliver on the ground.
First, I believe we can look at the provision of health services more holistically, understanding that the cycle of healthcare and its nodes of promotion, prevention and treatment are best approached simultaneously, rather than one at the exclusion of the others. A perfect example of this is HIV prevention and treatment, which have historically been silo’ed into separate delivery methods, but which are increasingly proven to influence each other. If these service delivery types were approached more holistically, I believe we would find efficiencies and inter-dependencies that are currently under-utilized.
Second, I believe we should invest heavily in understanding the continuum of care across geography and daily activities. Rather than fixating on health facilities as the appropriate place for the provision of healthcare, I think we should identify the places where people do most of their living – in the home, at school, in communities, and at work – and fully utilize these platforms which can provide infrastructural efficiencies as well as greater and more utilized access.
Finally, I think we should reinforce and financially invest in taking innovative ideas to scale. (Visit Duke’s CASE site for a wealth of knowledge on scaling innovation.) All too often, niche and small-scale solutions capture the imagination of social investors because they can be easily grasped and understood. Small is sexy. But it is only through economies of scale and mass adoption of practices that we will influence the majority of health outcomes and truly change the course of human existence. While I truly believe in the incubation of new and promising ideas, I don’t believe we should do so at the exclusion of established, proven practices that need funding to be taken to scale.
