As the author reflects thoroughly on the journey of the public health care system during the 30 - year period, he acknowledges that management systems, policy frameworks and various health initiatives of the government played a useful role in shaping the delivery of public health services. Accessibility and affordability of public health services are undoubtedly the main achievements of the public health sector.
Consideration of current trends and data for service delivery in the public health sector, however, reflects significant decrease in quality and efficiency, and this is complicated by troubling deficiency of essential resources. The author explores options for improving management approaches, especially at institutional level. He proposes drastic changes to the culture of the organization in order to give effect to the principles of healthcare provision. Central to the overhauling of the organization's culture is the need for improved systems and procedures for personnel supervision, accountability, discipline and clinical governance. He further believes that the involvement of communities through consultations, empowerment and community mobilization can directly or indirectly encourage health seeking, healthy behaviours and self-help health projects in such communities.
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