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Assessment of appropriate child care at district level: how useful are mortality rates?


 Where financial resources are sharply limited, routine process and health care output data could be used to assess district level child health care system appropriateness better than mortality data. The rural district health system serving Kasongo, Zaire was studied in reaching these conclusions. Appropriate systems were defined as affordable, acceptable, flexible, and effective. Each of these four characteristics should be met where a primary health care package of techniques and activities truly meets the needs of a given sociocultural setting. The authors do not accept mortality rates as the most suitable tools needed to determine if a system meets these criteria for appropriateness. Particular attention is called to the complexity of measuring system effectiveness. A decline in mortality rate may be an implicit system objective, but not the only goal of the program recognized by its users and workers. There is also a clear need for immediate care and relief from suffering in the community. Use of mortality rates as principle indicator of system effectiveness would not fully reflect positive steps in meeting the broader objectives of the system. Moreover, mortality rates lack sensitivity and specificity, lack relevance to indicators needed by decision-makers at the district level, and are otherwise costly and complex to accurately obtain. Instead of mortality rate determination and analysis, the authors call for a comparison of hospital admission rates between regions which do and do not have properly functioning rural health units accordingly. If health unit operations are conducted as effectively and efficiently as designed, hospital admission rates for illnesses readily treated at the rural level should decline over time. this information is readily and cheaply examined, and allows local decision makers to respond quickly and accurately to local needs.
