ABSTRACT
Introduction Mr Mudzawa Kuimba is a communal farmer in Chivhu District of Zimbabwe. His household of six now resides in a resettlement area. They own four indigenous breeds of cattle, six chicken and four goats. He uses his cattle mainly for draught power, but the family also depends on the cows for milk, and the occasional bull will be reserved for his son’s dowry. Health care services for his family as well as others in his village, are provided at the district health center several miles away. Similarly, veterinary services for Mr Kuimba and nearly half a million communal farmers like him all over Zimbabwe, are provided by animal health assistants either at the cattle dip, a trek of five kilometers away or at the animal health centers, thirteen kilometers away. They seldom see a veterinarian as they will need to travel at least thirty five kilometers to the nearest veterinary clinic. Human, as well as veterinary services for Kuimba and other rural farmers, have in the past, been subsidized by the government. Recently however, news is filtering through that they will now have to pay for most of these services. Even worse, a number of facilities in the communal areas will have to be shut down, as part of the government restructuring and privatization exercise. Says Mr Kuimba: “We will now have to travel even farther. I think the government is just not interested in our welfare.”All over Africa and in other developing economies, persistent budgetary constraint is forcing governments like Zimbabwe to undertake
both social and health care reforms. Such policy reforms involve the privatization of health care delivery services hitherto provided free by the government. Consequently, drug and input supplies will be liberalized and the participation of the private sector in the provision of clinical services. This will result in down-sizing or closure of some government veterinary facilities and the retrenchment of surplus government personnel. However, the dilemma for the authorities and planners is the difficulty of quantifying and qualifying availability and demand for services. Resources such as personnel and clinical facilities are therefore not optimally allocated or managed with consequences for millions of rural and poor households dependent on agriculture such as Mr Kuimba’s. It is estimated that by the turn of the century, less than one quarter of the rural livestock population in Africa will be receiving adequate clinical services, with grave economic and health consequences for the rural population (Odeyemi et al., 1998a).The on-going social and health care reforms in developing countries, especially within sub-Saharan Africa, have brought to the fore the problem of monitoring the efficiency of service delivery and the equity of access by all the population (Lavy et al., 1996, Bolduc et al., 1996). Although the need for developing a framework for the systematic evaluation of the delivery of health care services is apparent to a lot of scholars, a universally acceptable and workable framework does not yet exist. A major difficulty encountered by planners, especially in Africa, is the inherent diversities within their delivery systems. These differences make the development of a universally applicable methodology or even framework, difficult. In particular, epidemiological and socio-economic differences have been recognized as influencing the type and efficiency of health care delivery systems (Odeyemi, 1997; Majok, 1995). The recognition of such a phenomenon within populations is indicative of the need for area-specific methodologies and interventions which will identify and address the specific health care needs of the different segments of the population (Odeyemi et al., 1998b). This way, in addition to achieving efficiency objectives, equity of access may be ensured. The complexity of the task has led Doyle (1992) to suggest the combination of predictive models and other decision support tools as the only means of analyzing the delivery system.
