Management and health care reform in sub-Saharan Africa.

Recent discussions of health care reform in sub-Saharan Africa have centered on the potential of alternatives to public financing and provision of health care to address efficiency and resource weaknesses. This paper informs these discussions by reporting an overview of the findings of a detailed evaluation of the efficiency and quality of public and non government primary level health services in Tanzania, a sub-Saharan leader in health policy development since the 1960s and used here as an exemplar country for the region. The paper discusses the management actions necessary to address the performance weaknesses identified and considers the possible contribution alternative financing strategies might make in addressing the weaknesses. However, financing reforms will not by themselves address the performance failures; health care reform packages must allow for financing, organizational and management development.