| Anglophone |
Tanzania |
Bottom–up approach. Village health services for remote areas at level 1. Level 2 consists of dispensary services for localities with larger populations. Level 3 offers services to even larger populations, up to 50,000 people. |
Lack of access for the poor due to the copayment system, insurance requirements, and the insurgence of private physician practices. Absenteeism, low morale, inadequate qualified work force, lack of equipment and supplies. Centralisation at the high level of care. |
[63, 64] |
| Kenya |
Well organised and pyramidal, with dispensaries, health centres, subdistrict hospitals/private clinics, provincial and national hospitals. |
Recurrent strikes by doctors, problems with financing health systems, high cost of health services, HIV/AIDS and malaria alone consumes the greatest part of resources. |
[65] |
| Uganda |
Village health teams and community medicine distributors at level 1. Higher up is the health centre II in parishes, health centre III in sub-country, health centre IV, the regional referral hospitals, and three national referral and teaching hospitals. |
Village volunteers can be unreliable, lower levels are quick to refer cases. Inadequate infrastructure, inequity in health services, lack of sustenance, low remuneration for staff, paucity of specialised physicians, poor training, high rates of staff layoffs. Poor data collection and utilisation. |
[66] |
| Francophone |
Cote d’Ivoire |
Follows the 1996 health system organisation with three-tier pyramidal structure. Level 1: health, urban medical, school and university health centres. Level 2: general, regional and specialised hospitals. Level 3: specialised health institutes. |
Low level of qualified personnel (one doctor per 10,000). High cost of universal healthcare led to its abandonment, hence lots of out of pocket care. |
[63] |
| Senegal |
Similar structure to that of Cote d’Ivoire. Pyramidal with three levels. Central level: Ministry of Health. Regional level: local health systems. Peripheral level: health districts. |
Disparities in distribution of facilities across the country. Sustained by government budget and relies a lot on donor support. Inadequate workforce, inadequate training, poor infrastructure and communication machinery. Social and religious barriers with disparities in quality of care. |
[63] |
| Lusophone |
Angola |
Has three levels. Primary level: referral health centres or district hospitals, health posts. Secondary care: specialised facilities and general hospitals. Tertiary care: specialised health facilities and central hospitals |
Lack of proper remunerations, inadequate allocation of resources by leadership, lack of decentralisation, persistent shortage of essential drugs, lack of data collection and availability. |
[67] |
| Mozambique |
Has four levels. Primary level: health posts (the least equipped) and health centres. Secondary level: rural hospitals and urban hospitals. Tertiary level: five general and seven provincial and district hospitals. Quaternary level: three central hospitals. |
Shortage of qualified staff to brain drain, and the system has some of the lowest salaries in Africa. Over reliance on foreign donor support makes it unsustainable. Poor infrastructure and absence of diagnostic tools. Inequitable distribution of health facilities. |
[68] |
| Hispanophone |
Equatorial Guinea |
Similar structure to that of other countries with a national Ministry of health, Tertiary, Secondary, and Primary healthcare facilities. |
Poor leadership and governance, low health financing (93.5% of health cost is out of pocket). Poor service delivery, lack of skilled physicians, and poor management of medical resources. Lack of available health data countrywide. |
[69] |
