Sufficient funding and efficacioustechnology may be necessary conditions for achieving healthgains, but experience in many countries confirms that theyare not sufficient. Effective and efficient service deliveryis the point at which the potential of the health system toimprove lives meets the opportunity to realize health gains.Health service delivery performance means access and use bythose in need; adequate quality of care to produce healthbenefits; efficient use of scarce resources; andorganizations that can learn, adapt, and improve for thefuture. All too often, potential benefits are not realizedbecause service delivery underperforms. Organizations mustcombine financial, physical, and human resources to deliverhealth services. However, organizations can be complex, andthis complexity must be considered in developing strategiesfor change. This guide will help planners and policy makersnavigate the complexity and make better decisions to improvehealth services. Users of this Guide will find practicaladvice about what performance means in service delivery aswell as how to measure the performance of service deliveryorganizations. The Guide discusses reforms to servicedelivery organizations at the system level and at theindividual facility level. It emphasizes the internalworkings of the organization as well as the externalenvironment in which an organization functions, anddiscusses its capacity to develop and manage change. Adiverse set of theories and concepts explaining organizationperformance are brought together and compared. Guidance isgiven on how to identify the root causes of poorperformance, the most plausible explanations underlyingthese causes, and the right strategies to address andimprove performance.
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