The Quality of Health and Education Systems Across Africa
a subset of the WHO’s Model List of Essential Medicines, and availability is calculated as the percentage of those 14 medicines that are in stock and unexpired on the day of the facility visit (WHO 2019). Are all facilities equipped with these essential pieces of equipment and common medicines? The SDI surveys indicate that 67 percent of public and 79 percent of private facilities have all four pieces of equipment (that is, thermometer, stethoscope, blood pressure cuff, and weighing scale). Public facilities have more basic equipment available in Mozambique and Togo, whereas private facilities are better stocked in the remaining countries. Among public facilities, a slightly higher proportion of urban facilities (76 percent) than rural facilities (66 percent) has all four pieces of equipment. Although highly variable across the nine countries, there is no clear relationship between the availability of these basic tools and country-level living standards as proxied by average GDP per capita. Figure 2.11 shows the key pieces of equipment missing in different countries. Often, facilities are missing only one of the four necessary pieces of equipment, but more than 30 percent of facilities in Niger and Nigeria lack multiple items. Personal protective equipment is another important set of equipment for health facilities and is profiled in box 2.3 for Sierra Leone. Medicine availability is notably lower at health posts (32 percent) and health clinics (46 percent) than at hospitals (65 percent). This pattern might be expected, but, considering that the list of medicines is fairly basic, they should ideally be available at all levels. Medicines are also less available at public
FIGURE 2.11 Availability of equipment in public health facilities in nine African countries, by country and type of equipment Niger Mozambique Togo Sierra Leone Uganda Madagascar Tanzania Kenya Nigeria 0
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60
80
100
Equipment availability (% of facilities) All equipment available No stethoscope No scale
No thermometer No sphygmomanometer Multiple equipment missing
Source: SDI (Service Delivery Indicators) health surveys. Note: “Multiple equipment missing” refers to facilities lacking more than one piece of equipment. Country surveys were conducted in the following years: Kenya (2018), Madagascar (2016), Mozambique (2014), Niger (2015), Nigeria (2013), Sierra Leone (2018), Tanzania (2016), Togo (2013), and Uganda (2013).
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