As a result of decentralization and health sector reform, services are integrated as one goes down the hierarchy of health structure from the national to the sub-district.
At the regional level, curative services are delivered at the regional hospitals and public health services by the District Health Management Team (DHMT) as well as the Public Health division of the regional hospital. The Regional Health Administration or Directorate (RHA) provides supervision and management support to the districts and sub-districts within each region.
At the district level, curative services are provided by district hospitals many of which are mission or faith based. Public health services are provided by the DHMT and the Public Health unit of the district hospitals. The District Health Administration (DHA) provides supervision and management support to their sub-districts.
At the sub-district level both preventive and curative services are provided by the health centers as well as out-reach services to the communities within their catchment areas. Basic preventive and curative services for minor ailments are being addressed at the community and household level with the introduction of the Community-based Health Planning and Services (CHPS). The role played by the traditional birth attendants (TBAs) and the traditional healers is also receiving national recognition.
The health center has traditionally been the first point of contact between the formal health delivery system and the client. It is headed by a Medical Assistant and staffed with program heads in the areas of midwifery, laboratory services, public health, environmental, and nutrition. Each health center serves a population of approximately 20,000. They provide basic curative and preventive medicine for adults and children as well as reproductive health services. They provide minor surgical services such as incision and drainage. They augment their service coverage with outreach services and refer severe and complicated conditions to appropriate levels. The polyclinic is the urban version of the rural health center. Polyclinics are usually larger, offer a more comprehensive array of services, are manned by physicians, and can offer complicated surgical services. They are mainly in metropolitan areas.
District hospitals are the facilities for clinical care at the district level. District hospitals serve an average population of 100,000–200,000 people in a clearly defined geographical area. The number of beds in a district hospital is usually between 50 and 60. It is the first referral hospital and forms and integral part of the district health system.
A District Hospital should provide the following: