CHAPTER ONE
INTRODUCTION
Differences in health status, based on indices such as infant mortality, young and child mortality and maternal mortality, between developed countries and developing countries have witnessed historical documentation. Within the developing countries, the phenomenon has shown aggravation as we move from urban to rural areas. Unfortunately, the causes of this disturbing reality are illnesses that can be treated and deaths that can be prevented by simple interventions but for which inappropriate structures have constituted a stumbling block. In order to justify the amount of money spent on health and the number of workers employed, serious attention is required in improving quality of healthcare services while containing costs and also in planning of health care activities and carrying out effective management functions relating to health care delivery systems (HCDS).
This cannot be done outside the imperatives of utilization. This is because utilization is the most activity-related problem, being consumer-oriented with diverse dimensions in needs, perceptions and knowledge. To the extent that utilization entails the cooperation and invitation of people outside the health system crystallizes the magnitude of the problem. Indeed, utilization as a major factor in planning any health care delivery system is validated by past and contemporary situations around the world. At the inception of HFA/2000, WHO had warned that its goals, support activities, management and implementation may be irrelevant if they are not tuned towards maximum utilization. In the United States of America, hospitals and related health facilities require formal utilization review procedures as condition for participation under health plans and some kind of utilization review process in each institution seeking accreditation. In the United Kingdom, the comprehensive National Health Scheme (NHS) is structured to ensure equity and encourage all constituents to seek the use of services. Even in the apartheid era in South Africa, the health sector enjoyed desegregation by reconstructing health services along the principles of accessibility, affordability, acceptability, equity and efficacy. In developing countries, attempts have been directed towards promoting utilization particularly among the rural populations but success has been limited. Free medical services as a means of improving utilization through the elimination of financial barriers has formed a major issue of political activism. Success in this direction has been limited due to inappropriate structures that result from not tuning planning and management activities towards utilization, a situation compounded by other existing problems including