Sample Presentation Paper on Evaluation of School Health Service Delivery Programs in Tertiary Institutions in a Developing State


In developing countries, there has been an increasing problem with the quality and affordability of health services that are delivered to tertiary institutions. Most of the services, which have been delivered in some of the institutions, have been low-quality services. In addition to this, the services are offered in rare circumstances when the health care services providers are able to reach the institutions. There are some reasons that have hindered the adequate provision of these services to the institutions in developing states, among them being the advanced nature of health services as well as the systems involved in the delivery of the services. In addition to this, governments in the respective developing countries have lacked sufficient finances to meet the delivery of the services to all the tertiary institutions in the country. Due to overall financial constraints these countries face, they are not able to offer quality services to the institutions, and those that are lucky to receive the services are not fully serviced. This has created a need for the stakeholders involved in the delivery of the health services to tertiary institutions in developing countries to come together to lay don strategies that would improve the sector.

Drawing on the theories that have developed concerning this, research in health services is a field that involves several disciplines that are more than any other basic as well as applied research. This is because the research involves professionals in different areas such as sociology, epidemiology, nursing, medicine as well as psychology among others. When these professionals gather information in their respective areas of specialization, the government and other stakeholders in health services delivery are able to access informing knowledge in the field. However, in developing countries, mostly the media people who find a source of news in the field do research. Before analyzing the health services offered to tertiary institutions in a developing country, it is necessary to outline some of the goals for the services. This will aid in determining whether the goals have been met or not in the respective countries.

Goals of providing health services to tertiary institutions

Some of the important elements that the government in a country aims at when it decides to offer health services to students in tertiary institutions are as discussed below. Ensuring that students who fall sick in the institutions are safe is one of the goals. In this case, students are protected from any health attendants who may harm them instead of helping them out. There are errors that could happen when health attendants are attending to students as they take them to health care centers, and since they are far from health care institutions, these errors are avoided by the provision of the services in their institutions. To avoid the deaths of the students, the government provides health care professionals that offer the services in the respective tertiary institutions in the country. In many cases, tertiary institutions lack the appropriate facilities that provide health services to the students. This makes the health systems used in the delivery of services prone to medical errors. Thus, the government takes an initiative to provide the services to avoid the occurrence of errors.

Another objective of the provision of these services to tertiary institutions is to ensure effectiveness. This is because for any health service to be effective there has to be the incorporation of evidence-based science to bear desired results. Most tertiary institutions are not in a good position to access informing knowledge based on scientific researches, despite the studies done in the institutions by the students.  The government, through the researches done by the professionals included in the HSR, receives adequate information, thus able to manipulate it to bring improvements in the field (AKIN, J., BIRDSALL, N. & DE FERRANTI, D. 2007, 156). This avoids more errors from taking place during the delivery of the health services to the students, who are most affected by medical errors due to less effective health facilities in their institutions. Timeliness is also another goal that is aimed b providing health services to tertiary institutions. Students are forced to obtain appointments with medical officers for them to be attended to. They face challenges of timeliness especially if they receive medical treatment and care from public health centers. Since ether is many patients to be attended to, the rest of the patients made attempts to access the facilities in time.

However, it becomes a challenge for students to access health facilities in time.  Whenever they seek services, they face delays. They are forced to make long queues, which make them lose time to learn. This mostly affects those students that are in critical conditions. With the provision of health services to their institutions, they are able to access services on time, and thus, their health conditions do not worsen, especially for the students in critical conditions. Another goal of providing these services to tertiary institutions is the maintenance of a patient-health care attendant relationship that is long-term. In most cases, students who fall sick while in school are permitted to seek help from the nearest health center. However, when they are at their homes, they seek health services from other centers different from centers where previously help was sought. This disorganizes the health records continuity about the patients and thus, attendants from the two centers may not be able to progressively obtain the feedback of the patients after they have been attended to. With health services being offered to the institutions, there will be an effective and continuous record-keeping system for relevant health information about the students. This helps in getting feedback from any student served and thus providing a road map concerning their health status.

Providing health services to tertiary institutions ensures equity among the students as the services benefit all students. There has been strong evidence from HSR conducted in the recent past that the current system of rendering health services in health centers has not accomplished the goal. This is because in most cases, people will be served according to their races as well as ethnicity and thus leading to a division among the public. Those from races and ethnicities that are considered minor receive low-quality services while those from the majority populations are served with high-quality services.  However, with the services rendered to students in their institutions, equality is achieved.  With the status in developing countries, for these goals to be achieved, there need to be some radical changes in the system of delivering health services to tertiary institutions in the respective countries. This will involve coming up with approaches that will be meant to be the jumpstart of the rest of the improvements needed in the field. This is because; most of the goals outlined above are neglected and thus are not achieved in developing countries. Developing countries face financial as well as technological challenges in the delivery of health services to tertiary institutions, thus, low-quality services are rendered. There are fewer health professionals and thus, HSR is neglected and does not play the role it ought to in improving the services.


The quality of health services programs used to offer services to tertiary institutions in a developing country

Despite the simple definition that developing countries have attached to health service programs used in rendering health services to tertiary institutions, the field has proved to be complex. This is because of the adequate scientific studies that are needed in the implementation of the programs (REDICAN, K., OLSEN, L. & BAFFI, C. 2002, 176). Prevailing complexity is due to the knowledge gap of the professionals in the countries. The participating parties are not aware of the services that would lead to desired results in the health conditions of the students. However, developing countries tend to copy what developed countries do and because of the differences in terms of finances between them, they end up implementing programs that do not satisfy the goals outlined earlier in this paper. Evaluation of the quality of these programs could be done using Avedis Donabedian’s model (FITZPATRICK, J. & KAZER, M. 2012, 155).

He provided a formal model for evaluating programs used in the delivery of health services to tertiary institutions. The model incorporates three divergent dimensions that include the structure, process, and outcomes of the programs. However, there has been a challenge in understanding the quality of the programs with the current working environments that health professionals are subjected to. To begin with, developing countries lack suitable physical and socioeconomic conditions to implement the programs. This would improve the internal controls, which are the main benchmarks of the effectiveness of the programs. The programs have been found to influence possible risks in the health sector in tertiary institutions. This is because they lead to uncollaborative relationships between the parties involved. This is mainly because of the centralization of the making decisions depicted by the programs that regard the services provided in the institutions.

The program’s implementation is mainly affected by both internal as well as internal factors. Some of the internal factors include support from the administrative departments and relationships between physicians. External factors that affect implementation and the outcomes of the programs include insurance policies, geographic situation of tertiary institutions, and resources available for implementation purposes (JOHNSON, J. & STOSKOPF, C. 2009, 108). These factors determine the nature of care that patient students will afford as well as the impact that will befall them. To begin with, the structure of health systems involves technology, facilities, and personnel involved in the implementation of health care programs. With this factor being one of the most neglected areas in health care provision in developing countries, services offered to tertiary institutions end up being of low quality. The level of technology is not as high as in developed countries and thus, health care centers in the institutions are as well affected (COMPTON, W., FANJIANG, G., GROSSMAN, J. & REID, P. 2005, 127). Insufficient funds to allocate to the sector are also a problem and thus, facilities are not adequate to offer high-quality services to the students. Bearing in mind that the governments in the developing countries face a challenge in providing quality health services to the public in general, the same problem will be witnessed in tertiary institutions.

The process of offering health services to tertiary institutions in developing countries could also be used to rate the services provided. Programs used in offering the services lack the element of timeliness. In this case, services offered do not link to specific student complaints about their health. Students are forced to attend different centers for services when they are not in school. This is because the programs have failed to create room for students while they are away from school. Examination of the natural history of the complaint becomes a challenge due to the different centers the student seeks services from. Therefore, this ends up affecting students because of complications that result as the initial diagnosis progresses to change. This means that the programs have not created a room for examining the process of providing care to the students to make a determination of the recovery process after treatment episode. The programs do not accommodate assessment of the outcomes of the care given, unlike in developed countries. In connection with that, outcomes of the services are not fully followed up critically.

To get a better understanding of the outcomes, physicians need to ask the students served about their current status, whether they were satisfied with the services, and other necessary outcomes that they felt were related to the services. This could only be possible if the HSR department, which is ineffective, is able to give a chance to the students to report this information. Programs used in the process of delivery of health services in tertiary institutions in developing countries fail to consider this element. This, determining the extent to which students improve in their health is difficult. This is an indication that in developing countries, such programs have not been efficient and sufficient fully to impact the students in tertiary institutions positively. Despite the inadequate funds that the countries have, there should be attempts to improve on the quality of these programs, which could only be possible through improvement in HSR (Health Service Research) to bring necessary changes to the process of implementation of the programs (INSTITUTE OF MEDICINE (U.S.). 2003, 198).


Health researchers could contribute by conducting studies concerning accessibility as well as costs of delivering the services to tertiary institutions in developing countries (PETERS, D. 2009, 179). The information gathered would be given to the officials in the government of the developing country and thus, efforts would be made to improve the services. In most developed countries, those who make decisions regarding the services as well as those that do research on health services and the public. Specifically, the public representatives who receive the services, something that is not witnessed in developing countries. In developing countries, the role is left for the media and thus information that reaches the government is not adequate, thus, most of the challenges will not be noticed and will continue to prevail. The difference in the quality of health services delivered in a developing and a developed country, at this point could be said to be dependent on the health services research and studies done. In developing countries, less information about the services is captured while in developed countries, adequate information is captured and thus more improvements are implemented where needed.


AKIN, J., BIRDSALL, N., & DE FERRANTI, D. (2007). Financing health services in developing countries: an agenda for reform. Washington, D.C., U.S.A., World Bank.

COMPTON, W., FANJIANG, G., GROSSMAN, J., & REID, P. (2005). Building a better delivery system a new engineering/health care partnership. Washington, D.C., National Academies Press.

FITZPATRICK, J., & KAZER, M. (2012). Encyclopedia of nursing research. New York, Springer Pub.

INSTITUTE OF MEDICINE (U.S.). (2003). The Future of the public health in the 21st century. Washington, DC, National Academies Press.

JOHNSON, J., & STOSKOPF, C. (2009). Comparative health care systems: global perspectives. Sudbury, Mass, Jones and Bartlett Publishers.

PETERS, D. (2009). Improving health service delivery in developing countries: from evidence to action. Washington, DC, World Bank.

REDICAN, K., OLSEN, L., & BAFFI, C. (2002). Organization of school health programs. Madison, Wis, WCB Brown & Benchmark.