Level of Care (Service Delivery)

The community level is the foundation of the service delivery system, where individuals, families and communities at large are expected to take ownership of their health.

The focus at this level is mainly on health promotion services (demand creation) as well as specific supply side services mainly preventive services and limited curative services that are most effectively delivered at that level.

Countries have defined country specific structures for community health level but a majority do have workforce in the name of community health workers who mainly work under supervision of qualified health personnel from a health facility

This is the first physical level of the health system and therefore forms the link between the community and mainstream health care system. It is the first care level where most client’s health needs should be addressed. The primary care level usually a health centre in most countries (smaller health centres may be called dispensaries, health stations, health posts, clinics) serves a defined catchment area or defined community sections or units.

The Primary care level offers Health promotion, health preventive services, simple diagnostic, curative and rehabilitation services mainly for ambulant patients. Normally, the facilities in this level do not have beds except perhaps those needed for emergencies and for maternity care. In most instances. In most instances, the staffing at Primary care level are mainly nurses assisted by community or auxiliary health workers. Others may have physician assistants or medical assistants or what is known as clinical officers in other countries.

Hospital level complements the primary care level and offers a more comprehensive package of services including inpatient services. Different countries have different structures and sub categories of the hospital level. In most instances, the hospital level is divided into several categories including:

1. First level hospital or primary care hospital which is normally a district /sub national level hospital that is a recognized referral facility providing a 24-hour medical care and represents a higher level of competence than the source of referral, e.g. health centre. It may be very small with just few beds. The facilities usually have basic laboratory services and, basic imaging equipment, and the simple surgery is often done under local anesthesia. In some countries however the primary care hospitals do have operational theatres but mainly for basic uncomplicated surgeries while complex surgeries are referred to higher levels of care.
2. Secondary referral level - a more sophisticated hospital (may be a provincial hospital) providing multi-specialist outpatient and inpatient care, and serving as a backstop for the first referral hospitals in the hierarchy of technical competence. It may also, on occasion, have special expertise in some particular medical diagnostic and treatment domain, which would qualify it as an institution of last referral for a specific subject
3. Tertiary referral hospital - a most sophisticated hospital located in a national or provincial capital or other big city, typically a University Teaching Hospital, providing the highest level of medical care available in the country or a region. These facilities are highly specialised. This level follows a model of centralized expertise and high technology, and is a resource for education, training and consultation. Specialists in attendance can monitor and communicate with lower level centers by telemedicine

Specialized referral services