The referral system is not functional, and patients often ignore secondary or tertiary care due to the high costs involved. Stock- outs of drugs and supplies and inadequate HRH availability impact service delivery. Lack of financial and human resources adversely impacts regulation and quality control. Many services, including those related to HIV and tuberculosis (TB), are not well integrated into the general health delivery system and continue to be provided vertically. Evidence-based medicine is not consistently followed and facility- based quality improvement initiatives, while they exist, have not been institutionalized uniformly. The system also does not invest sufficiently in prevention and.
