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However, facility managers disagreed, noting that CHWs have always been managed at district and province levels.
Specialised care is managed at provincial level and provided by central or provincial hospitals, while primary and secondary care are managed at district level and provided by district hospitals, health centres and clinics.
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The NGO managing CHWs was overseen at the provincial level, while the other NGOs were managed at the district level.
In Zambia and Malawi, facility-based health services were managed at the district level and provided free.
Cases that cannot be managed at the district hospital are referred to regional or national hospitals (where, again, payment continues and services are free for referred children and pregnant women).
Politicians at the local government/district level were also divided; some were strong and opposed to the abolition of user fees due to the potential loss in revenue and the preference to generate local revenue that could be managed at the district level rather than receiving grant from the central government s.
We assumed infants with high-levelcare needs were referred to the zonal referral hospital; the infants in this study reflected a level of mild-to-moderate illness severity for which we expected that their care generally should be able to be managed at a district hospital level.
Around 75% of the rural patients were managed at regional, small district hospitals, while a vast majority of urban patients were treated in tertiary and private hospitals.
Instead the information is managed at the regional and district levels.
The regional managers clarified that since the PMTCT programme is managed at the regional level, the districts do not receive funds to carry out these activities.
The Health system is organized hierarchically, and is administratively managed at the national, regional and district levels.
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