Concentrated service configurations are common for activities such as hospital care,
central public health laboratories, and health education facilities, which do benefit from
economies of scale – lower costs with larger size – and scope – lower costs from undertaking
a variety of activities (42, 43). These interventions are highly specialized and expensive,
and require large teams of people with a wide range of skills. Some require continuous
observation (for surgical treatment and care), and highly controlled sterile conditions (for surgical and burns units). Accountability can usually be enforced through direct observation
of outputs or outcome. Most personnel can be employed as regular or part-time staff,
rather than under the contractual relationships that appear to be better for dispersed activities.
Countries have been more successful in integrating these services into hierarchical
public bureaucracies but pay the price of the disadvantages of this organizational form.