Leadership in health and medical education: lessons from a symposium on health sector development in Ghana

The Ghana College of Physicians and Surgeons (GCPS) has established an annual leadership symposium celebrating innovative leadership in the health sector. The 2022 symposium under the theme "Health Sector Development in Ghana; The Power of Good Leadership" was held in honour of Professor Samuel Ofosu-Amaah (the laureate), an Emeritus Professor of Public Health at the University of Ghana, about his leadership legacy. This article reflects on the leadership challenges in the health sector, the lessons learnt from the symposium, and the way forward. Leadership challenges identified in the health sector included the need for mentorship and coaching, the importance of teamwork and networking for delivering high-quality healthcare, and the role of leadership and governance in the health system. Key lessons from the symposium focused on skills in leading an event organisation, effective collaboration and teamwork, and learning from recognising prominent leaders' contributions to the health sector while these leaders are still alive. Key lessons from the personal and professional life of the laureate included a focus on giving back to the community, building mentorship of health leaders, being a catalyst of change, leadership and governance in public health institutions and publication of research findings. Suggestions were made to name the School of Public Health of the University of Ghana after Professor OfosuAmaah, to include a leadership and management module in all training modules at the GCPS and to establish a health leadership "Observatory" to focus on research on how leadership influences

Trends and Challenges in Access to Essential Medicines in Ethiopia and the Contributions of Local Pharmaceutical Production

Decades ago, the United Nations declared that access to essential medicines was a key element of universal human rights. Accordingly, member states have been striving to address this issue through strategic policies and programs. Strengthening local pharmaceutical production has been a pivotal strategy adopted by many developing countries including Ethiopia. The government of Ethiopia identified local pharmaceutical production as a key industrial sector and has been implementing a ten-years strategic plan to improve capabilities and attract investment. Such support is needed because local production could satisfy only 15 to 20% of the national demand, typically from a limited portfolio of medicines in conventional dosage forms. The increasing prevalence of chronic diseases has accentuated the need for a more sustainable supply to reduce reliance on imports and increase access to essential medicines. A full understanding of the structure, constraints and complexities of the Ethiopian pharmaceutical market structure is vital to direct effective policies, target most impactful investments and exploit opportunities for leapfrogging. Hence, the purpose of this review was to assess the trends and challenges in access to essential medicines and local pharmaceutical production in Ethiopia. Literature search through major databases and review of policy documents and performance reports from relevant sector institutions were made to extract information for the review

Diabetes in the public healthcare sector of four South African provinces: A comparative analysis

The growing burden of diabetes has long been under the radar in developing countries such as South Africa (SA). In recent years, there has been an unprecedented and exponential increase in recorded and undiagnosed diabetes mellitus (DM) cases. Unreliable data collection, overburdened health systems and poor infrastructure have all proved to be barriers to achieving optimum disease management. The District Health Information System (DHIS) serves as the data collection tool for the SA public healthcare sector. It is used in all nine SA provinces to gather data without individual patient identifiers. Objective. To analyse and compare the DM data collected by the DHIS in the Western Cape (WC), Eastern Cape (EC), KwaZulu-Natal (KZN) and Gauteng provinces of SA. Methods. An audit of diabetes-related data from the DHIS for 2016 was conducted. The data were then analysed using Excel. Time-series and cross-sectional analyses were made possible using pivot tables. Graphics were designed using Thinkcell software. Results. Of the four provinces surveyed, Gauteng recorded the highest incidence of DM, 67% higher than the reported global DM incidence estimate, while the WC had the lowest incidence. A similar pattern was also noted regarding the incidence of DM in people aged <18 years, with Gauteng having the highest and WC the lowest prevalence results. When comparing the number of DM-related consultations conducted in each province, the metropolitan districts were highlighted as hotspots of activity for DM care. This study found a moderate inversely proportional relationship between the incidence of DM in all provinces and education deprivation (p<0.05). Among the provinces that collected data on screening (excluding EC), KZN recorded the highest number of diabetic screenings. Conclusion. Metropolitan areas were highlighted as areas to be targeted, further reinforcing the current connection observed between urbanisation and DM in SA. The presence and recording of screening efforts is an excellent step in the right direction for the SA public healthcare sector and the DHIS. With improved interprovincial co-ordination regarding standardisation of the criteria and specifications of data collection fields, and enhanced training for data officers and primary collection agents, good quality and rich data is a very close possibility.

Investment case for the national health strategy 2021-2025

The Government and stakeholders in the health sector aspire to realize improved health outcomes for all, including the vulnerable and marginalized, to enhance Zimbabwe's human capital development towards a prosperous and empowered upper-middle income society. Zimbabwe's National Health Strategy (2021- 2025) was therefore developed, not only to advance its vision and goal for the next 5 years, but to also act as a guide on priority health interventions in the sector in order to improve the country's economy and overall wellbeing of the citizens. As such, the strategy is aligned with the National Development Strategy 1 (2021-2025). Chief among the NDS 1 priorities will be sustainable economic growth, anchored on sector specific growth enablers ­ such as infrastructure, human resources, technology, macroeconomic stability, financial stability, and sustainable public debt management. Focus on transformational value chains, international re-engagement, enablers for improved social welfare and inclusive growth (such as health, food security, effective governance and community and youth participation) complete the priority list of the NDS 1 2021-2025. The NHS 2021-2025 also considers a number of programme specific strategies in the health sector. These include the Human Resources for Health Strategy, National Infrastructure Development Plan, the HIV and AIDS Strategy, the Non-Communicable Disease Strategy, Mental Health Strategy, and the Community Health Strategy. The NHS 2021-2025 is anchored on the concept of an Investment Case. The NHS investment case outlines how the Government of Zimbabwe (GoZ), in partnership with donors, will efficiently save lives, improve health and nutrition outcomes and accelerate the attainment of national goals in line with the Sustainable Development Goals (SDGs). The NHS investment case considered the results and lessons learnt from the Mid Term Review of the National Health Strategy 2016-2020 and the Multiple Indicator Cluster Survey (MICS) 2019. NHS Investment Case used the World Health Organization (WHO)'s One Health Tool, which focuses on estimating the cost of Health Services and Health Systems Strengthening while the effectiveness of health interventions was estimated using the disease specific Impact Models and the Lives Saved Tool (LiST). Results were customized to the Ministry's Programme Based Budgeting format, which required that programmes be grouped first into 4 broad categories; Policy and Administration, Public Health; Curative Services and Bio- Medical Science Engineering and Pharmaceutical Production. The development of the National Health Strategy Investment Case was spearheaded by a taskforce led by MoHCC with technical assistance from its development partners. Technical Working Groups (TWGs) on Investment Case and Health Financing were set up to support the costing of the NHS. These TWGs drew membership from the MoHCC, MoFED, Development Partners and NGOs and Civil Society Organisations. These technical working groups identified the interventions and activities to be costed and also assisted in the prioritization of the interventions. 13 Mini

Inter-professional rivalry in Nigerian health sector: a search for a potential beginning

Background: Inter-professional rivalry (IPR) in Nigerian health sector has become a common practice for over a decade due to abuse of the existing laws and ethics governing the operations of the professional cadres manning the health institutions in the country. This has led to incessant strikes by the different cadres in the hospitals across the country, thereby affecting the quality of services delivered by all the categories of healthcare staff. This study was aimed at identifying the initial source of the problem by interviewing the students of the Faculty of Basic Medical Sciences of Bayero University Kano (BUK) and that of Yusuf Maitama Sule University (YUMSUK) and those that have passed their examinations and joined the clinical and allied science departments in Bayero University Kano. The Faculty of Basic Medical Sciences is the initial confluent point where all medical and students of allied sciences receive their training together especially in the first and second year of their training. Method: A random sampling method was used to select the subjects. Two hundred questionnaires were distributed but 139 (69.5%) students at various levels of training filled and returned the questionnaire. Results: Females constituted 62 (44.6%), while the male were 77 (55.4%). Those in level 4 and 6 dominated the study with 55 (39.6%) and 41 (29.5%) respectively. Medical students and students of Physiology program constituted 42(30.2%) and 23(16.5%) respectively. Majority of the students 126 (90.6%) chose their respective courses without external influence and 85 (61.2%) believed that their course of study has a supportive role in the health care system. Up to 63 (45.3%) believed there is no superiority among the various courses of study. Of the factors fueling superiority feelings among students, 70 (50.4%) did not provide any reason, while those that believe professional bodies encourage it constituted 40 (28.8%), followed by teachers 11 (7.9%) and students themselves 10 (7.2%). Superiority feelings lead to rivalry among the various programs as opined by 78 (56.1%), chaos in the health sector 26 (18.7%) and poor patients management 12 (8.6%). Majority, 61 (43.9%) believed that rivalry in health sector can be prevented by giving uniform opportunity to all professional group. Conclusion: It is clear that half of the students interviewed were not aware of superiority feeling among the different programs of study. However, professional bodies rank first among the factors fueling superiority feeling during undergraduate training. Superiority feeling has negative effects on the healthcare system, one of which is rivalry among the healthcare staff and it can be avoided by giving uniform opportunity to different professional groups

COVID-19: The role of artificial intelligence in empowering the healthcare sector and enhancing social distancing measures during a pandemic

Indiscriminatory in its spread, COVID-19 has engulfed communities from all social backgrounds throughout the world. While healthcare professionals work tirelessly testing for the virus and caring for patients, they too have become casualties of the pandemic. Currently the best way to attempt to curb the spread of the virus, echoed by almost all nation leaders, is to distance ourselves from one another socially or physically. However ideal this may seem, social distancing is not always practical in densely populated lower-income countries with many citizens below the breadline. With the majority of South Africans living in poverty, communities in overcrowded households are unable to distance themselves from one another appropriately. In addition, as a nation we struggle with high HIV and tuberculosis rates, malnutrition and an already overburdened healthcare system, emphasising the extreme vulnerability of our people. These factors, coupled with the fact that many of our healthcare professionals lack the necessary personal protective equipment to prevent them from contracting the virus themselves, highlight the gravity of the damaging repercussions that we may face in the coming months, after the complete national lockdown in force at the time of writing is lifted and we move towards a partial lockdown state. Nationally, there needs to be a shift in mindset towards exploring alternative technology-based preventive measures that may empower the healthcare sector in the long term and enhance social distancing

A study on strategic planning and procurement of medicals in Uganda's regional referral hospitals

This study was an analysis of the effect of strategic planning on procurement of medicals in Uganda's regional referral hospitals (RRH's). Medicals were defined as essential medicines, medical devices and medical equipment. The Ministry of Health (MOH) has been carrying out strategic planning for the last 15 years via the Health Sector Strategic Plans. Their assumption was that strategic planning would translate to strategic procurement and consequently, availability of medicals in the RRH's. However, despite the existence of these plans, there have been many complaints about expired drugs and shortages in RRH's. For this purpose, a third variable was important because it served the role of mediation. A questionnaire was used to obtain information on perceptions of 206 respondents who were selected using simple random sampling. 8 key informant interviews were held, 2 in each RRH. 4 Focus Group Discussions were held, 1 for each RRH, and between 5 and 8 staff took part as discussants for approximately three hours. The findings suggested that strategic planning was affected by funding to approximately 34% while the relationship between funding and procurement was 35%. The direct relationship between strategic planning and procurement was 18%. However when the total causal effect was computed it turned out that strategic planning and the related variable of funding contributed 77% to procurement of medicals under the current hierarchical model where MOH is charged with development of strategic plans for the entire health sector. Since even with this contribution there were complaints, the study proposed a new model called CALF which according to a simulation, if adopted by MOH, strategic planning would contribute 87% to effectiveness in procurement of medicals

Impact of Health Sector Services Fund on the Quality of Maternity Services at Health Centres in Kisii South Sub-County

Background: The Ministry of Health used to disburse funds to the sub-counties through the sub-county treasury. However; there were operational difficulties and challenges for the health facilities in accessing these funds. It is against this background that the Ministry of Health came up with a more innovative approach in 2005 in which funds are credited directly into health facility accounts thereby bypassing the sub-county treasury. The direct funding innovation was first piloted in the Coast Province in 2005 and in 2010 it was rolled to the rest of the country. Since then no further evaluation has been carried out to assess the impact of this funding scheme in other sub counties.Objectives: To assess the impact of the direct funding on the quality of deliveries in maternity units of health centres in Kisii South Sub-county.Design: Descriptive study. Setting: The three health centres in Kisii South Sub-county namely; Nyamagundo; Riana and Riotanchi.Subjects: Secondary data from the maternity registers and interviewing staff working in maternity units.Results:There was statistically significant (p=0.05) increase in the number of deliveries in all the three health centres with Nyamagundo having 131%; Riana 114% and Riotanchi 103%; 33% of the facilities were conducting outreach services and purchasing medical supplies. However; the medical supplies and staffing challenges were still there in all and the structural barriers to quality maternity services were identified in all the facilities.Conclusions: The recommendations are that the funding should be enhanced and it should be workload or output based as the challenges vary among the facilities and other service delivery indicators should also be evaluated; besides rolling it to the other sub-counties in the same category

Disaster Risk Management: A Strategy for the Health Sector in the African Region

The WHO African Region continues to be challenged by frequent natural and man-made emergencies causing injury; death; population displacement; destruction of health facilities and disruption of services; often leading to disasters. The frequency and magnitude of emergencies and disasters have increased since the adoption; in 1997; of the Regional Strategy on Emergency Preparedness and Response. In addition several global initiatives developed since 2005; including the World Health Assembly resolution WHA64.10 (Strengthening national health emergency and disaster management capacities and resilience of health systems) adopted in 2011; have focused on disaster risk management (DRM) as the approach to containing and minimizing the impact of emergencies. WHO has recognized the need for Member States to formulate policies and legislation; and develop capacities in order to institutionalize DRM in the health sector. An assessment conducted in 2011 revealed that most countries in the Region lack these policies; capacities and legislation. This regional strategy proposes that Member States strengthen DRM by developing appropriate laws and policies; building adequate capacities in ministries of health; assessing and mapping the risks from a health sector perspective; assessing the level of safety of; and applying standards to; hospitals and other health facilities; building community resilience; strengthening preparedness; developing national standards for response; and strengthening evidence and knowledge management. This will ensure that the health system has been prepared and will be able to provide adequate health sector response to emergencies and reduce their likelihood of becoming disasters

Clinics and Home-Based Care Organisations: an Interface between the Formal and Informal Health Sectors

The article outlines the findings of a study designed to explore the working relationship between home-based caregivers and clinic nurses at locations in two informal settlements in Johannesburg; South Africa. By considering the views and experiences of both sponsored and unsponsored caregivers; the research focused on how degrees of informality affect this relationship. The nurse/caregiver relationship represents a primary interface between the formal and informal health sectors and is an important part of the country's primary healthcare system. Despite the attention given to linking home-based care (HBC) with the formal health system; very little research has examined the functionality of this link at the ground level. Through a number of qualitative; semi-structured interviews with nurses; home-based caregivers; and staff from the Department of Health; information was collected to better understand what systems are in place to facilitate the relationship between clinics and HBC organisations; and whether these systems are helping to create the desired results. Do the formal and informal health sectors complement and strengthen or do they distract and damage each other? By examining the influence of degrees of informality; the research also lends insight into how this distinction plays a role in healthcare provision. For instance; how does state support impact the link between the formal and informal health sectors and the ultimate quality of care? And what steps can be taken to improve the health system in this regard; as a whole? The findings point to a number of problems and challenges with integrating HBC into the formal health sector. Degrees of informality are found to have a profound impact on the work of home-based caregivers in some respects; but a surprising lack of impact in others. These issues need to be confronted in order to improve the existing system and; ultimately; health outcomes in South Africa

Progress on the Acceleration of Health Sector HIV Prevention in the WHO African Region

In 2005; the WHO Regional Committee for Africa called upon countries to accelerate HIV prevention and to declare 2006 as the Year of Acceleration of HIV Prevention in the African Region. The strategy document that was developed by WHO Regional Office was adopted by the Region's ministers of health in August 2006. The strategy proposed targets to be met by 2010; in line with universal access targets; in areas of HIV testing and counselling; prevention of mother-to-child transmission of HIV; prevention and control of sexually-transmitted infections; blood safety; and access to comprehensive prevention; treatment and care. Specifically; it was envisaged that; by 2010; all districts will provide HIV testing and counselling services; 100100 safe blood and blood products will be ensured; at least 80of pregnant women attending antenatal care will access prevention of mother-to-child transmission of HIV services; at least 80of patients with sexually-transmitted infections will access comprehensive STI management; at least 80of people living with HIV/AIDS will have access to comprehensive prevention; treatment and care services; and condom use in high-risk sexual encounters will reach at least 60. This paper describes the progress made in accelerating key health sector HIV prevention interventions in the Region toward these targets and issues that should be taken into consideration for moving forward the HIV prevention agenda in the health sector

Availability of Essential Medicines in Sudan?

Introduction: Although availability of essential medicines is one of the most important objectives of national medicines' policies; the unavailability of essential medicines remains a major problem for poor countries. Objective: The study was carried out to measure availability and duration of out of stock of essential medicines in Sudan. Method: The study was carried out using the World Health Organization (WHO) Operational Package for Assessing and Monitoring Pharmaceutical Situation in Countries format for data collection. Results: On the average; availability of selected essential medicines at the public pharmacy; medicine stores and the private pharmacies was found to be 80.6; 90.0and 93.0; respectively. The survey found the mean duration of stock out at medicines store was 26.5 days and no records available about inventory control at the pharmacy level. Among the states; the study found low availability of medicines at North Kordufan public pharmacies. The study found no statistical significant difference as far as a Developing country concerning availability of medicines at rural or urban areas (p 0.05). Conclusion: Generally availability and stock out duration of essential medicines in the Sudan were acceptable

Will Private Health Insurance Schemes Subscriptions Continue after the Introduction of National Health Insurance in Uganda?

Introduction: Uganda is currently designing a National Health Insurance (NHI) scheme; with the aim of raising additional resources for the health sector. Very little was known about the health insurance market in Uganda before this study; so one of our main objectives was to investigate the nature of the private health insurance market in Uganda and the opinions of various stakeholders on NHI; with the view to establish the impact of NHI implementation on the existing PHI. Specifically; we aimed to gather the opinions of employees and employers on the likely impact of NHI on their PHI schemes. Methods: We conducted interviews with health insurance providers; and a sample of employers and employees in Kampala; using structured questionnaires and analysed quantitative data using STATA8. Qualitative data was analysed through grouping of emerging themes. Community-based health insurances were excluded from the study. Results: Health insurance and/or prepayment schemes are offered by a handful of organisations or private health providers; mainly in Kampala and cover a relatively small percentage of Uganda's population. The premiums charged and the benefit packages offered by the different agencies vary widely. There are 2 health insurance agencies; 2 HMOs and about 5 or more private providers offering pre-payment schemes to their patients. Responses from a significant proportion of employers and employees show that PHI schemes may be abandoned once the mandatory NHI scheme is implemented. A few respondents argued that they would maintain their PHI subscriptions because of their perceptions of the quality of services likely to be provided under the NHI scheme. Conclusion: If successfully introduced; the NHI scheme may displace existing private health insurance and/or pre-payment schemes in Uganda. The extent to which PHI schemes are displaced depends on whether NHI is successfully implemented and the quality of services being offered under the NHI scheme

Factors influencing HAART adherence among private health care sector patients in a suburb of the Ethekwini Metro

Background: The advent of highly active antiretroviral therapy (HAART) ushered in a new era in the management of the AIDS pandemic with new drugs; new strategies; new vigour from treating clinicians and enthusiasm on the part of their patients. What soon became evident; however; was the vital importance of patient adherence to prescribed medication in order to obtain full therapeutic benefits. Several factors can influence adherence to HIV drug regimens. Many treatment regimes are complex; requiring patients to take a number of drugs at set times during the day; some on a full stomach and others on an empty one. Other factors that could contribute to non-adherence include: forgetting to take medications; cost factor; side effects; incorrect use of drug; social reasons; denial or poor knowledge of drug regime. If the correct regimen is not prescribed and if patients do not adhere to therapy; then the possibility of resistant strains is high. Improving adherence is therefore arguably the single most important means of optimising overall therapeutic outcomes. Although several studies regarding patient adherence have been performed in the public health care sector; data on adherence in patients from the private health care sector of South Africa remain limited. Many factors influence compliance and identifying these factors may assist in the design of strategies to enhance adherence to such demanding regimens. This study aimed to identify these factors among private sector patients.Methods: Descriptive cross-sectional study was conducted among all consenting patients with HIV who visited the rooms of participating private sector doctors from May to July 2005. A questionnaire was administered to consenting participants. Participants who reported missing any medication on any day were considered non-adherent. The data obtained was analysed using SPSS 11.5. A probability value of 5or less was regarded as being statistically significant. Categorical data was described using frequency tables and bar charts. Pearson's chi-square tests or Fischer's exact tests were used interchangeably as appropriate to assess associations between categorical variables. The study received ethics approval from the University of KwaZulu-Natal's Nelson R Mandela School of Medicine Ethics Committee. Results: A total of 55 patients completed the questionnaires and 10 patients refused to participate. There was no statistical difference between adherence to treatment and demographics such as age; gender and marital status. In this study 89.1of patients were classified as non-adherent and reasons for nonadherence included difficulty in swallowing medicines (67.3) (p = 0.01); side effects (61.8) (p = 0.03); forgetting to take medication (58.2) (p = 0.003); and not wanting to reveal their HIV status (41.8) (p = 0.03). Common side effects experienced were nausea; dizziness; insomnia; tiredness or weakness. Reasons for taking their medicines included tablets would save their lives (83.6); understand how to take the medication (81.8); tablets would help them feel better (80.0); and were educated about their illness (78.2). The majority of participants (65.5) were on two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI). All participants that were on a regimen that comprised protease inhibitors and two NRTIs were found to be non-adherent. Conclusions: Some barriers to adherence among this cohort of private sector patients are similar to those experienced by public sector patients. It will be important for doctors to identify these problems and implement strategies that could improve adherence; e.g. using short message services (SMSs) reminders for those patients prone to forgetting to take their medicines; breaking the tablets into smaller pieces in order to overcome the difficulty of swallowing; if the medication is not available in a liquid form; looking at alternative medication with lesser or more tolerant side effect profiles and greater counselling on the drugs