Delanyo Dovlo - Academia.edu (original) (raw)
Papers by Delanyo Dovlo
Frontiers in Public Health
BackgroundDespite renewed emphasis on strengthening primary health care globally, the sector rema... more BackgroundDespite renewed emphasis on strengthening primary health care globally, the sector remains under-resourced across sub–Saharan Africa. Community-based Health Planning and Services (CHPS) has been the foundation of Ghana's primary care system for over two decades using a combination of community-based health nurses, volunteers and community engagement to deliver universal access to basic curative care, health promotion and prevention. This review aimed to understand the impacts and implementation lessons of the CHPS programme.MethodsWe conducted a mixed-methods review in line with PRISMA guidance using a results-based convergent design where quantitative and qualitative findings are synthesized separately, then brought together in a final synthesis. Embase, Medline, PsycINFO, Scopus, and Web of Science were searched using pre-defined search terms. We included all primary studies of any design and used the RE-AIM framework to organize and present the findings to understan...
Frontiers in Public Health, May 16, 2023
This study aimed to engage African leaders and key stakeholders to commit themselves toward the s... more This study aimed to engage African leaders and key stakeholders to commit themselves toward the strengthening of surgical, obstetric, and anesthesia care systems by in Africa. Methods: From research to a political commitment, a baseline assessment was performed to foster the identification of the gaps in surgical care as a first step of an inclusive process. The preliminary findings were discussed during the International Symposium on Surgical, Obstetric, and Anesthesia Systems Strengthening by in Africa. The conclusions served to draft the Dakar Declaration and its Regional Action Plan-to improve access to surgical care by in Africa, endorsed by Heads of State.
BMJ Global Health, Oct 1, 2019
background Most maternal and child deaths are preventable or treatable with proven, cost-effectiv... more background Most maternal and child deaths are preventable or treatable with proven, cost-effective interventions for infectious diseases and maternal and neonatal complications. In 2015 sub-Saharan Africa accounted for up to 66% of global maternal deaths and half of the under-five deaths. Access to essential medicines and commodities and trained healthcare workers to provide lifesaving maternal, newborn and post-natal care are central to further reductions in maternal and child mortality. Methods Available data for 24 priority medicines for women and children were extracted from WHO service availability and readiness assessments conducted between 2012 and 2015 for eight countries in sub-Saharan Africa. The mean availability of medicines in facilities stating they provide services for women or children and differences by facility type, ownership and location are reported. results The mean availability of 12 priority essential medicines for women ranged from 22% to 40% (median 33%; IQR 12%) and 12 priority medicines for children ranged from 28% to 57% (median 50%; IQR 14%). Few facilities (<1%) had all nominated medicines available. There was higher availability of priority medicines for women in hospitals than in primary care facilities: range 32%-80% (median 61%) versus 20%-39% (median 23%) and for children's medicines 31%-71% (median 58%) versus 27%-57% (median 48%). Availability was higher in public than private facilities: for women's medicines, range 21%-41% (median 34%) versus 4%-36% (median 27%) and for children's medicines 28%-58% (median 51%) versus 5%-58% (median 46%). Patterns were mixed for rural and urban location for the priority medicines for women, but similar for children's medicines. Conclusions The survey results show unacceptably low availability of priority medicines for women and children in the eight countries. Governments should ensure the availability of medicines for mothers and children if they are to achieve the health sustainable development goals.
Journal of Higher Education in Africa, Jan 14, 2004
A health crisis is facing sub-Saharan Africa. The population has increased markedly. In recent de... more A health crisis is facing sub-Saharan Africa. The population has increased markedly. In recent decades, communicable diseases and 'new' noncommunicable disease epidemics have intensified. HIV/AIDS is perhaps the biggest health challenge. However, the supply of health workers remains low and has been worsened by their migration to developed countries. This paper reviews health professionals' 'brain drain' using data from Ghana and other African countries, with proxy data supplying some information on which direct data do not exist. Not only is retention of health professionals a serious challenge, but training output has also remained limited. There are few studies of how stakeholders, including institutions of tertiary education, can moderate the effects of brain drain. Sub-Saharan Africa cannot compete economically with industrialised countries in the same health labour market. This paper discusses ways in which educational systems and the health sector can collaborate to mitigate the effects of health professionals' migration and to sustain health services including (a) new modes of selecting candidates for the professions, (b) establishing new and relevant curricula, (c) profiling new cadres that are better retained, and (d) coordinating with the health sector on bonding and community service schemes to facilitate retention. Résumé L'Afrique subsaharienne est confrontée à une crise sanitaire. La population de cette zone a connu une forte croissance. Au cours des dernières décennies, les épidémies de maladies contagieuses et de « nouvelles » maladies non contagieuses se sont intensifiées. Parmi celles-ci figure le SIDA, qui pose un défi majeur. Or, le nombre
The health status in the African Region has increased in the past 15 years, though still faced wi... more The health status in the African Region has increased in the past 15 years, though still faced with many challenges and threats. To move forward, improvements in the health planning process are needed as part of the effort to strengthen health governance. The history of health planning is rich in effort, and shows evolution with the prevailing paradigm of health management at each point in time. As a result, with the advent of SDGs as health security preparedness needs, it is imperative that the heath planning process be realigned with the governance needs and expectations of countries. Recognizing persisting planning challenges relating to poor policy dialogues, uneven prioritization capacity, rigid processes, poor linkages of planning tools and with inter-sectoral actions and implementation guidance, the WHO regional office is proposing adoption of a comprehensive planning framework and process that takes cognizance of these challenges. It defines the respective tools and processe...
Interdisciplinary studies in human rights, Nov 29, 2019
The right to health is recognized as a basic human right in various United Nations official docum... more The right to health is recognized as a basic human right in various United Nations official documents and in the founding principles of the World Health Organization whose constitution envisaged a right to the highest attainable standard of health for everyone. The health implications of the SDGs is linked to fundamental Human rights that the 2030 Agenda is anticipated to contribute extensively to (see footnotes 9, 10, 11). We discuss the ability of Sub-Saharan African countries to protect the health rights of its populations given the challenges of poor economic development and significant poverty levels though some countries (Rwanda, Ethiopia, Ghana, etc.) have improved health services coverage by removing financial barriers. The right to health can be expensive and African countries did increase their health budgets, as decided in the "Abuja Declaration" target of allocating 15% of overall government budgets to health. Between 1990 and 2013 this allocation did increase from an average of 3.7% to 11.4%. Attaining health rights in Africa requires certain policy emphases including protections from catastrophic expenditures for health, ensuring access to quality health services, and building effective "voice" for populations to exercise their rights. Enablers of health rights should include good policy and governance, with expanded social movements; and SSA countries should seize upon crises such as the
... Pakistan 3 13 44 207 172 ... structured approaches used to recruit doctors, the methods used ... more ... Pakistan 3 13 44 207 172 ... structured approaches used to recruit doctors, the methods used to recruit nurses and other health professionals tend to be based on recruiting &#x27;batches&#x27; of ten, twenty, fifty or more at a time from a specific country, often using recruitment agencies. ...
Frontiers in Public Health, Nov 15, 2019
Background: Innovative strategies such as digital health are needed to ensure attainment of the a... more Background: Innovative strategies such as digital health are needed to ensure attainment of the ambitious universal health coverage in Africa. However, their successful deployment on a wider scale faces several challenges on the continent. This article reviews the key benefits and challenges associated with the application of digital health for universal health coverage and propose a conceptual framework for its wide scale deployment in Africa. Discussion: Digital health has several benefits. These include; improving access to health care services especially for those in hard-to-reach areas, improvements in safety and quality of healthcare services and products, improved knowledge and access of health workers and communities to health information; cost savings and efficiencies in health services delivery; and improvements in access to the social, economic and environmental determinants of health, all of which could contribute to the attainment of universal health coverage. However, digital health deployment in Africa is constrained by challenges such as poor coordination of mushrooming pilot projects, weak health systems, lack of awareness and knowledge about digital health, poor infrastructure such as unstable power supply, poor internet connectivity and lack of interoperability of the numerous digital health systems. Contribution of digital health to attainment of universal health coverage requires the presence of elements such as resilient health system, communities and access to the social and economic determinants of health. Conclusion: Further evidence and a conceptual framework are needed for successful and sustainable deployment of digital health for universal health coverage in Africa.
Human Resources for Health, Feb 24, 2012
Background: Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease ... more Background: Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in the region. Methods: The SAMSS survey is a descriptive survey study of Sub-Saharan African medical schools. The survey instrument included quantitative and qualitative questions focused on institutional characteristics, student profiles, curricula, postgraduate medical education, teaching staff, resources, barriers to capacity expansion, educational innovations, and external relationships with government and non-governmental organizations. Surveys were sent via e-mail to medical school deans or officials designated by the dean. Analysis is both descriptive and multivariable. Results: Surveys were distributed to 146 medical schools in 40 of 48 Sub-Saharan African countries. One hundred and five responses were received (72% response rate). An additional 23 schools were identified after the close of the survey period. Fifty-eight respondents have been founded since 1990, including 22 private schools. Enrolments for medical schools range from 2 to 1800 and graduates range from 4 to 384. Seventy-three percent of respondents (n = 64) increased first year enrolments in the past five years. On average, 26% of respondents' graduates were reported to migrate out of the country within five years of graduation (n = 68). The most significant reported barriers to increasing the number of graduates, and improving quality, related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower percentage loss of faculty over the previous five years (P = 0.018); strengthened institutional research tools (P = 0.00015) and funded faculty research time (P = 0.045) and greater faculty involvement in research; and country compulsory service requirements (P = 0.039), a moderate number (1-5) of postgraduate medical education programs (P = 0.016) and francophone schools (P = 0.016) and greater rural general practice after graduation. Conclusions: The results of the SAMSS survey increases the level of data and understanding of medical schools in Sub-Saharan Africa. This data serves as a baseline for future research, policies and investment in the health care workforce in the region which will be necessary for improving health.
Human Resources for Health, Jun 18, 2004
Background: Substitute health workers are cadres who take on some of the functions and roles norm... more Background: Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. Methods: A desk review is conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization in countries such as Tanzania, Malawi, Mozambique, Zambia, Ghana etc., using curricula, evaluations and key-informant questionnaires. Results: The cost-effectiveness of using substitutes and their relative retention within countries and in rural communities underlies their advantages to African health systems. Some studies comparing clinical officers and doctors show minimal differences in outcomes to patients. Specialized substitutes provide services in disciplines such as surgery, ophthalmology, orthopedics, radiology, dermatology, anesthesiology and dentistry, demonstrating a general bias of use for clinical services. Conclusions: The findings raise interest in expanding the use of substitute cadres, as the demands of expanding access to services such as antiretroviral treatment requires substantial human resources capacity. Understanding the roles and conditions under which such cadres best function, and managing the skepticism and professional turf protection that restricts their potential, will assist in effective utilization of substitutes.
BMJ Open
IntroductionWith rapid urbanisation in low-income and middle-income countries, health systems are... more IntroductionWith rapid urbanisation in low-income and middle-income countries, health systems are struggling to meet the needs of their growing populations. Community-based Health Planning and Services (CHPS) in Ghana have been effective in improving maternal and child health in rural areas; however, implementation in urban areas has proven challenging. This study aims to engage key stakeholders in urban communities to understand how the CHPS model can be adapted to reach poor urban communities.Methods and analysisA Participatory Action Research (PAR) will be used to develop an urban CHPS model with stakeholders in three selected CHPS zones: (a) Old Fadama (Yam and Onion Market community), (b) Adedenkpo and (c) Adotrom 2, representing three categories of poor urban neighbourhoods in Accra, Ghana. Two phases will be implemented: phase 1 (‘reconnaissance phase) will engage and establish PAR research groups in the selected zones, conduct focus groups and individual interviews with urba...
BMJ Global Health
Several countries in Africa have developed human resources for health (HRH) policies and strategi... more Several countries in Africa have developed human resources for health (HRH) policies and strategies to synergise efforts in setting priorities, directions and means to address the major challenges around leadership and governance, production, recruitment, management, motivation and retention and coordination. In this paper, we present information on the availability, quality and implementation of national HRH policies and strategic plans in the WHO Africa Region. Information was obtained using a questionnaire completed by the head of HRH departments in the Ministries of Health of 47 countries in the WHO Africa Region. Of the 47 countries in the Region, 57% (27 countries) had HRH policies and 11% (5 countries) were in the process of developing one. Thirty-two countries (68%) had national strategic plans for HRH with 12 (26%) being in the process of developing a strategic plan, and 28 countries reporting the implementation of their strategic plans. On the quality of the policies and s...
Cambridge University Press eBooks, Dec 22, 2022
Whilst the issue of international migration of health workers is sometimes presented as a one-way... more Whilst the issue of international migration of health workers is sometimes presented as a one-way linear "brain drain", the dynamics of international mobility, migration and recruitment of health workers re complex, covering individual choice, motivations and attitudes to career development; the relative status of health workers in different systems; the differing approaches of country governments to managing, facilitating or attempting to limit outflow or inflow; and the role of recruitment agencies as intermediaries in the process. The study is based on analysis of published and unpublished data provided by professional registration bodies and government departments, combined with information from organizational case studies in the NHS, and key informant interviews in the UK, Ghana and Barbados, with international recruitment agencies, and with international organisations.
BMJ Open, 2019
ObjectivesTo assess the impact of refresher training of healthcare workers (HCWs) in infection pr... more ObjectivesTo assess the impact of refresher training of healthcare workers (HCWs) in infection prevention and control (IPC), ensuring consistent adequate supplies and availability of IPC kits and carrying out weekly monitoring of IPC performance in healthcare facilities (HCFs)DesignThis was a before and after comparison studySettingsThis study was conducted from June to July 2018 during an Ebola virus disease (EVD) outbreak in Equateur Province in the Democratic Republic of the Congo (DRC).Participants48 HCFsInterventionsHCWs capacity building in basic IPC, IPC kit donation and IPC mentoring.Primary outcome measuresIPC scoreResults48 HCFs were evaluated and 878 HCWs were trained, of whom 437 were women and 441 were men. The mean IPC score at baseline was modestly higher in hospitals (8%) compared with medical centres (4%) and health centres (4%), respectively. The mean IPC score at follow-up significantly increased to 50% in hospitals, 39% in medical centres and 36% in health centre...
Bulletin of the World Health Organization, Jul 1, 2017
BMC Health Services Research, 2016
Background: Policy-making is a dynamic process involving the interplay of various factors. Power ... more Background: Policy-making is a dynamic process involving the interplay of various factors. Power and its role are some of its core components. Though power exerts a profound role in policy-making, empirical evidence suggests that health policy analysis has paid only limited attention to the role of power, particularly in policy dialogues. Methods: This exploratory study, which used qualitative methods, had the main aim of learning about and understanding policy dialogues in five African countries and how power influences such processes. Data were collected using key informant interviews. An interview guide was developed with standardised questions and probes on the policy dialogues in each country. This paper utilises these data plus document review to understand how power was manifested during the policy dialogues. Reference is made to the Arts and Tatenhove conceptual framework on power dimensions to understand how power featured during the policy dialogues in African health contexts. Arts and Tatenhove conceptualise power in policy-making in relational, dispositional and structural layers. Results: Our study found that power was applied positively during the dialogues to prioritise agendas, fast-track processes, reorganise positions, focus attention on certain items and foster involvement of the community. Power was applied negatively during the dialogues, for example when position was used to control and shape dialogues, which limited innovation, and when knowledge power was used to influence decisions and the direction of the dialogues. Transitive power was used to challenge the government to think of implementation issues often forgotten during policy-making processes. Dispositional power was the most complex form of power expressed both overtly and covertly. Structural power was manifested socially, culturally, politically, legally and economically. Conclusions: This study shows that we need to be cognisant of the role of power during policy dialogues and put mechanisms in place to manage its influence. There is need for more research to determine how to channel power influence policy-making processes positively, for example through interactive policy dialogues.
BMC Health Services Research, 2016
International Journal of Health Policy and Management, 2015
The editorial is commendable and I agree with many of the points raised. Management is an importa... more The editorial is commendable and I agree with many of the points raised. Management is an important aspect of health system strengthening which is often overlooked. In order to build the capacity of management, we need to consider other factors such as, the environment within which managers work, their numbers, support systems and distribution. Effective leadership is an issue which cannot be overemphasized as part of management capacity in resource deprived settings as difficult settings require leadership skills in order to achieve managerial success. A primary issue of importance highlighted in the editorial is country ownership of management effectiveness initiatives, which may be very difficult when the health sector is dependent on support and funding from donors and influential partners, who drive change often without a good understanding of the context. How partners finance health programmes is another dilemma as it can distract from locally determined priorities. Further research should help us to understand better what works and under different settings.
Frontiers in Public Health
BackgroundDespite renewed emphasis on strengthening primary health care globally, the sector rema... more BackgroundDespite renewed emphasis on strengthening primary health care globally, the sector remains under-resourced across sub–Saharan Africa. Community-based Health Planning and Services (CHPS) has been the foundation of Ghana's primary care system for over two decades using a combination of community-based health nurses, volunteers and community engagement to deliver universal access to basic curative care, health promotion and prevention. This review aimed to understand the impacts and implementation lessons of the CHPS programme.MethodsWe conducted a mixed-methods review in line with PRISMA guidance using a results-based convergent design where quantitative and qualitative findings are synthesized separately, then brought together in a final synthesis. Embase, Medline, PsycINFO, Scopus, and Web of Science were searched using pre-defined search terms. We included all primary studies of any design and used the RE-AIM framework to organize and present the findings to understan...
Frontiers in Public Health, May 16, 2023
This study aimed to engage African leaders and key stakeholders to commit themselves toward the s... more This study aimed to engage African leaders and key stakeholders to commit themselves toward the strengthening of surgical, obstetric, and anesthesia care systems by in Africa. Methods: From research to a political commitment, a baseline assessment was performed to foster the identification of the gaps in surgical care as a first step of an inclusive process. The preliminary findings were discussed during the International Symposium on Surgical, Obstetric, and Anesthesia Systems Strengthening by in Africa. The conclusions served to draft the Dakar Declaration and its Regional Action Plan-to improve access to surgical care by in Africa, endorsed by Heads of State.
BMJ Global Health, Oct 1, 2019
background Most maternal and child deaths are preventable or treatable with proven, cost-effectiv... more background Most maternal and child deaths are preventable or treatable with proven, cost-effective interventions for infectious diseases and maternal and neonatal complications. In 2015 sub-Saharan Africa accounted for up to 66% of global maternal deaths and half of the under-five deaths. Access to essential medicines and commodities and trained healthcare workers to provide lifesaving maternal, newborn and post-natal care are central to further reductions in maternal and child mortality. Methods Available data for 24 priority medicines for women and children were extracted from WHO service availability and readiness assessments conducted between 2012 and 2015 for eight countries in sub-Saharan Africa. The mean availability of medicines in facilities stating they provide services for women or children and differences by facility type, ownership and location are reported. results The mean availability of 12 priority essential medicines for women ranged from 22% to 40% (median 33%; IQR 12%) and 12 priority medicines for children ranged from 28% to 57% (median 50%; IQR 14%). Few facilities (<1%) had all nominated medicines available. There was higher availability of priority medicines for women in hospitals than in primary care facilities: range 32%-80% (median 61%) versus 20%-39% (median 23%) and for children's medicines 31%-71% (median 58%) versus 27%-57% (median 48%). Availability was higher in public than private facilities: for women's medicines, range 21%-41% (median 34%) versus 4%-36% (median 27%) and for children's medicines 28%-58% (median 51%) versus 5%-58% (median 46%). Patterns were mixed for rural and urban location for the priority medicines for women, but similar for children's medicines. Conclusions The survey results show unacceptably low availability of priority medicines for women and children in the eight countries. Governments should ensure the availability of medicines for mothers and children if they are to achieve the health sustainable development goals.
Journal of Higher Education in Africa, Jan 14, 2004
A health crisis is facing sub-Saharan Africa. The population has increased markedly. In recent de... more A health crisis is facing sub-Saharan Africa. The population has increased markedly. In recent decades, communicable diseases and 'new' noncommunicable disease epidemics have intensified. HIV/AIDS is perhaps the biggest health challenge. However, the supply of health workers remains low and has been worsened by their migration to developed countries. This paper reviews health professionals' 'brain drain' using data from Ghana and other African countries, with proxy data supplying some information on which direct data do not exist. Not only is retention of health professionals a serious challenge, but training output has also remained limited. There are few studies of how stakeholders, including institutions of tertiary education, can moderate the effects of brain drain. Sub-Saharan Africa cannot compete economically with industrialised countries in the same health labour market. This paper discusses ways in which educational systems and the health sector can collaborate to mitigate the effects of health professionals' migration and to sustain health services including (a) new modes of selecting candidates for the professions, (b) establishing new and relevant curricula, (c) profiling new cadres that are better retained, and (d) coordinating with the health sector on bonding and community service schemes to facilitate retention. Résumé L'Afrique subsaharienne est confrontée à une crise sanitaire. La population de cette zone a connu une forte croissance. Au cours des dernières décennies, les épidémies de maladies contagieuses et de « nouvelles » maladies non contagieuses se sont intensifiées. Parmi celles-ci figure le SIDA, qui pose un défi majeur. Or, le nombre
The health status in the African Region has increased in the past 15 years, though still faced wi... more The health status in the African Region has increased in the past 15 years, though still faced with many challenges and threats. To move forward, improvements in the health planning process are needed as part of the effort to strengthen health governance. The history of health planning is rich in effort, and shows evolution with the prevailing paradigm of health management at each point in time. As a result, with the advent of SDGs as health security preparedness needs, it is imperative that the heath planning process be realigned with the governance needs and expectations of countries. Recognizing persisting planning challenges relating to poor policy dialogues, uneven prioritization capacity, rigid processes, poor linkages of planning tools and with inter-sectoral actions and implementation guidance, the WHO regional office is proposing adoption of a comprehensive planning framework and process that takes cognizance of these challenges. It defines the respective tools and processe...
Interdisciplinary studies in human rights, Nov 29, 2019
The right to health is recognized as a basic human right in various United Nations official docum... more The right to health is recognized as a basic human right in various United Nations official documents and in the founding principles of the World Health Organization whose constitution envisaged a right to the highest attainable standard of health for everyone. The health implications of the SDGs is linked to fundamental Human rights that the 2030 Agenda is anticipated to contribute extensively to (see footnotes 9, 10, 11). We discuss the ability of Sub-Saharan African countries to protect the health rights of its populations given the challenges of poor economic development and significant poverty levels though some countries (Rwanda, Ethiopia, Ghana, etc.) have improved health services coverage by removing financial barriers. The right to health can be expensive and African countries did increase their health budgets, as decided in the "Abuja Declaration" target of allocating 15% of overall government budgets to health. Between 1990 and 2013 this allocation did increase from an average of 3.7% to 11.4%. Attaining health rights in Africa requires certain policy emphases including protections from catastrophic expenditures for health, ensuring access to quality health services, and building effective "voice" for populations to exercise their rights. Enablers of health rights should include good policy and governance, with expanded social movements; and SSA countries should seize upon crises such as the
... Pakistan 3 13 44 207 172 ... structured approaches used to recruit doctors, the methods used ... more ... Pakistan 3 13 44 207 172 ... structured approaches used to recruit doctors, the methods used to recruit nurses and other health professionals tend to be based on recruiting &#x27;batches&#x27; of ten, twenty, fifty or more at a time from a specific country, often using recruitment agencies. ...
Frontiers in Public Health, Nov 15, 2019
Background: Innovative strategies such as digital health are needed to ensure attainment of the a... more Background: Innovative strategies such as digital health are needed to ensure attainment of the ambitious universal health coverage in Africa. However, their successful deployment on a wider scale faces several challenges on the continent. This article reviews the key benefits and challenges associated with the application of digital health for universal health coverage and propose a conceptual framework for its wide scale deployment in Africa. Discussion: Digital health has several benefits. These include; improving access to health care services especially for those in hard-to-reach areas, improvements in safety and quality of healthcare services and products, improved knowledge and access of health workers and communities to health information; cost savings and efficiencies in health services delivery; and improvements in access to the social, economic and environmental determinants of health, all of which could contribute to the attainment of universal health coverage. However, digital health deployment in Africa is constrained by challenges such as poor coordination of mushrooming pilot projects, weak health systems, lack of awareness and knowledge about digital health, poor infrastructure such as unstable power supply, poor internet connectivity and lack of interoperability of the numerous digital health systems. Contribution of digital health to attainment of universal health coverage requires the presence of elements such as resilient health system, communities and access to the social and economic determinants of health. Conclusion: Further evidence and a conceptual framework are needed for successful and sustainable deployment of digital health for universal health coverage in Africa.
Human Resources for Health, Feb 24, 2012
Background: Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease ... more Background: Sub-Saharan Africa suffers a disproportionate share of the world's burden of disease while having some of the world's greatest health care workforce shortages. Doctors are an important component of any high functioning health care system. However, efforts to strengthen the doctor workforce in the region have been limited by a small number of medical schools with limited enrolments, international migration of graduates, poor geographic distribution of doctors, and insufficient data on medical schools. The goal of the Sub-Saharan African Medical Schools Study (SAMSS) is to increase the level of understanding and expand the baseline data on medical schools in the region. Methods: The SAMSS survey is a descriptive survey study of Sub-Saharan African medical schools. The survey instrument included quantitative and qualitative questions focused on institutional characteristics, student profiles, curricula, postgraduate medical education, teaching staff, resources, barriers to capacity expansion, educational innovations, and external relationships with government and non-governmental organizations. Surveys were sent via e-mail to medical school deans or officials designated by the dean. Analysis is both descriptive and multivariable. Results: Surveys were distributed to 146 medical schools in 40 of 48 Sub-Saharan African countries. One hundred and five responses were received (72% response rate). An additional 23 schools were identified after the close of the survey period. Fifty-eight respondents have been founded since 1990, including 22 private schools. Enrolments for medical schools range from 2 to 1800 and graduates range from 4 to 384. Seventy-three percent of respondents (n = 64) increased first year enrolments in the past five years. On average, 26% of respondents' graduates were reported to migrate out of the country within five years of graduation (n = 68). The most significant reported barriers to increasing the number of graduates, and improving quality, related to infrastructure and faculty limitations, respectively. Significant correlations were seen between schools implementing increased faculty salaries and bonuses, and lower percentage loss of faculty over the previous five years (P = 0.018); strengthened institutional research tools (P = 0.00015) and funded faculty research time (P = 0.045) and greater faculty involvement in research; and country compulsory service requirements (P = 0.039), a moderate number (1-5) of postgraduate medical education programs (P = 0.016) and francophone schools (P = 0.016) and greater rural general practice after graduation. Conclusions: The results of the SAMSS survey increases the level of data and understanding of medical schools in Sub-Saharan Africa. This data serves as a baseline for future research, policies and investment in the health care workforce in the region which will be necessary for improving health.
Human Resources for Health, Jun 18, 2004
Background: Substitute health workers are cadres who take on some of the functions and roles norm... more Background: Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. Methods: A desk review is conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization in countries such as Tanzania, Malawi, Mozambique, Zambia, Ghana etc., using curricula, evaluations and key-informant questionnaires. Results: The cost-effectiveness of using substitutes and their relative retention within countries and in rural communities underlies their advantages to African health systems. Some studies comparing clinical officers and doctors show minimal differences in outcomes to patients. Specialized substitutes provide services in disciplines such as surgery, ophthalmology, orthopedics, radiology, dermatology, anesthesiology and dentistry, demonstrating a general bias of use for clinical services. Conclusions: The findings raise interest in expanding the use of substitute cadres, as the demands of expanding access to services such as antiretroviral treatment requires substantial human resources capacity. Understanding the roles and conditions under which such cadres best function, and managing the skepticism and professional turf protection that restricts their potential, will assist in effective utilization of substitutes.
BMJ Open
IntroductionWith rapid urbanisation in low-income and middle-income countries, health systems are... more IntroductionWith rapid urbanisation in low-income and middle-income countries, health systems are struggling to meet the needs of their growing populations. Community-based Health Planning and Services (CHPS) in Ghana have been effective in improving maternal and child health in rural areas; however, implementation in urban areas has proven challenging. This study aims to engage key stakeholders in urban communities to understand how the CHPS model can be adapted to reach poor urban communities.Methods and analysisA Participatory Action Research (PAR) will be used to develop an urban CHPS model with stakeholders in three selected CHPS zones: (a) Old Fadama (Yam and Onion Market community), (b) Adedenkpo and (c) Adotrom 2, representing three categories of poor urban neighbourhoods in Accra, Ghana. Two phases will be implemented: phase 1 (‘reconnaissance phase) will engage and establish PAR research groups in the selected zones, conduct focus groups and individual interviews with urba...
BMJ Global Health
Several countries in Africa have developed human resources for health (HRH) policies and strategi... more Several countries in Africa have developed human resources for health (HRH) policies and strategies to synergise efforts in setting priorities, directions and means to address the major challenges around leadership and governance, production, recruitment, management, motivation and retention and coordination. In this paper, we present information on the availability, quality and implementation of national HRH policies and strategic plans in the WHO Africa Region. Information was obtained using a questionnaire completed by the head of HRH departments in the Ministries of Health of 47 countries in the WHO Africa Region. Of the 47 countries in the Region, 57% (27 countries) had HRH policies and 11% (5 countries) were in the process of developing one. Thirty-two countries (68%) had national strategic plans for HRH with 12 (26%) being in the process of developing a strategic plan, and 28 countries reporting the implementation of their strategic plans. On the quality of the policies and s...
Cambridge University Press eBooks, Dec 22, 2022
Whilst the issue of international migration of health workers is sometimes presented as a one-way... more Whilst the issue of international migration of health workers is sometimes presented as a one-way linear "brain drain", the dynamics of international mobility, migration and recruitment of health workers re complex, covering individual choice, motivations and attitudes to career development; the relative status of health workers in different systems; the differing approaches of country governments to managing, facilitating or attempting to limit outflow or inflow; and the role of recruitment agencies as intermediaries in the process. The study is based on analysis of published and unpublished data provided by professional registration bodies and government departments, combined with information from organizational case studies in the NHS, and key informant interviews in the UK, Ghana and Barbados, with international recruitment agencies, and with international organisations.
BMJ Open, 2019
ObjectivesTo assess the impact of refresher training of healthcare workers (HCWs) in infection pr... more ObjectivesTo assess the impact of refresher training of healthcare workers (HCWs) in infection prevention and control (IPC), ensuring consistent adequate supplies and availability of IPC kits and carrying out weekly monitoring of IPC performance in healthcare facilities (HCFs)DesignThis was a before and after comparison studySettingsThis study was conducted from June to July 2018 during an Ebola virus disease (EVD) outbreak in Equateur Province in the Democratic Republic of the Congo (DRC).Participants48 HCFsInterventionsHCWs capacity building in basic IPC, IPC kit donation and IPC mentoring.Primary outcome measuresIPC scoreResults48 HCFs were evaluated and 878 HCWs were trained, of whom 437 were women and 441 were men. The mean IPC score at baseline was modestly higher in hospitals (8%) compared with medical centres (4%) and health centres (4%), respectively. The mean IPC score at follow-up significantly increased to 50% in hospitals, 39% in medical centres and 36% in health centre...
Bulletin of the World Health Organization, Jul 1, 2017
BMC Health Services Research, 2016
Background: Policy-making is a dynamic process involving the interplay of various factors. Power ... more Background: Policy-making is a dynamic process involving the interplay of various factors. Power and its role are some of its core components. Though power exerts a profound role in policy-making, empirical evidence suggests that health policy analysis has paid only limited attention to the role of power, particularly in policy dialogues. Methods: This exploratory study, which used qualitative methods, had the main aim of learning about and understanding policy dialogues in five African countries and how power influences such processes. Data were collected using key informant interviews. An interview guide was developed with standardised questions and probes on the policy dialogues in each country. This paper utilises these data plus document review to understand how power was manifested during the policy dialogues. Reference is made to the Arts and Tatenhove conceptual framework on power dimensions to understand how power featured during the policy dialogues in African health contexts. Arts and Tatenhove conceptualise power in policy-making in relational, dispositional and structural layers. Results: Our study found that power was applied positively during the dialogues to prioritise agendas, fast-track processes, reorganise positions, focus attention on certain items and foster involvement of the community. Power was applied negatively during the dialogues, for example when position was used to control and shape dialogues, which limited innovation, and when knowledge power was used to influence decisions and the direction of the dialogues. Transitive power was used to challenge the government to think of implementation issues often forgotten during policy-making processes. Dispositional power was the most complex form of power expressed both overtly and covertly. Structural power was manifested socially, culturally, politically, legally and economically. Conclusions: This study shows that we need to be cognisant of the role of power during policy dialogues and put mechanisms in place to manage its influence. There is need for more research to determine how to channel power influence policy-making processes positively, for example through interactive policy dialogues.
BMC Health Services Research, 2016
International Journal of Health Policy and Management, 2015
The editorial is commendable and I agree with many of the points raised. Management is an importa... more The editorial is commendable and I agree with many of the points raised. Management is an important aspect of health system strengthening which is often overlooked. In order to build the capacity of management, we need to consider other factors such as, the environment within which managers work, their numbers, support systems and distribution. Effective leadership is an issue which cannot be overemphasized as part of management capacity in resource deprived settings as difficult settings require leadership skills in order to achieve managerial success. A primary issue of importance highlighted in the editorial is country ownership of management effectiveness initiatives, which may be very difficult when the health sector is dependent on support and funding from donors and influential partners, who drive change often without a good understanding of the context. How partners finance health programmes is another dilemma as it can distract from locally determined priorities. Further research should help us to understand better what works and under different settings.