Background: Meeting health security capacity in sub-Saharan Africa will require strengthening existing health systems to prevent, detect, and respond to any threats to health. The purpose of this review was to examine the literature on health workforce, surveillance, and health governance issues for health systems strengthening. Methods: We searched PubMed, Science Direct, Cochrane library, CINAHL, Web of Science, EMBASE, EBSCO, Google scholar, and the WHO depository library databases for English-language publications between January 2007 and February 2017. Electronic searches for selected articles were supplemented by manual reference screening. The review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results: Out of 1,548 citations retrieved from the electronic searches, 31 articles were included in the review. Any country health system that trains a cadre of health professionals on the job, reduces health workforce attrition levels, and builds local capacity for health care workers to apply innovative mHealth technologies improves health sector performance. Building novel surveillance systems can improve clinical care and improve health system preparedness for health threats. Effective governance processes build strong partnerships for health and create accountability mechanisms for responding to health emergencies. Conclusions: Overall, policy shifts in African countries’ health systems that prioritize training a cadre of willing and able workforce, invest in robust and cost-effective surveillance capacity, and create financial accountability and good governance are vital in health strengthening efforts.

Background: The Ministry of Health, Ghana, in accordance with global policy, recommends that all suspected malaria cases be confirmed parasitologically before treatment. Not all clinicians, however, base their treatment on test results. Patients also spend a lot of time at health facilities waiting to consult a clinician before being asked to go for testing and to see a clinician with test results. The purpose of the study was to determine if testing all children aged 6 to 59 months with fever reporting at an outpatients department (OPD) for malaria before consultation with a clinician (pre-consultation testing) will influence clinicians to adhere to test results and also reduce the time spent by such patients. Methods:A quasi-experimental study design was used involving two randomly selected government-owned hospitals in the Northern Volta, Ghana. In each hospital, 439 children were recruited between November 2018 and January 2019. The intervention hospital implemented pre-consultation testing. In the comparator arm, standard practices, which involved patients seeing the clinician before he/she decides whether to send the patient for testing or not, were maintained. Results:Out of 878 children screened the overall prevalence of malaria was 31.9% by malaria rapid diagnostic test (RDT) and 26.7% by microscopy. Clinicians in the intervention arm adhered more to the malaria test results than those in the comparator arm (93.2 vs. 84.3%; p < 0.001). The proportion of children who tested negative but were still diagnosed with malaria was significantly lower in the intervention arm compared to the comparator arm (8.4 vs. 21.2%

BackgroundNeonates are at a greater risk of infection, but data on the maternal knowledge and practice of infection prevention in neonates (IPNs) are scarce. This study aimed to assess sociodemographic characteristics and reproductive health factors associated with maternal knowledge and practice of IPNs in North Dayi District, Ghana.MethodsThis was a multicenter cross-sectional study conducted among 612 mothers. A structured questionnaire was used for data collection adapted from previous studies and the IPN guidelines of the World Health Organization (WHO). Bivariable analyses were performed to determine the association between maternal knowledge and practice of IPNs and sociodemographic characteristics and reproductive health factors.ResultsAnalysis showed that less than one-fifth of the mothers (12.9%) had poor knowledge of IPNs, while 21.6% incorrectly practiced it. Mothers who had poor knowledge of IPNs [adjusted odds ratio (AOR) = 13.33 (95% CI: 7.69–23.26), p &lt; 0.001] were more likely to have a poor practice of IPNs.ConclusionAbout one-fifth of the mothers in this study had poor knowledge or poor practice of IPNs according to the WHO’s guidelines. The Health Directorate of North Dayi District should explore the risk factors associated with poor IPNs and increase successful guideline adherence with intensified educational outreach and campaigns.

Background The World Health Organization recommended the Test, Treat and Track (T3) strategy for malaria control that, every suspected malaria case should be tested prior to treatment with Artemisinin-based combination therapy (ACT) and tracked. We assessed the performance and challenges in the implementation of T3 strategy among children under-five years in Volta and Oti Regions of Ghana. Method A descriptive cross-sectional study was carried in 69 health facilities. Exit interviews were conducted for caregivers of children with fever using a semi-structured questionnaire. Clinicians were interviewed at the out-patient department in each facility. Descriptive statistics was conducted, Chi-square test and logistic regression were used to determine the associations between completion of T3 and independent variables. Results Most children, 818/900 (90.9%) were tested for malaria and 600/818 (73.4%) were positive for malaria parasitaemia using rapid diagnostic test. Of those testing positive for malaria, 530/600 (88.3%) received treatment with ACTs. Half, (109/218) of the children testing negative for malaria also received ACTs. Also, 67/82 (81.7%) of children not tested for malaria received ACTs. Only 408/900 (45.3%) children completed T3 with Community Health-based Planning Services (CHPS) compound having the highest completion rate 202/314 (64.3%). CHPS Compounds were 6.55 times more likely to complete T3 compared to the hospitals [(95% CI: 3.77, 11.35), p<0.001]. Health facilities with laboratory services were 2.08 times more likely to complete T3 [(95% CI: 1.55, 2.79), p<0.001] The main challenge identified was clinicians’ perception that RDTs do not give accurate results. Conclusion Testing fever cases for malaria before treatment and treating positive cases with ACTs was high. Treating negative cases and those not tested with ACTs was also high. Health facilities having laboratory services and facility being CHPS compounds were key predictors of completing T3. Clinician’s not trusting RDT results can affect the T3 strategy in malaria control. Periodic training/monitoring is required to sustain adherence to the strategy.

Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screen-ing in the North Tongu District.Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cer-vical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing.Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes.Main outcome measure: The detection of screen positives.Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes.Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of ‘spokes’ could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed.