The Impact of Hand Washing Initiative on Young People in the Eastern Region of Ghana

Hand washing has been a lifelong practice because of its many health benefits, social and moral obligations. It is perceived to be one of the most important and cost-effective methods of preventing infectious and diarrhoeal diseases like the Coronavirus disease 2019, (COVID-19). (Ghana Health Survey, 2020). Promoting hand washing as an intervention for hand hygiene and behaviour change activity for continuous practice have been rolled out among young people so that they learn proper hand washing and maintain personal hygiene. This study assesses the impact of hand washing initiative among young people in the Eastern Region of Ghana.This is an exploratory and qualitative study that combines a Focus Group Discussions (FGD) of young people and In-Depth Interviews of key stakeholders such as parents, teachers, community leaders, health workers and NGO’s in the Eastern Region of Ghana. The data derived from the study was analyse using a qualitative technique such as thematic analysis to extract the key findings. During the study, ethical considerations were observed to protect respondents.Key findings from the study indicates that there is a general awareness of hand washing and its importance among young people. However, they find it difficult to adhere to the practice because of non-availability of basic items such as soap, water and knowledge of proper hand washing techniques. The study also revealed that key stakeholders contribute to promote hand washing initiative in diverse ways at home, in schools, health facilities and in the community. However, some stakeholders are predisposed to resources that enable them to achieve hand washing initiative. The least of those not predisposed to basic resources to support the practice are teachers, schools and community leaders because of shortage basic resources such as soap and water to support the practice of hand washing. This study concludes that despite all the efforts by young people to adhere to practice and key stakeholders’ effort to promote hand washing, they are confronted with basic challenges. Hence, the need to have basic resources such as water and soap in schools and communal areas, to advocate for young people to engage in global hand washing day and using young people as ambassadors to advocate for proper hand washing practices especially among their peers. Keywords: Infectious Diseases, Hand Washing Initiative, Non-Governmental organizations, Focus Group Discussion, Thematic Analysis, Behavioural Changes DOI: 10.7176/PPAR/11-4-01 Publication date:May 31st 2021

Health system resilience: a critical review and reconceptualisation

This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neglect of equity and of who is bearing the costs of resilience strategies. Resilience depends crucially on relationships between system actors and components, and—as amply shown during the COVID-19 pandemic—relationships with wider systems (eg, economic, political, and global governance structures). Resilience is therefore connected to power imbalances, which need to be addressed to enact the transformative strategies that are important in dealing with more persistent shocks and stressors, such as climate change. We discourage the framing of resilience as an outcome that can be measured; instead, we see it emerge from systemic resources and interactions, which have effects that can be measured. We propose a more complex categorisation of shocks than the common binary one of acute versus chronic, and outline some of the implications of this for resilience strategies. We encourage a shift in thinking from capacities towards capabilities—what actors could do in future with the necessary transformative strategies, which will need to encompass global, national, and local change. Finally, we highlight lessons emerging in relation to preparing for the next crisis, particularly in clarifying roles and avoiding fragmented governance

COVID-19 autopsy reports from the Ga-East Municipal and the 37 Military Hospitals in Accra, Ghana

Introduction: Since the declaration of COVID-19 by the World Health Organisation (WHO) as a global pandemic on 11th March 2020, the number of deaths continue to increase worldwide. Reports on its pathologic manifestations have been published with very few from the Sub-Saharan African region. This article reports autopsies on COVID-19 patients from the Ga-East and the 37 Military Hospitals to provide pathological evidence for better understanding of COVID-19 in Ghana.Methods: Under conditions required for carrying out autopsies on bodies infected with category three infectious agents, with few modifications, complete autopsies were performed on twenty patients with ante-mortem and/or postmortem RT -PCR confirmed positive COVID‑19 results, between April and June ,2020.Results: There were equal proportion of males and females. Thirteen (65%) of the patients were 55years or older with the same percentage (65%) having Type II diabetes and/or hypertension. The most significant pathological feature found at autopsy was diffuse alveolar damage. Seventy per cent (14/20) had associated thromboemboli in the lungs, kidneys and the heart. Forty per cent (6/15) of the patients that had negative results for COVID-19 by the nasopharyngeal swab test before death had positive results during postmortem using bronchopulmonary specimen. At autopsy all patients were identified to have pre-existing medical conditions.Conclusion: Diffuse alveolar damage was a key pathological feature of deaths caused by COVID-19 in all cases studied with hypertension and diabetes mellitus being major risk factors. Individuals without co-morbidities were less likely to die or suffer severe disease from SARS-CoV-

Towards Core Competencies for Health Policy and Systems Research (HPSR) Training: Results From a Global Mapping and Consensus-Building Process.

BACKGROUND: As the field of health policy and systems research (HPSR) continues to grow, there is a recognition of the need for training in HPSR. This aspiration has translated into a multitude of teaching programmes of variable scope and quality, reflecting a lack of consensus on the skills and practices required for rigorous HPSR. The purpose of this paper is to identify an agreed set of core competencies for HPSR researchers, building on the previous work by the Health Systems Global (HSG) Thematic Working Group on Teaching & Learning. METHODS: Our methods involved an iterative approach of four phases including a literature review, key informant interviews and group discussions with HPSR educators, and webinars with pre-post surveys capturing views among the global HPSR community. The phased discussions and consensus-building contributed to the evolution of the HPSR competency domains and competencies framework. RESULTS: Emerging domains included understanding health systems complexity, assessing policies and programs, appraising data and evidence, ethical reasoning and practice, leading and mentoring, building partnerships, and translating and utilizing knowledge and HPSR evidence. The development of competencies and their application were often seen as a continuous process spanning evidence generation, partnering, communicating and helping to identify new critical health systems questions. CONCLUSION: The HPSR competency set can be seen as a useful reference point in the teaching and practice of high-quality HPSR and can be adapted based on national priorities, the particularities of local contexts, and the needs of stakeholders (HPSR researchers and educators), as well as practitioners and policy-makers. Further research is needed in using the core competency set to design national training programmes, develop locally relevant benchmarks and assessment methods, and evaluate their use in different settings

Health system resilience: a critical review and reconceptualisation

Sophie Witter - ORCID: 0000-0002-7656-6188 https://orcid.org/0000-0002-7656-6188Alastair Ager - ORCID: 0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563This Viewpoint brings together insights from health system experts working in a range of settings. Our focus is on examining the state of the resilience field, including current thinking on definitions, conceptualisation, critiques, measurement, and capabilities. We highlight the analytical value of resilience, but also its risks, which include neglect of equity and of who is bearing the costs of resilience strategies. Resilience depends crucially on relationships between system actors and components, and—as amply shown during the COVID-19 pandemic—relationships with wider systems (eg, economic, political, and global governance structures). Resilience is therefore connected to power imbalances, which need to be addressed to enact the transformative strategies that are important in dealing with more persistent shocks and stressors, such as climate change. We discourage the framing of resilience as an outcome that can be measured; instead, we see it emerge from systemic resources and interactions, which have effects that can be measured. We propose a more complex categorisation of shocks than the common binary one of acute versus chronic, and outline some of the implications of this for resilience strategies. We encourage a shift in thinking from capacities towards capabilities—what actors could do in future with the necessary transformative strategies, which will need to encompass global, national, and local change. Finally, we highlight lessons emerging in relation to preparing for the next crisis, particularly in clarifying roles and avoiding fragmented governance.This Viewpoint has no specific funding, but SW's time was supported by the ReBUILD for Resilience research consortium, funded by the UK Foreign, Commonwealth & Development Office.https://doi.org/10.1016/S2214-109X(23)00279-611pubpub

Strategic leadership capacity building for Sub-Saharan African health systems and public health governance: a multi-country assessment of essential competencies and optimal design for a Pan African DrPH

Leadership capacity needs development and nurturing at all levels for strong health systems governance and improved outcomes. The Doctor of Public Health (DrPH) is a professional, interdisciplinary terminal degree focused on strategic leadership capacity building. The concept is not new and there are several programmes globally–but none within Africa, despite its urgent need for strong strategic leadership in health. To address this gap, a consortium of institutions in Sub-Saharan Africa, UK and North America have embarked on a collaboration to develop and implement a pan-African DrPH with support from the Rockefeller Foundation. This paper presents findings of research to verify relevance, identify competencies and support programme design and customization. A mixed methods cross sectional multi-country study was conducted in Ghana, South Africa and Uganda. Data collection involved a non-exhaustive desk review, 34 key informant (KI) interviews with past and present health sector leaders and a questionnaire with closed and open ended items administered to 271 potential DrPH trainees. Most study participants saw the concept of a pan-African DrPH as relevant and timely. Strategic leadership competencies identified by KI included providing vision and inspiration for the organization, core personal values and character qualities such as integrity and trustworthiness, skills in adapting to situations and context and creating and maintaining effective change and systems. There was consensus that programme design should emphasize learning by doing and application of theory to professional practice. Short residential periods for peer-to-peer and peer-to-facilitator engagement and learning, interspaced with facilitated workplace based learning, including coaching and mentoring, was the preferred model for programme implementation. The introduction of a pan-African DrPH with a focus on strategic leadership is relevant and timely. Core competencies, optimal design and customization for the sub-Saharan African context has broad consensus in the study setting

Post-doctoral research fellowship as a health policy and systems research capacity development intervention: a case of the CHESAI initiative

BACKGROUND: Building capacity in health policy and systems research (HPSR), especially in low- and middle-income countries, remains a challenge. Various approaches have been suggested and implemented by scholars and institutions using various forms of capacity building to address challenges regarding HPSR development. The Collaboration for Health Systems Analysis and Innovation (CHESAI) – a collaborative effort between the Universities of Cape Town and the Western Cape Schools of Public Health – has employed a non-research based post-doctoral research fellowship (PDRF) as a way of building African capacity in the field of HPSR by recruiting four post-docs. In this paper, we (the four post-docs) explore whether a PDRF is a useful approach for capacity building for the field of HPSR using our CHESAI PDRF experiences. METHODS: We used personal reflections of our written narratives providing detailed information regarding our engagement with CHESAI. The narratives were based on a question guide around our experiences through various activities and their impacts on our professional development. The data analysis process was highly iterative in nature, involving repeated meetings among the four post-docs to reflect, discuss and create themes that evolved from the discussions. RESULTS: The CHESAI PDRF provided multiple spaces for our engagement and capacity development in the field of HPSR. These spaces provided us with a wide range of learning experiences, including teaching and research, policy networking, skills for academic writing, engaging practitioners, co-production and community dialogue. Our reflections suggest that institutions providing PDRF such as this are valuable if they provide environments endowed with adequate resources, good leadership and spaces for innovation. Further, the PDRFs need to be grounded in a community of HPSR practice, and provide opportunities for the post-docs to gain an in-depth understanding of the broader theoretical and methodological underpinnings of the field. CONCLUSION: The study concludes that PDRF is a useful approach to capacity building in HPSR, but it needs be embedded in a community of practice for fellows to benefit. More academic institutions in Africa need to adopt innovative and flexible support for emerging leaders, researchers and practitioners to strengthen our health systemsIS

From policy to process : an insider perspective of implementing the national health insurance scheme (NHIS) at the Districts in Ghana

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Determinants of MSME Compliance in Paying Taxes (Case Study of Sea Product Processing MSME in Bintan District)

In Indonesia, Sustainable Development Goals (SDGs) are regulated in Presidential Regulation No. 59 of 2017. SDGs is a document that contains global goals and targets from 2016 to 2023. Funds are needed to support sustainable development so the government needs to have a source of funding. One of the largest sources of funding in Indonesia is taxes. State revenues from taxes account for more than 80% of all revenues received from 2017 to 2022. The aim of the research is to determine the influence of tax knowledge, taxpayer awareness, income, tax sanctions and tax services on taxpayer compliance. The object of the research is MSMEs processing sea products in Bintan Regency. This research used quantitative descriptive method. Results of the research are that awareness and level of service partially influence taxpayer compliance and knowledge, income and tax sanctions do not influence taxpayer compliance. Regression analysis calculations obtained R2 of 0.632. Thus, the Tax Knowledge, Taxpayer Awareness, Income, Tax Sanctions and Services variables can explain the Taxpayer Compliance variable by 63.2%, the remainder (36.8%) is explained by other variables

It\u27s such a lazy summer night, there\u27s not a moving thing in [first line]

Performers: Mickey Rooney, Sara Haden, Fay Holden, Patricia Breslin, Cecilia Parker, Johnny Weissmuller, Jr., Gina Gillespie, Teddy RooneyPiano and Voice (with lyrics