Juliet Nabyonga-Orem

Introduction: Ghana has embarked on several health workforce policy initiatives and health workforce governance structural changes, with critical shifts in the production and demand of health workers over the last two decades. Many more policy proposals are being made regarding the production and recruitment of health workers due to current challenges, such as skills mismatch, underproduction of some essential cadres, a huge surplus of some cadres, and fiscal space challenges leading to 40% unemployment rate in the health sector. It is imperative to generate evidence, from the perspective of practicing health workforce policy actors, on what influences the production of and demand for the health workforce to inform future health workforce policy. Materials and Methods: We adopted an exploratory, descriptive qualitative design guided by the Standards for Reporting Qualitative Research (SRQR), enabling us to capture nuanced perspectives of health workforce policy actors on production and demand dynamics. Participants were purposively sampled from health workforce policy actors within Ghana’s public health sector, prioritising those actively involved in health workforce policy formulation or implementation at national or organisational levels while excluding those outside the health sector. The sampled participants represented the sector ministry, three service delivery agencies (collectively accounting for about 70% of the public health workforce), and a professional labour group (representing 60% of the total health workforce), engendering broad institutional representation. Semi-structured interviews were conducted, audio-recorded with consent and transcribed verbatim, and thematically analysed following Braun and Clarke’s six-step framework, supported by MaxQDA software. Results: Our findings reveal a complex interplay between structural limitations, fiscal constraints, and political interference in shaping Ghana’s health workforce landscape. Limited production capacity for upper-level cadres (doctors, pharmacists) intersects with political patronage, which influences the proliferation and citing of training institutions. These dynamics exacerbate skill-mix imbalances and inequitable distribution, where, due to fiscal space constraints, the government is unable to absorb surplus cadres, reflecting a structural disconnect between production planning and demand absorption. Discussion: Repurposing nursing and midwifery training schools to award degrees instead of certificates is essential in increasing the quality of the health workforce and the services provided. Moreover, politicians should use their influence to support health workforce planning and ensure the implementation of plans. A managed migration of surplus health workers with the signing of recruitment agreements with countries in need of health workforce, particularly enrolled nurses who were overproduced and remained unemployed, is an inevitable policy reform consideration for Ghana. Conclusion: These findings underscore the need for integrated governance frameworks that link production decisions to labour market analytics and fiscal realities.

This founding editorial traces the origins of the African Journal of Health Economics, Systems and Policy (AJHESP), describes the editorial commitments that govern it, and introduces the three commentaries that open the inaugural issue. African Journal of Health Economics, Systems and Policy launches in May 2026 as a fully open-access, bilingual, peer-reviewed journal, the first indexed journal in this field to publish in both English and French, governed by a founding editorial board of eleven researchers from across Africa and the diaspora. We describe the gap the journal addresses, the principles guiding its editorial decisions, and the three commentaries that launch it.

Access to safe, effective, and quality-assured medicines is a cornerstone of public health. The availability of essential medicines is a significant indicator of a functional healthcare system and ...

Antimicrobial resistance (AMR) is a growing global health threat, particularly in low- and middle-income countries. Understanding public knowledge, attitudes, and practices (KAP) regarding antimicrobial use (AMU) and AMR is essential for designing effective interventions. Through this cross-sectional study, we aimed to assess the KAP related to rational AMU and AMR among Namibian adults using an online, self-administered survey. We distributed an online questionnaire between 1 September and 17 November 2024, targeting Namibian adults aged 18 years and older, who had lived in Namibia for at least six months, were willing to participate, and were English literate. We analysed associations between sociodemographic factors and KAP scores using descriptive statistics and χ² tests. Most of the 541 respondents were female (70%), aged 25-34 (40.5%) and had a tertiary education (91.9%). Good knowledge, attitudes, and practices were observed in 64.3%, 79.7%, and 74.9% of participants, respectively. Higher KAP scores were associated with education, employment, urban residence, and access to water, sanitation, and hygiene infrastructure. Misconceptions persisted across all groups, however, particularly regarding AMU in healthy animals and personal AMR risk. While surveyed participants demonstrated generally good KAP, gaps remain. Our findings support the need for targeted AMR education campaigns and policy interventions, which need to be supported by a better understanding of the KAP of Namibian adults regarding AMU and AMR.

Despite improvements in health workforce density, the World Health Organization (WHO) African Region Member States an additional 6.1 million additional health workers by 2030 to achieve universal health coverage (UHC) and health sustainable development goals (SDGs) targets and ensure health security. Additional investments are needed for their education, employment, and retention. However, most countries cannot meet this and require support to secure increased sustainable long-term domestic and external investments in the health workforce to strengthen health systems as part of broader health and national development efforts to improve health, economic, and social outcomes. The Africa Health Workforce Investment Charter, launched by the WHO Africa Regional Office in May 2024, outlines a set of key principles that countries can adapt to stimulate and secure the multisectoral domestic and external investments needed to reduce Africa’s health workforce shortages by 2030. This would ultimately increase access and availability of health care workers and primary healthcare services, especially in rural and underserved communities. The Investment Charter sets out the following key principles for coordinating and sustaining investments in education, employment, retention, and public health functions: (1) Enabling government leadership and stewardship; (2) Applying evidence-informed prioritisation investment; (3) Aligning multisectoral investments through partnership and collaboration; (4) Stimulating more and better investments; and (5) Securing sustainable health workforce investments.

Improving private sector engagement (PSE) in the governance of mixed health systems has been part of the programme of work of the World Health Organization (WHO) in the Africa Region over the past few years. We understand PSE in health governance to mean that governments focus on governing the whole system – that is, both […]

Countries in the World Health Organization (WHO) African region are lagging behind in the global push toward universal health coverage (UHC), a core component of the 2030 Agenda for Sustainable Development. As the target year steadily approaches, it is crucial to assess countries' current and planned health financing reforms to understand their path towards UHC. We examine both current and planned health financing reforms in the WHO African region and assess their implications for UHC. We sent a survey to all 47 Member States of the WHO African Region in August 2024 about their current and planned health financing reforms in the three health financing functions of revenue raising, pooling, and purchasing, as well as public finance management. We used responses from 43 countries, of which 18 countries had a current endorsed national health financing strategy to assess the implications of their reforms based on current literature on using health financing to progress towards UHC goals. Of the 43 countries in the WHO African Region that responded to our survey, 33 (77%) have current or planned health financing reforms across the various health financing functions. A major focus of these reforms is on establishing contributory health insurance schemes, despite their limited potential to address the region's challenges. Additionally, countries are prioritising expanding performance-based financing and provider payment mechanisms. These purchasing strategies could improve service coverage and quality of care if implemented within robust public finance management structures. Countries in the WHO African Region are adopting and planning various health financing reforms to achieve UHC. To ensure success, they will require support in effectively implementing evidence-based reforms in the areas of purchasing and reducing fragmentation from various coverage schemes.

Background: Digital health technologies offer promising avenues for addressing challenges in healthcare systems, particularly in regions such as Sub-Saharan Africa, including Cameroon. These technologies can improve access to care, enhance quality, and optimize healthcare delivery and monitoring through better data management and interoperability. This study aimed to assess the landscape of digital health implementation for data services in Cameroon, focusing on governance, interoperability, and the adoption of digital platforms. Methods: We used a mixed methods approach, administering questionnaires ( n = 60) and conducting in-depth interviews ( n = 6) with digital health experts. The sample was purposively selected to include individuals with experience in digital health projects. Data were analyzed to assess the extent of digital health adoption, including challenges related to interoperability with the District Health Information System 2 (DHIS2). Results: The study revealed significant gaps in governance and policy support for digital health in Cameroon, with 85% of respondents unaware of any existing guidelines. This gap in governance highlights the need for comprehensive policies to guide digital health initiatives. Moreover, 86.7% felt there was inadequate policy support for digital health implementation, particularly among those with higher academic qualifications ( f = 16.033, p = 0.001) and those working at the central level (90.9%). This lack of policy support underscores the necessity for stronger governance and specific policies to support digital health implementation. While 63.3% of organizations had used digital platforms, only 63.3% of respondents received formal training, and 80% were aware of DHIS2. However, 45% reported challenges in interoperability between their systems and DHIS2, which was significantly more common among males (χ² = 4.411, p = 0.036) and those with a Master's degree ( f = 12.057, p = 0.003). These interoperability issues indicate a need for technical solutions and training to ensure seamless data exchange between different health information systems. Conclusion: Cameroon faces critical challenges in digital health implementation, particularly in governance, policy support, and system interoperability. Addressing these issues requires a concerted effort to develop comprehensive digital health policies, enhance training, and ensure interoperability of health information systems. These measures are essential for leveraging digital health technologies to improve healthcare delivery and outcomes in Cameroon.

Background: HIV/AIDS is a major public health issue in Cameroon. Traditional paper-based monitoring systems often fail to provide timely and accurate data, essential for effective program management. The increasing availability of mobile phones and internet services presents an opportunity for mHealth technologies to improve data collection and monitoring. However, the successful integration of mHealth into existing systems requires an understanding of the attitudes and challenges faced by end-users. This study explores the attitudes of mHealth end-users and the challenges they face in integrating mobile technology into HIV program monitoring in Cameroon. Methods: A mixed-methods approach was employed, involving both qualitative and quantitative data collection. The study included 251 respondents from 4 regions (East, Adamawa, Centre, and Littoral) and 4 FGDs. Data were collected using questionnaires and focus group discussion guides. The quantitative data were analyzed using SPSS, while qualitative data were transcribed and analyzed using Nvivo9 with an inductive thematic approach. Results: The quantitative analysis revealed that 78% of respondents had a good attitude toward mHealth, with a mean score of 4.48 ± 0.956. A significant difference was found in the mean attitude scores between those categorized as having good (M = 4.94, SD = 0.244) and poor attitudes (M = 2.71, SD = 0.540; t = -42.50, df = 237, p < 0.001). Qualitative findings supported these results, with most FGD participants expressing a preference for mobile applications over traditional methods due to ease of use and efficiency. Factors such as region of work (F = 5.259, p = 0.002) and educational level (F = 13.45, p < 0.001) significantly influenced attitudes toward mHealth, while age and work experience did not show significant associations. Key challenges identified include the need for better training and support for mHealth technologies, issues with the reliability of mobile devices, and the need for integration with existing systems. Conclusion: There is strong support for the use of mobile technology in improving data collection and patient care. There is a generally positive attitude toward mHealth among end-users in Cameroon, with significant support for its continued integration into HIV program monitoring. However, challenges such as device usability and internet access need to be addressed to enhance the effectiveness of mHealth interventions. Future initiatives should consider these factors to improve data collection and program monitoring in Cameroon.