Background Electronic Health Record (EHR) systems are increasingly central to healthcare delivery in low- and middle-income countries, yet their effectiveness depends less on technology availability than on the leadership and management practices guiding implementation. Ghanaian evidence remains scarce. Aim To examine the association between leadership and management practices and EHR implementation, focusing on leadership roles, post-implementation commitment and perceived success. Methods This mixed-methods study surveyed 342 health professionals at three Ghanaian hospitals, sampled by stratified randomisation. Analyses comprised chi-square tests, Pearson correlation and multivariable logistic regression using Firth’s penalised likelihood, with the leadership constructs entered as z-standardised predictors. Findings were tested against alternative cut-points, ordinal and continuous-outcome models, and the instrument assessed for reliability and discriminant validity. A companion qualitative study of eight Health Information Management leaders added context. Results Leadership roles, commitment and EHR success were positively correlated, most strongly between leadership roles and commitment (r = 0.687, p < 0.001). With covariates held constant, each standard deviation increase in leadership roles was associated with 4.07 times the odds of high commitment (95% CI 2.79–6.21), and both commitment (AOR = 3.46, 95% CI 2.21–5.64) and leadership roles (AOR = 1.87, 95% CI 1.22–2.93) were independently associated with high perceived success, across specifications. Working experience was the most consistent sociodemographic correlate, though largely accounted for by perceived leadership engagement, and technical challenges were the leading barrier (43.0%). Corrected for attenuation, leadership and commitment were not separable (r = 1.00), indicating one leadership-engagement dimension. Conclusion Leadership and management practice is strongly associated with EHR implementation experiences, though the cross-sectional design and common instrument preclude causal inference. Sustained engagement beyond go-live, rather than deployment-phase activity alone, is most consistently associated with perceived success and is the clearest implication for facility leadership. Independent measures are needed to establish direction.
Background Nepal’s National Health Insurance program has expanded access to medicines for older adults with chronic illness, yet no validated tool exists to measure whether this access improves medication-related quality of life. Objective To translate and validate the Nepali PROMPT-QoL among older adults with chronic illness. Methods A two phase cross-sectional study involving ISPOR-guided translation/cultural adaptation, followed by psychometric validation, was conducted among 360 outpatients aged ≥65 years with chronic illness at a tertiary care hospital of Nepal. Construct validity was assessed via CFA, convergent, discriminant, known-group and criterion (against EQ-5D-3L) validity; and reliability via Cronbach’s α, McDonald’s ω and composite reliability. Results The sample (median age 72.0 years; 55.6% male) primarily had hypertension (43.6%). The original 8-domain structure fit poorly, with negative loadings on the Medicine and Disease Information domain. Re-specification into a 10-domain model, splitting this domain into Medication Administration Information and Disease & Treatment Rationale, and separating two Psychological Impact items into a Treatment Regimen Burden domain, eliminated negative loadings. RMSEA (0.059), CFI, and TLI (0.999) were acceptable-to-excellent, but SRMR (0.122) remained elevated above the 0.08 threshold. Nine of ten domains showed convergent validity; all showed discriminant validity. Reliability was acceptable to excellent for most domains (ω 0.766–1.000); the Availability & Accessibility domain was weakest (ω = 0.766), failing convergent validity. Known-group comparisons broadly supported a priori hypotheses. The overall score correlated significantly with EQ-VAS (ρ = 0.437) and EQ-5D-3L utility (ρ = 0.418). Administration took a median of 10.0 minutes (IQR 9.0, 12.0), with no missing data. Conclusion The 10-domain Nepali PROMPT-QoL shows promising, though not unequivocal, structural validity requiring independent confirmation. Convergent/discriminant validity, reliability, known-group and criterion-related validity, and practical feasibility were otherwise good. The residual misfit, weak Availability & Accessibility domain, and single-center design indicate it is not yet ready for national-scale deployment; multicenter and longitudinal evaluation is needed first.
Introduction Few high-risk individuals receive appropriate chronic kidney disease (CKD) screening, contributing to increased cardiovascular morbidity, mortality, and rising healthcare costs. Despite the availability of evidence-based therapies, gaps in early detection limit timely intervention. Community pharmacists are well positioned to support CKD recognition, intervention, and health equity. Objective To evaluate the feasibility of a community pharmacy-driven CKD screening model. Methods This quasi-experimental implementation feasibility study was conducted at three community pharmacies in under-resourced areas with high diabetes and hypertension prevalence. Pharmacists identified high-risk individuals, provided CKD awareness education and referred eligible participants for testing. After testing, pharmacists reviewed findings with participants, performed medication reviews, and shared recommendations with primary care providers. Feasibility was assessed using the Technical, Economic, Legal, Operational, and Schedule (TELOS) framework. Results A total of 1093 individuals received education, and 178 completed testing. Of those tested, 28% (n=50) had abnormal results, with twenty-four participants (48%) having evidence of albuminuria despite a preserved estimated glomerular filtration rate (eGFR). Most tested participants (58%) were recruited through a pharmacy utilizing community health workers in their workflow. TELOS evaluation found pharmacists had the skills, resources, and infrastructure for the project (technical) and successfully integrated referrals into existing workflows (operational). The program aligns with pharmacies’ financial goals and may offer payers a return on investment through quality measure gap closure (economic), but regulatory changes (e.g., payer credentialing and payment parity policies) would open reimbursement pathways (legal). Planning took six months, followed by an 18-month intervention (schedule). Discussion Community pharmacies are possible sites for closing CKD screening gaps, aiding in quality measure fulfillment, and improving overall access to care. While currently feasible, regulatory changes would yield a stronger return on investment, allowing pharmacists appropriate remuneration for supporting optimized CKD care. Further analysis is needed to assess long-term impact on CKD management and outcomes.
Kidney diseases affect around 850 million people worldwide; the prevalence of chronic kidney disease (CKD) varies by diagnostic definition, dataset and year of ascertainment, but it is estimated at 14.2% of the adult population (788 million adults) in the most recent Global Burden of Disease analysis; CKD ranks among the leading causes of mortality globally, having risen from the 17th to within the top 10 causes in recent estimates. Projections continue to place CKD among the top five causes of years of life lost worldwide by 2040. This narrative review maps how CKD disparity distributes across time, geography and demography, examines what drives progression once disease is established, and asks why nephroprotective therapy with established outcome data reaches so few of the patients in whom it is indicated. In high-income systems, therapeutic inertia is best read as a clinician-level failure: control is recognised as inadequate, but no intensification follows, and the routine threshold for intensification continues to lag the supporting evidence by several years. The corresponding gap in low- and middle-income countries is structural, but it has also been documented among uninsured, rural, migrant and Indigenous populations in high-income countries. Specialist nephrology is often out of reach, and where it exists the necessary diagnostic tests cannot always be performed locally, while the indicated medications are absent or priced beyond what patients can afford. The burden is not limited to CKD itself but also relates to its comorbidities. Type 2 diabetes and hypertension together account for approximately half of the aetiology-specific disability-adjusted life years in CKD; elevated fasting plasma glucose, high body mass index and systolic blood pressure remain the leading modifiable risk factors at the population level. The audit gap between guideline-indicated and prescribed nephroprotective therapy persists wherever it has been measured.
In response to the compelling evidence on Community Health Worker (CHW) contributions to PHC and UHC, in the past decade, governments across Sub-Saharan Africa (SSA) have intensified efforts to institute/enhance national CHW training programs to equip this workforce with required competencies. However, minimal published evidence is available on the components of national CHW curricula. The study comprised of an initial descriptive analysis of fifteen national CHW curricula, followed by a comparative analysis mapping the content from national CHW curricula with the universal modules and tasks described in the WHO Global Curriculum Guide for CHWs to determine alignment and opportunities for further integration. The descriptive analysis showed variability across all the countries’ curricula, mostly in design, andragogy, and module content, based on health system context and CHW task expectations. Only 47% of the curricula described the training duration, but 60% detailed total learning hours and 67% specified training evaluation methods. Results of the comparative analysis showed that 7-15 of the national curricula aligned with at least 50% of the tasks for the following universal modules in the WHO Global CHW Curriculum Guide: conducting a home visit, providing information and support to impact individual health behaviors, facilitating referrals, assessing community health needs, mobilizing community resources, contributing to program implementation and providing learning opportunities for other CHWs. Few (1-3) national curricula addressed ≥50% of the tasks for modules planning service delivery, supporting/promoting the health needs of individuals and households, supporting/promoting the health needs of communities and assisting with community-based research . As national health systems reconfigure to fully integrate CHWs, to ensure universal coverage of essential PHC services, it is imperative to equip this workforce with key competencies. The WHO Global Curriculum Guide may be considered for future integration in the national curricula, as they can enhance and augment the spectrum of services CHWs can deliver.
