BACKGROUND:In Ghana, medical laboratories are a vital component of the health system, but there has been limited evidence on how well they meet international quality standards. This study assessed compliance with laboratory standards by medical laboratories in the Kumasi Metropolis of Ghana. METHODS:A descriptive cross-sectional survey was conducted among forty-three (43) laboratory facilities, including those operating within healthcare facilities and private standalone laboratories, in the Kumasi metropolis from 8th March to 26th November, 2021. The healthcare facilities assessed include seven (7) government, four (4) Christian Health Association of Ghana (GHAG), twenty-one (21) private hospitals, and eleven (11) standalone laboratories. The World Health Organisation Stepwise Laboratory Quality Improvement Process Towards Accreditation (WHO SLIPTA) checklist was used to assess compliance with laboratory standards. The checklist comprises 12 main sections, containing 117 questions, resulting in a total of 275 scores. Each item is awarded a point value of 2, 3, or 5 points based on relative importance and complexity. Scores and percentages of compliance are categorized as follows: 0-150 (<55%), 151-177 (55-64%), 178-205 (65-74%), 206-232 (75-84%), 233-260 (85-94%), and 261-275 (≥95%). These categories ultimately translate to a rating of 0-5 stars. Descriptive analysis and the Kruskal-Wallis test were conducted to examine the differences in overall compliance scores across the types of health facilities. RESULTS:The overall median compliance score was 61(interquartile range 53-66), the minimum score was 49, and the maximum score was 104. CHAG facilities had significantly higher scores than private facilities (Z = 2.53, p = 0.03) and standalone facilities (Z = 3.60, p < 0.001). Similarly, scores for government facilities were significantly higher than standalone facilities (Z = 3.30, p < 0.001). CONCLUSION:All facilities had a zero (0) star rating and failed to meet the minimum compliance level of 55%.

Despite universal health coverage policies, diabetes management in resource-constrained settings remains challenging due to complex interactions between patient behaviours and systemic barriers. This study combines health behaviour theories with healthcare system constraints in an agent-based model to evaluate the influence of policy scenarios on type 2 diabetes patients’ self-management behaviours, blood glucose control, medication adherence, and hospital admissions within Ghana’s public health system. Using pattern-oriented modelling with multiple validation levels, the model integrates empirical evidence from clinical data, service provider expertise, and behavioural research to simulate how patients’ daily decisions about taking medicines, following lifestyle recommendations, and seeking healthcare interact with system-level factors like medicine availability and insurance coverage. We evaluate three public health scenarios: expanding insurance coverage, increasing medicine availability, and implementing a sugar-sweetened beverage tax. Our analysis indicates that a sustained 10

Recent research has examined factors contributing to the successful transition of middle-income countries away from international health aid. Three factors are especially important: effective leadership, using domestic resources to close the financing gap created by loss of aid, and realigning country systems to new sources of domestic funding.

Background: Nearly a quarter of a century after African Union member states adopted the Abuja Declaration (AD), most of these countries continue to miss their targets. A crucial forward-looking question remains whether countries can meet the target under the current situation. This paper examines the likelihood that AU member states will meet the AD target under existing fiscal patterns and within what timeframe. Methods: We used panel data on 51 AU member states from 2002 to 2023, sourced from the WHO and the World Bank’s data repositories. We used discrete-time survival analysis to model first-time compliance and estimated the unconditional probability of meeting the target by 2063, in line with the AU agenda. To address concerns about sustained compliance, we complement this analysis with trend-based projections to determine the number of years required to reach the target under a status quo scenario. Findings: We observed rare first-time compliance during the study period, with five countries meeting the target and 2 countries meeting the 15% health budget share target in 2023. The probability of meeting the target by 2063 was less than 1% for more than 90% of the countries in the sample. This is consistent with trend-based projections showing that more than three-quarters of AU member states were off track to meet the AD target if current fiscal patterns persist, based on historical performance and current fiscal conditions. In addition, where domestic resource is mobilized for health, governments appear to have a higher willingness to pay for system-oriented investments (like Primary Health Care) than for vertical programmes such as immunization. Interpretation: The findings highlight persistent health financing challenges across AU member states, with AD compliance unlikely for most countries. Without deliberate efforts to improve and sustain domestic financing, the future of health financing could remain bleak. With the worsening landscape of health aid, the need for deliberate and sustained commitment to reprioritize domestic resources for health has become inevitable, requiring a recalibration of the AD and other continental health financing effort.

This paper draws upon a process evaluation of a public-private partnership (PPP) for diagnostics in three Sub-Saharan African countries, Ethiopia, Ghana and Kenya. The study sought to identify challenges in managing health PPP projects and potential solutions. We used an extensive document review and 72 recent key informant interviews (KIIs), building on 63 KIIs previously conducted to analyze the African Health Diagnostics Platform (AHDP) project in-depth. Our analysis employed a framework developed by Magalhaes et al based on the broader (non-health) PPP literature that identifies key challenges, strategies and success factors in PPP management across three main stages of PPP implementation. We find considerable alignment between the management challenges identified in the broader PPP literature and AHDP. Certainly, intensive negotiations and high transaction costs; difficulties managing risks and financing; the need for highly complex planning; and challenging stakeholder management all played a role in slowing progress on AHDP. An additional, critical theme concerns lack of capacity for managing health PPPs. The AHDP project generated a number of innovations to facilitate management but overall, if health PPPs are to succeed, more needs to be done to support their implementation. In particular, we propose investment in training government and technical assistance providers in health PPPs; development of repositories of guidance documents to support health PPPs; employment of systems-thinking based planning approaches that illuminate connections across the health system; more sophisticated approaches to stakeholder management; and investment in research that supports modeling of different PPP arrangements and how their progression is influenced by local contextual factors. While evidence on the impact of health PPPs remains scarce, moves toward increased healthcare corporatization in the context of dwindling aid underscores the urgency of building experience and evidence on PPPs in healthcare and other social sectors.

Community-based Health Planning and Services (CHPS) was initially designed to address the healthcare needs of Ghana’s rural communities. However, with urban population growth and the subsequent healthcare demands of the urban poor, the CHPS policy was extended to urban areas. There is a significant gap in our understanding of the wealth-related disparities, correlates, and utilization levels of healthcare services under the urban CHPS. This study is a pioneering effort to fill this gap, aiming to quantify the utilization level, identify correlates, and measure wealth-related inequality in healthcare services provided by the CHPS in poor urban settings. The survey was conducted in four poor urban communities in the Greater Accra Region of Ghana using a quantitative analytic cross-sectional survey design with multistage cluster sampling, ensuring a representative sample of 3543 respondents (97.9

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.

BackgroundTo lessen the burden of cervical cancer, Nigeria introduced the HPV vaccine to its national immunization program, but the program has faced operational and contextual problems during its early rollout. This study explored the systemic and community-level barriers affecting HPV vaccine delivery across selected Nigerian states.MethodThis exploratory qualitative study employed key informant interviews with policymakers, immunization officers, government agencies, community-based organizations, and implementing partners across three states: Kaduna, Kano, and Lagos, from April 2025 to October 2025. Data were thematically analyzed using NVivo, with emphasis on identifying factors influencing the sustainability of HPV vaccination. The analysis focused on key domains such as policy implementation, financing, service delivery, supply chain systems, human resources, data management, and demand generation.ResultThe study found that HPV vaccine implementation is hindered by limited state-level policy adaptation, reliance on donor funding, human resource shortages, supply chain weaknesses, data management gaps, and strong socio-cultural resistance driven by misinformation. These interconnected barriers reduce vaccine acceptance and disrupt service delivery.ConclusionThe HPV vaccination program in Nigeria is constrained by systemic weaknesses and socio-cultural resistance. Addressing these challenges requires stronger state-level policy adaptation, sustainable financing, improved supply chain and data systems, and targeted community engagement to enhance acceptance and ensure effective service delivery.

Background Although Africa experiences the highest burden of infectious diseases, the continent currently produces less than 1% of its vaccine needs. In 2021, the African Union set a target to locally produce at least 60% of the continent’s vaccine needs by 2040. However, at the time of developing this scoping review protocol, there is no consolidated, evidence-based framework for assessing national or regional “readiness” to establish or scale vaccine production. Objective This protocol aims to describe a methodological approach that will be used to review existing literature to identify, map, and synthesize the existing evidence on all relevant frameworks, indicator sets, and policy documents (global or national) developed pre- and post–COVID-19 pandemic (January 1, 2010, to December 31, 2025) that addresses readiness for local human vaccine manufacturing with focus on African countries. Methods This scoping review will be conducted and reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, following the 9-step framework outlined in the Arksey and O’Malley methodology and further informed by guidance from the Joanna Briggs Institute. We will search MEDLINE (PubMed), Scopus, Web of Science, Africa-focused databases (eg, Africa-Wide Information, African Index Medicus, and African Journals Online), and gray literature. Eligibility criteria will follow Population, Concept, and Context guidelines (Population: 55 African Union member states; Concept: readiness frameworks, indices, indicators, and policies for human vaccine manufacturing; Context: African national or regional initiatives or global frameworks applied to Africa). Materials in English, French, Portuguese, or Arabic will be included. Publication types will be limited to frameworks, policies, guidance, and reports. Two reviewers will perform calibrated dual screening (Cohen κ) and standardized data charting. We will create an evidence map and inductive thematic synthesis using a vaccine-specific Political, Economic, Social, Technological, Legal, Environmental, plus Market taxonomy. Consistent with the guidance by the Joanna Briggs Institute, critical appraisal will not be performed. An optional expert consultation will help identify missed sources and validate domains. Results Ethics approval for the expert consultation component was obtained from the University of Geneva Research Ethics Committee (application submitted May 21, 2025; approval September 9, 2025). The initial search strategy has been finalized, and pilot searches were completed (May-August 2025). The screening calibration is planned; dual-review title and abstract screening begins in December 2025, with full-text screening and data charting scheduled for January-March 2026. Thematic synthesis and expert consultation are planned from April to May 2026. We anticipate submitting the completed scoping review paper by June or July 2026. Conclusions This review will generate Africa’s first continent-focused evidence map of vaccine-manufacturing readiness, compiling indicators by domain, comparing frameworks, identifying gaps, and informing a multidomain Country Readiness Assessment Index for policy and investment decisions. Trial Registration Open Science Framework 10.17605/OSF.IO/UVSWX; https://osf.io/uvswx International Registered Report Identifier (IRRID) DERR1-10.2196/81231

BackgroundChildhood cancer is not a high priority in health care financing for many countries, including in Ghana. Delayed care seeking and treatment abandonment, often due to the financial burden of care seeking to families, are common reasons for a relatively low overall survival (OS) in low-and middle-income countries. In this study, we analyzed the cost-effectiveness of extending health insurance coverage to children with Burkitt lymphoma (BL) in Ghana.MethodsWe developed a Markov model in Microsoft Excel to estimate the costs and effects of BL treatment when National Health Insurance Scheme (NHIS) was provided compared to the status quo where NHIS does not cover care for childhood cancer. The analysis was undertaken from the societal and health system (payer) perspective. Both costs (measured in $) and effects, measured using disability adjusted life years (DALYs), were discounted at a rate of 3%. The time horizon was a lifetime. Probabilistic sensitivity analysis was done to assess uncertainty in the measurement of the incremental cost-effectiveness ratio (ICER). A budget impact analysis was undertaken from the perspective of the NHIS.ResultsIn the base-case analysis, the intervention (NHIS reimbursed treatment) was less costly than current practice ($8,302 vs $9,558). The intervention was also more effective with less DALYs per patient than the standard of care (17.6 vs 23.33). The ICER was -$219 per DALY averted from societal perspective and $113 per DALY averted from health system perspective. The probabilistic sensitivity analysis showed that the intervention is likely to be both less costly and more effective than current practice in 100% of the 1,000 simulations undertaken.ConclusionProviding health insurance coverage to children with BL is potentially cost-effective. The effectiveness and cost-savings relating to this strategy is driven by its positive impact on treatment initiation and retention. Based on this evidence, there has been a policy change where Ghana's NHIS has prioritized financing for cancer treatment in children.

Low-income and middle-income countries (LMICs) are facing an urgent and complex challenge: how to transition to greater self-sustainability in health financing amid declining donor support. While this shift is inevitable, the policy responses it elicits carry significant implications for health system equity and access. This commentary highlights four policy choices increasingly observed in LMICs that we argue are unacceptable in the pursuit of sustainability. These include: (1) shifting the financial burden to out-of-pocket payments; (2) over-reliance on contributory health insurance schemes; (3) displacement of basic primary healthcare services; and (4) abandoning community-based service delivery in favour of facility-centric models, undermining the integrity of people-centred health systems. We argue that while short-term fiscal pressures may push countries towards these decisions, they ultimately erode health gains, exacerbate inequities and threaten progress towards universal health coverage. We call on policymakers to adopt evidence-informed approaches that enhance efficiency, protect the most vulnerable, prioritise public financing and preserve the core values of inclusive and equitable health systems during this critical transition.

Childhood cancers present a significant health problem and contribute to global child mortality. Low- and middle-income countries experience higher rates of childhood cancers with survival rates between 10% and 50%. In Ghana, about 2,500 children are diagnosed with cancer annually. Despite availability of effective management strategies, childhood cancers are not fully integrated into the NHIS, leaving patients and caregivers to make out-of-pocket payments leading to delayed diagnosis and treatment abandonment. Although stakeholders have made efforts to address the issue, the various stakeholders in childhood cancer management and their roles are still unclear. The study sought to identify and analyze stakeholders involved and challenges in childhood cancer management and financing in Ghana. A stakeholder analysis was conducted which included a rapid review of policy documents and a stakeholder engagement workshop. 21 stakeholders were purposively selected and focus group discussions were held with an interview guide at a one-day stakeholder engagement meeting. Stakeholders were categorized using Mendelow's power-interest grid, and their roles, interests, and influence on childhood cancer policies were assessed. Key stakeholders identified included the Ministry of Health, NHIA, healthcare providers, NGOs, WHO, and patient advocacy groups. The Ministry of Health, NHIA, and healthcare providers were primary drivers with high interest and influence. The burden of Burkitt's Lymphoma constituted 30-35% of all childhood cancer cases. Ghana has adapted treatment protocols with some inclusion on the NHIS. However, NHIS tariffs remain low. Challenges in managing Burkitt's Lymphoma included inadequate reimbursement rates, high treatment costs, treatment abandonment, limited access to paediatric oncology specialists and indirect costs such as transportation and accommodation. Achieving universal health coverage through management and financing of childhood cancers in Ghana requires comprehensive policies, equitable financial coverage under the NHIS, enhanced stakeholder collaboration and increased investments in building capacity of paediatric oncologists in Ghana.

In resource-limited settings, compliance with laboratory standards remains a significant challenge, resulting in delays and inaccurate results that can compromise emergency responses, clinical decision-making, and patient outcomes. In Ghana, medical laboratories are a vital component of the health system, but there has been limited evidence on how well they meet international quality standards. This study assessed compliance with laboratory standards by medical laboratories in the Kumasi Metropolis of Ghana. A descriptive cross-sectional survey of forty-three (43) laboratory facilities operating within healthcare facilities and private standalone laboratory facilities in the Kumasi metropolis was conducted from January to December 2021. The WHO SLIPTA checklist, which specifies the requirements for the quality and competency of laboratories, was used to assess compliance with laboratory standards. Descriptive analysis and the Kruskal-Wallis test were conducted to examine the differences in overall compliance scores across the types of health facilities. The median compliance score was 61(interquartile range 53-66), the minimum score was 49, and the maximum score was 104. Tertiary-level facility laboratories performed better (93) compared with secondary (66) and primary (64.8) level facilities. Similarly, faith-based facilities (CHAG) performed better (80.8) than private hospitals (60.1) and private standalone laboratories (54.3). There were significant differences in the overall median compliance score (p=0.00) among the four (4) categories of health facilities. The degree of compliance with quality laboratory standards was low across all facility types. Medical laboratories not meeting basic quality standards could significantly impact the accuracy, reliability, and timeliness of test results.

BACKGROUND:The methods of economic evaluation and HTA should be based on best practices and standards, tailored to unique country contexts that can be systematically applied to inform decisions. This paper outlines standards for the conduct of economic evaluations for HTA in Ghana. METHODS:A five-step process was followed to develop the HTA reference case as a methodological and reporting benchmark. These include (a) a review of literature and evidence synthesis, (b) a review of country policies, (c) a review and adaption of international frameworks, (d) expert/stakeholder consultations, and (e) the development of a methodological framework. A series of stakeholder consultations were done to refine, finalize, and validate the outcomes of the processes to generate a finalized reference case. RESULTS:The Ghana reference case is made up of 14 components comprising: evidence synthesis, evaluation type, perspectives on cost, perspectives of outcomes, choice of comparator, data sources, outcome measures, discount rate, uncertainty, equity considerations, time horizon, heterogeneity, transparency, and budget impact. These provide methodological considerations and reporting requirements for economic evaluations for HTA. It provides a framework to ensure the best research methods are adopted to harmonize the evidence-generation process with the expectations of policy and decision-makers and ensure that policy decisions are based on uniform evidence. CONCLUSION:Recommendations set out in this reference case when followed can provide context-specific evidence to support a rigorous and transparent system for evaluating healthcare interventions and technologies. It will support decision-making, ultimately improving the quality and efficiency of healthcare delivery in the country.

Background Many cultures across the world have varying conceptions about death and dying. Perceptions about health states considered worse than death also vary based on socio-cultural norms as well as health system capacity. We explore health states considered to be worse than death by Ghanaian respondents as well as reasons for opting for death in those health states.Methods We interviewed 28 participants from three regions in Ghana to explore this concept. The data were analysed inductively and thematically.Results We identified two main health states domains, physical impairments and mental impairments, that were considered as worse than death. The main reasons for preferring death to these particular health states were being a burden and loss of status. Decisions regarding health states worse than death holds considerable importance, particularly in a context where culture and societal norms play a role in shaping how health related quality of life is assessed.Conclusion Findings from the study may provide evidence on healthcare resource allocation and aid policymakers and clinicians in making informed decisions on which treatments to prioritize, and how to maximize the overall health and well-being of individuals.

Patient choice of health facilities is increasingly gaining recognition for potentially enhancing the attainment of health system goals globally. In Kenya, National Health Insurance Fund (NHIF) members are required to choose an NHIF-contracted outpatient facility before accessing care. Understanding their preferences could support resource allocation decisions, enhance the provision of patient-centered care, and deepen NHIF's purchasing decisions. We employed a discrete choice experiment to examine NHIF members' preferences for attributes of NHIF-contracted outpatient facilities in Kenya. We developed a d-efficient experimental design with six attributes, namely availability of drugs, distance from household to facility, waiting time at the facility until consultation, cleanliness of the facility, attitude of health worker, and cadre of health workers seen during consultation. Data were then collected from 402 NHIF members in six out of 47 counties. Choice data were analysed using panel mixed multinomial logit and latent class models. NHIF members preferred NHIF-contracted outpatient facilities that always had drugs [β=1.572], were closer to their households [β=-0.082], had shorter waiting times [β=-0.195], had respectful staff [β=1.249] and had either clinical officers [β=0.478] or medical doctors [β=1.525] for consultation. NHIF members indicated a willingness to accept travel 17.8km if drugs were always available, 17.7km to see a medical doctor for consultation, and 14.6km to see respectful health workers. Furthermore, NHIF members indicated a willingness to wait at a facility for 8.9 hours to ensure the availability of drugs, 8.8 hours to see a doctor for consultation, and 7.2 hours to see respectful health workers. Understanding NHIF member preferences and trade-offs can inform resource allocation at counties, service provision across providers, and purchasing decisions of purchasers such as the recently formed social health insurance authority in Kenya as a move towards UHC.

BackgroundSeasonal malaria chemoprevention (SMC) is a widely implemented malaria prevention strategy for children under five in the Sahel and sub-Sahel regions of Africa. This study aimed to estimate the full opportunity costs associated with SMC implementation in Mali, Burkina Faso and Senegal, addressing a gap in existing research that often focused solely on health system costs.Using a repeated descriptive cross-sectional design, data were collected from April to November 2022 during two SMC cycles. The study involved 376 caregivers in Mali, 398 in Senegal and 373 in Burkina Faso, alongside 127 community health volunteers in Mali, 41 in Senegal and 97 in Burkina Faso. Health worker supervisors recruited were 96 in Mali, 96 in Senegal and 42 in Burkina Faso. Data collection occurred across 15 health facilities in Burkina Faso and Senegal and 16 health facilities in Mali across four districts within each country.Both financial and economic costs were analysed using an ingredients approach, encompassing direct and indirect costs. Financial costs per SMC dose were estimated at US$0.99 in Mali, US$1.42 in Burkina Faso and US$1.51 in Senegal. Economic costs per dose were US$3.02 in Senegal, US$3.14 in Burkina Faso and US$2.96 in Mali. Total annual costs per child receiving four doses ranged from US$3.97 to US$6.05 for financial costs and US$11.85 to US$12.57 for economic costs. Notably, indirect costs, mainly related to productivity losses among caregivers, volunteers and healthcare workers, constituted 50%-66% of total economic costs.The findings highlight the economic cost of SMC implementation, driven largely by productivity losses of caregivers and volunteers which have often been overlooked in policy decisions. This study highlights the need for comprehensive cost assessments in malaria control programmes to inform effective decision-making.

Acceptability of malaria chemoprevention interventions by caregivers is crucial for overall programme success. This study assessed coverage and acceptability of Seasonal Malaria Chemoprevention (SMC) in selected communities in the Northern part of Ghana. An analytical cross-sectional design was conducted from “July 23rd to August 4th, 2020—a 12-day period that covered 5 days of the first SMC implementation cycle and 7 days post-implementation. Using a stratified multi-stage sampling technique, a total of 495 caregivers providing care for 569 eligible children aged 3–59 months from randomly selected households in the study communities were enrolled into the study. Acceptability of SMC was assessed on a set of 19 questionnaire items-8 of the items measured caregivers’ perceptions and 11 items measured children’s reaction to administered medicines. Univariable and stepwise multivariable logistic regression analyses were performed to assess the predictors of acceptability of SMC at a 95