Editorial: Global Excellence in Health Policy and Management: Africa

Godfrey Martin Mubyazi^1*Suzanne Kiwanuka²

• ¹National Institute of Medical Research (Tanzania), Dar es Salaam, Tanzania
• ²School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

This Journal's research topic, titled, 'Global Excellency In Health Policy and Management: Africa' attracted a number of manuscripts from the authors seeking to publish their work. In general, each team of authors underscored the urgency of strengthening national health policies and management systems based on reliable systematic evidence. The authors also emphasized that policies and practices need to be reviewed periodically in order to cope with contemporary needs and to enhance their acceptability, feasibility, sustainability and attainment of desired outcomes.The articles presented have addressed health policy and management issues in both broad and specific terms. Reflecting on the findings from a study undertaken in several districts in rural Tanzania, Isangula et al., highlight the need for policies aimed at improving maternal and child health (MCH) to be clear and viable, in order to facilitate their interpretation and uniform translation into action. They opine that reliable research evidence is crucial to inform such policies, although clear policy statements are not enough unless there are corresponding guidelines for their implementation. The authors also underscore the value of good relationships between nurses and their clients which contribute to the realization of more positive service delivery outcomes.The same authors recommend the use of field-tested interventions to generate the evidence to inform the respective policies.Zenebe et al., present a protocol for field-testing the feasibility and effectiveness of datainformed platforms for health, reasoning that this could contribute to guiding policy and management decisions, ultimately improving maternal health services (MHS) delivery processes and outcomes. The authors plan to test this proposition across several districts in Ethiopia. In their view, such an approach has the potential to minimize the chronic health data/information distortions or wastage and therefore lead to increased MHS delivery improvements, service uptake, and MHS outcomes' chances.Okondo et al., present findings from a study conducted across five hospitals in Kenya to assess HCWs compliance with the standard person-centered care in practice. They report that shortages of key structural and process elements of the QoHC were a hindrance to HCWs' ability to comply with the recommended standards. These included; hurdles caregivers faced when seeking the care for their children; confusing user-fee payments modalities; the lack of feedback to caregivers about the diagnostics performed, treatment given, and the progress of the child. The authors believe that policy and program authorities should further prioritize the strategies for mitigating these structural and process QoHC delivery elements if they seek to improve MCH services. Likewise, Yevoo et al., highlight the consequences of structural and process QoHC dimensions for all types of the services. The findings from this study done at referral facilities among Health care workers (HCWs) in Accra, Ghana, documents reports from clients condemning the unethical practice of HCWs who habitually turn away patients who are brought to facilities with the expectation of being admitted for emergency care. In their remarks, the authors appeal for the responsible policy and program authorities to accord the emergency care issue a priority it deserves and to reverse the perceived negative attitude HCWs show towards the clients approaching them.The study from Kenya and Tanzania by Mkumbo et al., highlights the implications of the absence of a universal definition of the term 'critical illness'. They argue that this leads to variations in frontline HCWs' interpretation of the term, consequently hampering communication and the selection of patients who deserve urgent life-saving care. They justify the need for the respective HCWs to be oriented to the right definition of "critical illness" as recently highlighted by other scholars. In a similar manner, Keleb et al. report findings from a study done in public hospitals in one of the zones in Ethiopia assessing the degree to which HCWs comply with the available standard precautions for infection prevention (IP) practice. With only about a fifth of the respondents complying, the authors suggest that more efforts need to be made to overcome the challenges faced by HCWs, which discourage them from following the recommended IP measures properly. Among the challenges noted were; pervasive unreliable water supplies at the workplace and inadequate working experience. Chekol et al., underscore the need for properly designed and optimally functioning 'routine health information Systems (RHIS). They state that this facilitates knowledge acquisition or transferability as long as other supporting health communication channels or mechanisms are available. According to these authors, the low quality of a given RHIS-based data at the national level, compounded by the chronic complexities in the formal RHIS such as the scarcity of key staff, result in improper routine data management and thereby compromise the utilization of data for decision making. The authors also urge the RHIS to improve feedback mechanisms in order to enhance routine data production and utilization for the betterment of the QoHC as desired.The article by Chaker et al., reports findings obtained from a study done in Tunisia, focusing on the role a 'multi-criteria decision analysis' (MCDA) approach. They argue that MCDA can help policy decisionmakers and policy actors to identify individuals unquestionably deserving a 'mostat-risk' categorization so that they can be prioritized to receive vaccines and associated services during epidemics like COVID 19. However, these authors warn that, a special prioritization in relation to a vaccine or a vaccination shortage should not overlook the need to adhere to the guidelines for proper service delivery. Ultimately data driven MCDA can contribute significantly towards achievement of vaccination goals with more public benefits.