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Background: Delivering primary care services within the context of rapid urbanization and a changing disease burden is a major challenge in sub-Saharan Africa. Rural models of primary care, including the "Community-based Health Planning and Services" (CHPS) programme in Ghana, have shown improved health outcomes. However, adapting these to the urban context has proved problematic. Differences in the determinants of health found in these settings may help to explain the challenges of delivering CHPS in poor urban neighborhoods in Accra. To inform the redesign of CHPS for the urban context, we aimed to understand the determinants driving health and engagement with health services in three informal settlements in Accra., Methods: This study formed a reconnaissance phase for a subsequent participatory action research study. We used qualitative and participatory methods to explore the influence of wider and proximal determinants on health and the use and perceptions of CHPS. Three transect walks with community leaders across the study settings informed interview guides and the recruitment of suitable participants for key informant and focus group interviews. Using a Framework Approach, we analysed transcripts and reports from these activities and developed themes and sub-themes in participants' experiences accessing healthcare., Results: Our findings highlight the importance of wider and proximal determinants of health including physical environment, gender and other social stratifiers including age, ethnicity, religion and disability, on health, health seeking behavior and personal behaviors such as substance misuse, tobacco use and alcohol. Utilization of CHPS was low and seen primarily as a service for maternal and child health. Private providers, ranging from informal drug stores to private clinics, were used most commonly. Community leaders and groups were active, but engagement was limited by opportunity costs for members., Conclusion: Traditional service delivery packages need to be adapted to include non-communicable diseases driven by risk behaviors such as tobacco, unhealthy diet, alcohol and substance abuse. Assets such as volunteerism and nurses embedded within communities are challenging to attain in complex urban settings, yet other assets exist including occupational associations and a range of informal and private providers that could support delivery of preventive and promotive health care with equitable reach., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Amedzro, Anaseba, Darkwa, Twumasi, Ayim, Ansah-Ofei, Dovlo, Awoonor-Williams, Agongo, Agyepong and Elsey.)

Objectives: The study explored the health-seeking experiences of women with obstetric fistula from the onset of the condition until surgical treatment was obtained. It also describes their interactions with health staff and traditional healers., Design: Exploratory, descriptive qualitative study., Setting: Two secondary-level health facilities in the northern and central regions of Ghana; data collection took place in 2018-2019., Participants: A purposive sample of 37 women who had experienced fistula resulting from childbirth and were awaiting fistula repair at the two fistula centres in Ghana was obtained., Data Analysis: Thematic analysis was used to analyse the data., Results: Health-seeking experiences and behaviours of women with obstetric fistula were identified. Six major themes were generated: attribution and perceptions of fistula; competing alternatives/multiple sources of care; limited awareness and access to care; financial barriers; psychosocial challenges, and abuse by healers. The results indicate that the health-seeking experiences of women with obstetric fistula were characterised by long delays in care-seeking. The major themes and subthemes are presented with quotes from participants., Conclusion: The women experienced winding pathways of treatment-seeking due to lack of awareness and incorrect attribution. The major barriers to health-seeking included poverty, challenges with transportation and inadequate repair centres. Increased awareness of obstetric fistula and access to repair centres could shorten the suffering women go through while awaiting fistula treatment. Improved awareness of obstetric fistula and establishment of more fistula centres would be beneficial., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Nurse managers' planning practices are essential to the practice of management in the unit, and the overall efficiency of the healthcare service delivery. This study aims to explore the planning practices of nurse managers in the Greater Accra Region, Ghana., Design/methodology/approach: A descriptive phenomenological design was employed to explore nurse managers' planning practices. In total, 15 nurse managers and 47 nurses from 19 primary and secondary hospitals of the Ghana Health Service and two specialized hospitals in the Greater Accra Region, Ghana, were involved in the study. Data were collected using semi-structured interview guides and probes., Findings: The findings suggested that plans were widely common to all the units of the hospitals and were considered satisfactory by nurse managers. However, most of these plans were not effectively utilized. Nurse managers had only fair knowledge about the planning process and were moderately involved and communicated ideas to colleagues in the process. Furthermore, nurse managers do not frequently share the vision neither do they even communicate expectations to achieve unit goals and objectives with subordinates., Originality/value: The research emphasizes the relevance of planning in healthcare management. It highlights the management practice of planning in the context of nurse managers and accentuates the values the healthcare system derives with effective planning practices., (© Emerald Publishing Limited.)

Aim: The study aim was to examine governance practices of nurse managers at the unit level in the Greater Accra Region of Ghana., Background: Health care managers are encouraging authorities of hospitals to appoint knowledgeable and experienced nurse managers to better coordinate and carry out the delivery of health care services. Nurse managers' governance practices have been identified as essential in ensuring quality health care delivery. This study investigated nurse managers' governance practices at the unit level., Methods: The study employed a quantitative cross-sectional design to gather data from 522 nurses in 19 selected hospitals in the Greater Accra Region of Ghana. Data were analysed using descriptive statistics and linear regression analyses., Results: The study findings showed that nurse managers exhibited a moderate level of governance practices. Qualification, training in management, experience as a nurse and experience as nurse manager together had no significant influence on governance practice (R 2  = .012, p = .180). The only experience as a nurse manager was a significant predictor in the model (B = 0.037, p = .023)., Conclusion: Nurse managers' roles and responsibilities continue to evolve within the complex health care system. It is important to empower nurse managers to enhance their governance practices through a well-structured programme such as coaching and mentorship to improve efficiency and effectiveness at the unit level., Implication for Nursing Management: Governance practices of nurse managers to create a favourable environment is essential to ensure efficiency, quality and unit outcomes. Experience as a nurse manager predicted governance practices, this implies that nurse managers should be assisted to enable them to gain experiences in governance practices., (© 2021 John Wiley & Sons Ltd.)

Introduction: With rapid urbanisation in low-income and middle-income countries, health systems are struggling to meet the needs of their growing populations. Community-based Health Planning and Services (CHPS) in Ghana have been effective in improving maternal and child health in rural areas; however, implementation in urban areas has proven challenging. This study aims to engage key stakeholders in urban communities to understand how the CHPS model can be adapted to reach poor urban communities., Methods and Analysis: A Participatory Action Research (PAR) will be used to develop an urban CHPS model with stakeholders in three selected CHPS zones: (a) Old Fadama (Yam and Onion Market community), (b) Adedenkpo and (c) Adotrom 2, representing three categories of poor urban neighbourhoods in Accra, Ghana. Two phases will be implemented: phase 1 ('reconnaissance phase) will engage and establish PAR research groups in the selected zones, conduct focus groups and individual interviews with urban residents, households vulnerable to ill-health and CHPS staff and key stakeholders. A desk review of preceding efforts to implement CHPS will be conducted to understand what worked (or not), how and why. Findings from phase 1 will be used to inform and co-create an urban CHPS model in phase 2, where PAR groups will be involved in multiple recurrent stages (cycles) of community-based planning, observation, action and reflection to develop and refine the urban CHPS model. Data will be managed using NVivo software and coded using the domains of community engagement as a framework to understand community assets and potential for engagement., Ethics and Dissemination: This study has been approved by the University of York's Health Sciences Research Governance Committee and the Ghana Health Service Ethics Review Committee. The results of this study will guide the scale-up of CHPS across urban areas in Ghana, which will be disseminated through journal publications, community and government stakeholder workshops, policy briefs and social media content. This study is also funded by the Medical Research Council, UK., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Purpose: To explore the staffing practices of nurse managers at the unit., Design/methodology/approach: Introduction: Ensuring that units are staffed with adequate nurses to render quality nursing care to clients has become increasingly challenging for most hospitals. There is growing evidence linking best patient outcomes and fewer adverse events to the presence of nurses at the bedside. Hospitals require to attract and retain nurses in the units to address the issues of quality, staff and patient safety. Methods: The study used a descriptive phenomenological design to purposively select 15 nurse managers (NMs) and 47 nurses for in-depth interviews and focus group discussions respectively., Findings: The study found that the demand for nurses to work in the unit was not scientific. Nurses affirmed their frustration of inadequate numbers of staff in the unit especially, at the periphery hospitals. Time can be used as a source of motivation for nurses and nurses should be involved in the development of the duty roster to enable effective compliance. Compensation for additional duties is relevant in nursing., Research Limitations/implications: The research was carried only in one region in Ghana, and the findings may not be the same in the other regions., Practical Implications: Inadequate staffing level has serious implications on patient safety, quality of care and staff outcomes. This situation necessitates the implementation of health sector staffing norms to ensure the right calibre of mix staff are recruited and retained., Originality/value: This study is the first in Ghana that we aware of that explore staffing practices at the unit that identifies factors that impact staff schedules for effective care., (© Emerald Publishing Limited.)

This article reports the results of a study that explored the planning practices of nurse managers at ward level, their knowledge of planning process and the factors that influence effective planning. Although the practice of planning was almost universal, half the participants had no knowledge of the process, and this knowledge gap was traced to a lack of educational preparation before their appointment. In-service training, support from management and staff, and funding were identified as major factors influencing effective planning at ward level. The authors recommend that prospective nurse managers have educational preparation before they take up these positions and nurse managers already in post have capacity-building training in planning.