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Public financial management (PFM) theory suggests that improvements in the allocation, execution, and monitoring of public funds can result in improved sectoral outcomes, including in health. However, the existing literature on the relationship between PFM quality and health outcomes provides limited empirical documentation and insufficient explanation of the mechanics of that relationship. This paper contributes to the literature by estimating the correlation between PFM quality and health outcomes from a sample of sub-Saharan African countries over the period 2005-2018, using a pooled ordinary least squares (OLS) estimator. The analysis uses Public Expenditure and Financial Accountability (PEFA) scores as proxies for PFM quality. The findings indicate that countries with high-quality PFM tended to have the lowest maternal, under-five and noncommunicable diseases (NCDs) mortality. Among the standard PFM dimensions, the one associated with the higher correlation with maternal and under-five mortality was " predictability and control in budget execution ." Better PFM quality was significantly associated with a drop in maternal and under-five mortality in countries which allocated a higher proportion of their budget to the health sector. In countries allocating a lower proportion of their budget to health, the correlations between PFM quality and the three mortality indicators were not significant. The negative correlations between PFM quality and maternal and under-five mortality were significant only in countries with more effective governance. These findings support an emphasis on strengthening PFM as a means of improving health service provision and health outcomes.

Countries that are reforming their health systems to progress towards Universal Health Coverage (UHC) need to consider total resource requirements over the long term to plan for the implementation and sustainable financing of UHC. However, there is a lack of detailed conceptualization as to how the current health financing mechanisms interplay across health system elements. Thus, we aimed to generate evidence on how to utilize resources from different sources of funds in Africa. We conducted a scoping review of empirical research following the six-stage methodological framework for Scoping Review by Arksey & O'Malley and Levac, Colquhoun & O'Brien. We searched for published and grey literature in Medline, Cochrane Library, PubMed, WHO database, World bank and Google Scholar search engines databases and summarized data using a narrative approach, involving thematic syntheses and descriptive statistics. We included 156 studies out of 1,168 studies among which 13% were conceptual studies while 87% were empirical studies. These selected studies focused on the financing of the 13 health system elements. About 45% focused on service delivery, 13% on human resources, 5% on medical products, and 3% on infrastructure and governance. Studies reporting multiple health system elements were 8%, while health financing assessment frameworks was 23%. The publication years ranged from 1975 to 2021. While public sources were the most dominant form of financing, global documentation of health expenditure does not track funding on all the health system dimensions that informed the conceptual framework of this scoping review. There is a need to advocate for expenditure tracking for health systems, including intangibles. Further analysis would inform the development of a framework for assessing financing sources for health system elements based on efficiency, feasibility, sustainability, equity, and displacement., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Karamagi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The COVID-19 pandemic had multiple adverse impacts on the health workforce that constrained their capacity to contain and combat the disease. To mitigate the impact of the pandemic on the Ghanaian health workforce, the government implemented a strategy to recruit qualified but unemployed health workers to fill staffing gaps and incentivise all public sector health workers. This paper estimated the cost of the new recruitments and incentives given to health workers and presented lessons for health workforce planning in future health emergencies towards health systems resilience. Between March and November 2020, 45 107 health workers were recruited, representing a 35% boost in the public sector health workforce capacity, and an increase in the recurrent public health sector wage bill by about GHS103 229 420 (US$17 798 176) per month, and about GHS1.24 billion (US$213.58 million) per annum. To incentivise the health workforce, the government announced a waiver of personal income taxes for all health workers in the public sector from April to December 2020 and offered a 50% additional allowance to some health workers. We estimate that the Government of Ghana spent about GH¢16.93 million (equivalent to US$2.92 million) monthly as COVID-19 response incentives, which translates into US$35 million by the end of 2020. Ghana invested considerably in health workforce recruitment and incentives to respond to the COVID-19 pandemic, resulting in an almost 37% increase in the public sector wage bill. Strengthening investments in decent employment, protection and safety for the health workforce using the various resources are helpful in addressing future pandemics., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Soil fertility decline is a major constraint to crop production in sub-Saharan Africa. The positive effect of biochar and compost applications on soil fertility has been reported by many authors. In this study, a 30-day laboratory incubation experiment was done using 120 g samples each of a Haplic acrisol amended with corn cob biochar (cbio), rice husk biochar (rbio), coconut husk biochar (coco300 and coco700) or poultry manure compost (compost); and co- composted rice husk biochar (rcocomp) or co-composted corn cob biochar (cococomp) at rates of 1 % w/w amendment: soil, respectively. Other treatments in the study were combined poultry manure compost and corn cob biochar or rice husk biochar (1 % compost + 1% biochar: 1% soil w/w), respectively, to examine their effects on basal soil respiration, soil pH; soil microbial carbon; cation exchange capacity; total organic carbon, total nitrogen and available nitrogen concentration. Biochar and compost applied solely or together, and composted biochar increased soil pH by 0.28-2.29 pH units compared to the un-amended control. Basal respiration from the sole compost or composted rice husk, or corn cob biochar or combined biochar and compost were higher than the un-amended control, which was similar to that from the biochar only treatments. TOC in the sole compost and combined corn cob biochar and compost treatments were up to 37% and 117% higher, respectively, than the control. Combined application of rice husk biochar and compost increased MBC by 132% while sole compost addition increased MBC by 247%, respectively, compared to the control. In conclusion, the study demonstrated that sole or combined application of compost and biochar, or composted biochar improved soil quality parameters such as soil pH and MBC, and promoted soil C stabilization through enhanced TOC and reduced soil C loss through basal respiration., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors.)

The preparation and application of biochar by smallholder farmers is labour intensive hence an effective one-time application for multiple cropping seasons would be desirable by farmers and researchers. In this study, one-time biochar application as a soil amendment and its interaction with compost and NPK on yield performances of different crops was investigated across three cropping seasons. Treatments included biochar applied alone or together with compost, inorganic NPK fertilizer or both. Maize, okra and cassava were planted in succession and data was collected on their shoot N, P and K concentrations, yields as well as selected soil parameters (pH, exchangeable acidity, total exchangeable bases, effective cation exchange capacity, total N, total organic carbon, available phosphorus). Data was analyzed with GenSTAT and results were presented in tables and bar graph. Corn cob biochar applied solely did not significantly improve maize and okra yield in the first and second cropping season but increased yield of cassava significantly at the third cropping season. Yield increased in sole NPK, compost and NPK + compost treatments for all cropping cycles, but yields obtained from these treatments in the presence of biochar were greater than their corresponding treatments without biochar. The study also showed that biochar application together with compost, NPK or both, improved total organic carbon, total nitrogen, available phosphorus, total exchangeable bases, exchangeable acidity, effective cation exchange capacity and pH as well as tissue N, P and K of all crops. Our findings demonstrated that a single application of biochar, particularly in the presence of compost, inorganic NPK fertilizer or both can increase yields across three cropping seasons and improve soil fertility., Competing Interests: The authors declare no conflict of interest., (© 2021 The Authors. Published by Elsevier Ltd.)

The effect of biochar alone or co-applied with triple superphosphate on rhizosphere soil characteristics, nodule formation, phytoconstituents and antioxidant property of cowpea ( Vigna uguiculata ) is yet to be adequately examined in sub Saharan Africa. A field experiment was conducted where cowpea ( Vigna unguiculata ) was grown in a tropical sandy loam soil amended with biochar at 1.5 t ha -1 and 2.5 t ha -1 solely or together with inorganic phosphate fertilizer (Triple superphosphate), applied at a rate of 60 kg P ha -1 . At 50% flowering, changes in selected rhizosphere soil properties (pH, total nitrogen, available phosphorus, soil organic carbon, cation exchange capacity), nodule count, phytochemicals (phenols, flavonoids, alkaloids, tannins, saponins) and antioxidant property of cowpea roots and leaves were determined by standard laboratory procedures. Differences between means of the measured parameters were established using ANOVA, and relationships among the parameters were explored using Pearson correlation (p < 0.05). Addition of biochar solely or in combination with TSP significantly (p < 0.05) increased soil pH, total nitrogen, available phosphorus, soil organic carbon, cation exchange capacity and root nodule count. Flavonoids, phenols, alkaloids, saponin, tannin contents and antioxidant activity in the roots and leaves were significantly (p < 0.05) higher in the amended soils compared with the unamended soil. Similarly, soil flavonoids, phenols, alkaloids and antioxidant activity were significantly higher in amended soils compared with control. Significant, positive inter and intra correlation with varying strength was found between soil properties, nodule number and phytoconstituents. This is an indication that biochar can be co-applied with triple superphosphate to sustain soil fertility, improve nodulation and enhance concentrations of phytoconstituents in soil, cowpea roots and leaves., (© 2020 The Author(s).)

Our food security depends on finding a sustainable alternative to rock phosphate for fertilizer production. Furthermore, over 2 billion people worldwide are currently affected by micronutrient deficiencies, and crop concentrations of essential minerals are declining. This paper examines whether a novel multi-element fertilizer, Thallo®, can produce crop yields comparable to conventional rock phosphate derived fertilizers, and have an additional benefit of increasing essential mineral concentrations. Thallo®, produced from abattoir and recycled industrial by-products, was tested against conventional mineral fertilizers in a pot trial with wheat and grass. In soil, yields were comparable between the fertilizer types, but, in a low-nutrient substrate, Thallo® showed a yield benefit. Elemental concentrations in the plant material typically reflected the relative concentrations in the fertilizer, and Thallo® fertilized plants contained significantly more of some essential elements, such as selenium and zinc. Furthermore, concentrations of the toxic element cadmium were significantly lower in Thallo® fertilized crops. Among the fertilizers, manganese concentrations were greatest in the Thallo®, but within the fertilized plants, they were greatest under the mineral fertilizer, showing the complexity of assessing whether nutrients will be taken up by crops. In summary, fertilizers from livestock waste have the potential to improve wheat and grass concentrations of essential elements while maintaining yields., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Elemental Digest Systems, who manufacture Thallo® fertilizer, funded the experimental work and the time of Robert Dunn. This does not alter our adherence to PLOS ONE policies on sharing data and materials.