Assessing the governance environment for private sector engagement in health in Africa: Results from a multi-country survey.

Background: The role of the private sector in health is clear in many countries but engagement can be improved. The World Health Organization (WHO) developed a global strategy in 2020 focused on engaging the private sector in health service delivery through governance in mixed health systems and detailed six governance behaviours to guide its Member States. To operationalise these global ideas into practice, the Regional Office for Africa conducted a multi-country study to understand perceptions around the six governance behaviours. This article examines the perceptions of respondents from 13 African countries on the governance environment for private sector engagement in health. Methods: Data were collected through an online survey that was distributed to individuals from ministries of health and their partner organisations, private sector institutions and initiatives in countries and development organisations (n = 81) across 13 countries. The survey was based on the following six governance behaviours: build understanding, enable stakeholders, nurture trust, foster relations, align structures and deliver strategy. Results: Results showed that respondents had mixed perceptions of the governance environment for private sector engagement in health in their respective countries. Although 88% of respondents (n = 63/72) were familiar with the general inclusion of the private sector in national health sector plans, 63% of respondents (n = 45/71) noted there was limited or no integration of the private sector in the health system, and further, 28% of respondents noted there was no private sector reporting in health information systems (n = 19/69). Key opportunities presented in more than one governance behaviour include: (i) increasing private sector engagement in public sector activities, (ii) establishing clear roles and responsibilities through formal partnership agreements, (iii) improving data sharing through shared health information systems, (iv) incentives and subsidies, (v) capacity building, (vi) creating norms, guidelines, and regulations and (vii) conducting joint monitoring and evaluation. Many of these outlined overlapping concepts are not exclusive to one behaviour, thus, it is evident that when targeted, there is the potential to improve numerous governance behaviours. This further reiterates the view that the governance behaviours should be understood as connected and not unrelated areas. Conclusions: The study provides insight into the perceptions of respondents from select African countries on the governance environment for private sector engagement in health. These findings can inform the development of strategies and interventions to support and enhance private sector engagement in health in the region.

Vaccination against Hepatitis B among health care workers in the Bamenda Health District: influence of knowledge and attitudes, Cameroon.

INTRODUCTION: Hepatitis B virus (HBV) infection is one of the most serious occupational hazards faced by healthcare workers (HCW). This study aimed at assessing the influence of knowledge and attitudes of HCWs in the Bamenda Health District (BHD) on their vaccination status. METHODS: this was a cross-sectional analytic study carried out in Bamenda health district, Cameroon. Random sampling method was used to select 10 private, 10 public, and 4 confessional health facilities, from which 280 HCW were included in the study by convenience sampling. Data were analysed using Epi Info 7 and presented using tables, figures, and percentages. RESULTS: the vaccination coverage among HCW in the BHD was found to be 13.9%. Healthcare workers who had no knowledge of the minimum number of doses for complete primary HBV vaccination were less likely to be vaccinated than those who had knowledge (p = 0.00). Healthcare workers who had been tested for HBsAg were more likely to be vaccinated than those who had not done the test (p = 0.00). Among HCW (90.7%) who knew they were more at risk of contracting HBV, 98.6% knew it can be prevented out of which 72.6% reported that vaccination is the most effective means of prevention; only 13.9% of HCW were vaccinated. Other factors could have influenced the vaccination status of HCW; high cost of the vaccine, lack of time for vaccination, negligence, and the non-availability of the vaccine. CONCLUSION: awareness should be created among HCW and they should be encouraged to go for HBsAg screening and those who are negative should receive a full dose of HBV vaccine. Also, the vaccine should be subsidized and made available to all HCW in the BHD.