The penetration of mobile phones and mobile technologies in developing countries has led to innovative developments of various m-Health applications. These applications have proven the potential of mobile technologies for improving the quality of health care service in general and the fight against HIV/AIDS in particular. However, to achieve greater impact on the ground level (e.g. in an antiretroviral (ARV) treatment clinic) in a developing country's context, these applications have to be adopted and their utilization sustained. A study was undertaken to investigate sustainability and scalability challenges of mobile phone-based applications/projects for HIV/AIDS care in developing countries and the adoption and sustainability prospects of such m-Health applications in an ARV clinic in Pretoria. The findings presented here, are that from a care givers' and patients' perspective, adoption and sustainability of these applications is not merely dependent on the proposed technology's capabilities to enhance service delivery. Adoption and sustainability is however, mostly dependant on: (1) the care givers and patients' willingness and capability to incur any technological adoption and continuous use costs and, (2) their pre-conceived notions of government or sponsor-supported service provision.These technologies have the potential to improve access to health care services [43] particularly in developing countries where mobile phones are more prevalent than ICTs such as landlines, telephones and the internet [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. In these regions the healthcare system constantly faces challenges such as infrastructural deficit, resources shortages, tropical diseases and the burden of widespread diseases such as the HIV/AIDS epidemic [43]. The magnitude of the HIV/AIDS pandemic in developing countries combined with the contextual healthcare provision factors in many ARV clinics has raised the need to develop innovative ways to tackle the complexity that involves the provision of adequate health care in such circumstances.The exploration of the potential of mobile phones in the fight against HIV/AIDS has led to the establishment of mobile phone-based projects for HIV/AIDS care and the development of mobile phone-based applications for health care in developing countries such as South Africa, India, Rwanda, Peru, Uganda, etc [39]. These applications fall in the following utilisation areas: Education and Awareness, Remote Data Collection, Remote Monitoring, Communication and Training for healthcare workers, Disease and Epidemic Outbreak Tracking, and Diagnostic and treatment support [39]. White [42] and Fynn et al [11] note that these applications take advantage of the mobility and flexibility that mobile phones provide, in combination with other ICT technologies such as the internet and database technologies, the potential to overcome many of the barriers of distance and cost facing developing countries.Although these applications have proven the potential ...

Leadership capacity needs development and nurturing at all levels for strong health systems governance and improved outcomes. The Doctor of Public Health (DrPH) is a professional, interdisciplinary terminal degree focused on strategic leadership capacity building. The concept is not new and there are several programmes globally–but none within Africa, despite its urgent need for strong strategic leadership in health. To address this gap, a consortium of institutions in Sub-Saharan Africa, UK and North America have embarked on a collaboration to develop and implement a pan-African DrPH with support from the Rockefeller Foundation. This paper presents findings of research to verify relevance, identify competencies and support programme design and customization. A mixed methods cross sectional multi-country study was conducted in Ghana, South Africa and Uganda. Data collection involved a non-exhaustive desk review, 34 key informant (KI) interviews with past and present health sector leaders and a questionnaire with closed and open ended items administered to 271 potential DrPH trainees. Most study participants saw the concept of a pan-African DrPH as relevant and timely. Strategic leadership competencies identified by KI included providing vision and inspiration for the organization, core personal values and character qualities such as integrity and trustworthiness, skills in adapting to situations and context and creating and maintaining effective change and systems. There was consensus that programme design should emphasize learning by doing and application of theory to professional practice. Short residential periods for peer-to-peer and peer-to-facilitator engagement and learning, interspaced with facilitated workplace based learning, including coaching and mentoring, was the preferred model for programme implementation. The introduction of a pan-African DrPH with a focus on strategic leadership is relevant and timely. Core competencies, optimal design and customization for the sub-Saharan African context has broad consensus in the study setting.

BackgroundBuilding capacity in health policy and systems research (HPSR), especially in low- and middle-income countries, remains a challenge. Various approaches have been suggested and implemented by scholars and institutions using various forms of capacity building to address challenges regarding HPSR development. The Collaboration for Health Systems Analysis and Innovation (CHESAI) – a collaborative effort between the Universities of Cape Town and the Western Cape Schools of Public Health – has employed a non-research based post-doctoral research fellowship (PDRF) as a way of building African capacity in the field of HPSR by recruiting four post-docs. In this paper, we (the four post-docs) explore whether a PDRF is a useful approach for capacity building for the field of HPSR using our CHESAI PDRF experiences.MethodsWe used personal reflections of our written narratives providing detailed information regarding our engagement with CHESAI. The narratives were based on a question guide around our experiences through various activities and their impacts on our professional development. The data analysis process was highly iterative in nature, involving repeated meetings among the four post-docs to reflect, discuss and create themes that evolved from the discussions.ResultsThe CHESAI PDRF provided multiple spaces for our engagement and capacity development in the field of HPSR. These spaces provided us with a wide range of learning experiences, including teaching and research, policy networking, skills for academic writing, engaging practitioners, co-production and community dialogue. Our reflections suggest that institutions providing PDRF such as this are valuable if they provide environments endowed with adequate resources, good leadership and spaces for innovation. Further, the PDRFs need to be grounded in a community of HPSR practice, and provide opportunities for the post-docs to gain an in-depth understanding of the broader theoretical and methodological underpinnings of the field.ConclusionThe study concludes that PDRF is a useful approach to capacity building in HPSR, but it needs be embedded in a community of practice for fellows to benefit. More academic institutions in Africa need to adopt innovative and flexible support for emerging leaders, researchers and practitioners to strengthen our health systems.

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Background: Widespread evidence on implementation indicates that health policies once adopted are not implemented as envisioned and do not always achieve the intended outcomes. The challenges associated with policy implementation gaps have been widely attributed to several factors, ranging from problematic policies to lack of governance and resources. Yet developing countries continue to experience these problems in their bid to translate policy into outcomes, including reduced health care and health inequity. This study seeks to understand the complexity associated with health policy implementation and why implementation gaps remain a challenge for low-and-middle income countries. Methods: A thematic synthesis of findings from three PhD studies, each focusing on national health policies across three African countries (Malawi, Ghana and Botswana) was undertaken to provide insight into the complex processes and factors influencing implementation outcomes. We developed ‗descriptive themes' and ‗analytical themes' to elucidate and explain key factors leading to policy implementation gaps guided by theoretical and empirical literature. Through an iterative process of data extraction, core themes from the studies were thematically analysed to highlight the contributing factors leading to implementation gaps. Results and discussion: These three cases provided experience of the system-wide complexity associated with implementing national health policies that seek to promote health care equity. We identified overarching factors contributing towards implementation gaps and policy failures across the three countries which include issues of: collaboration, discretionary powers, resources, governance and sociocultural appropriateness. These factors are not exclusive but interlinked, illustrating a complex interaction among actors with the processes and context of implementation. The results of our analysis also showed that health policy implementation occurs in a highly dynamic and complex environment that is constantly being shaped and