We developed and applied tools to evaluate HH resources and practices in a large African hospital. These assessments were undertaken to guide future efforts to improve HH at this hospital but can also serve as a model of the way to perform a systematic assessment at acute care hospitals in developing countries.

Telemedicine has been acknowledged to improve the quality of healthcare. However, many telemedicine services fail beyond the pilot phase. A literature review on business model components for telemedicine services was conducted. Based on specified inclusion criteria, 22 publications were included in the review. To facilitate the analysis of literature, a business model framework with value as its central focus was proposed. Improvement in quality, efficiency and accessibility of care were identified to be the outcomes of telemedicine with patients and healthcare personnel being the main users of the services which are delivered through home, institutional and community-based care. Patients, health providers, vendors, payers and government agencies are actors involved in the delivery of telemedicine services which require investments in resources like videoconferencing technologies, home monitoring devices and other IT infrastructure. Subscriptions, reimbursements and pay per use revenue streams were identified as feasible for commercializing telemedicine services.

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The diagnosis and management of COVID-19 are much dependent on the adherence to standardized protocols. Healthcare workers play a crucial role in the case management of COVID-19 in many institutions. Globally, the disease burden is increasing, and the mortality has reached over 2 041 426 compared with 323 000 in May 2020. In West Africa, the pandemic has shown a slow but steady rise in many countries. Existing protocols and their utilization are best assessed after the occurrence of the index case. General aim. The study assessed the health worker’s response to COVID-19 protocols at three designated areas of the in-hospital management care triaging, holding area, and treatment centers. Method. A qualitative design was used to assess the response of healthcare workers with regards to early case detection, infection prevention, risk communication to clients and compliance to protocols. The study conducted observational visits and purposively selected healthcare workers comprising of clinicians, nurses, emergency medical technicians, and laboratory technicians who perform routine duties at the triaging, holding, and treatment centers. A total of 41 observations were made over two weeks. Results. Participants comprised 23 males and 18 females. At all observed units, the case definition was being used to screen attendants presenting, and appropriate categorization of patients was ensured. The use of temperature in screening for COVID-19 at the units was generally adhered to. Only 50% of participants used the prescribed PPEs. The physical distancing between healthcare workers and client and between clients and caregivers were not enforced; however, hand hygiene was practiced. Disinfection of working surfaces and equipment with 0.5% chlorine or 70% alcohol-based rubs were used most of the time. It was observed however that no psychological counselling was given to suspected cases or their relatives. Conclusion. Healthcare workers showed discordant response to different parts of the protocols for COVID-19 especially appropriate distancing. There was an enhanced awareness among healthcare workers and improvement in infection prevention protocols. The study also observed that as the risk of infection increased from triaging to holding area and to treatment centers, the response of healthcare workers to COVID-19 protocols also improved. Risk communication is an essential part of the COVID-19 management strategy. At the treatment centers, healthcare workers adhered to this protocol, whereas it was a major gap at the triaging and holding areas.

Background: Diagnostic testing for the current SARS CoV 2 infections involves the collection and testing of invasive pharyngeal specimens by qualified Health workers. Though fully clad in personal protective equipment, the concern is that sampling in close proximity to the patient poses as a major health hazard. The present study sought to verify if saliva or faeces could become a possible surrogate for pharyngeal samples for SARS CoV 2 testing in suspected Ghanaian COVID-19 patients. Objectives: To ascertain if there is SARS CoV 2 viral shedding in the saliva and faecal samples of Ghanaian COVID 19 patients, their sensitivity and specificity as compared to pharyngeal samples. Method: Fifty (50) recruited COVID 19 patients who have been confirmed via RT PCR using their nasopharyngeal/oropharyngeal samples and twenty (20) SARS CoV 2 negative suspected patients each provided some faecal and saliva sample for RT PCR analysis for SARS CoV 2. Results: Forty three (43) out of the fifty (50) COVID 19 patients recruited representing 86% tested positive for SARS CoV 2 via their saliva sample whiles all their faecal samples tested positive for SARS CoV 2 representing 100%. The sensitivity of saliva samples was 86% whiles the specificity was 100% but the sensitivity and specificity of the faecal samples were all 100%. Conclusion: There is indeed viral shedding of SARS CoV 2 in the saliva and faeces of Ghanaian COVID 19 patients just like their counterparts in other parts of the world. Saliva and faeces could possibly become an alternative sample to the current in place of the invasive pharyngeal samples for SARS CoV 2 testing in resource limited settings. Further research to explore this possibility at different testing sites with larger sample size is recommended. Keywords: Severe Acute Respiratory Syndrome Corona Virus 2 (SARS CoV2), Real Time Polymerase Chain Reaction (RT PCR), saliva, faeces, nasopharyngeal, oropharyngeal, sensitivity, specificity