The University of Ghana Hospital was established in 1957 to provide medical care for the university community. In the 1970s, its remit expanded to provide healthcare to adjacent local communities and is now part of wider healthcare services for the greater Accra region, serving a population of approximately 5 million people.
It continues to provide healthcare services to the university’s 6,000 staff and 40,000 students through the University of Ghana Health Services (UGHS). Korle-Bu Teaching Hospital and 37 Military Hospitals are two of the main referral hospitals for the University Hospital.
Between 2012-2022, Commonwealth Alumnus Dr Gloria Ansa was the Head of Public Health at UGHS. At the time she assumed the role, there was no public health unit, and Dr Ansa was tasked with reviewing existing health services at the university hospital to establish an overarching unit.
Integrating important health services
Existing services included an HIV treatment and the national tuberculosis (TB) programme, and occupational health services available to university staff and external clients.
Dr Ansa re-joined the UGHS in 2011, following the completion of her PhD in Public Health with a Commonwealth Scholarship. Her PhD explored the benefits of integrating TB and HIV services and she observed that integration resulted in more effective healthcare and improved uptake and outcomes for patients.
Developing the unit provided an opportunity for Dr Ansa to apply her research skills and expertise to create a one-stop shop for TB and HIV patients to access services and healthcare. For the team members, working in a single unit enabled informal and formal training opportunities to acquire a variety of skills as they could observe and participate in the different practices used in the management of the different medical conditions. This broader knowledge led to improved and more timely identification of potential cases, ultimately reducing diagnosis time and the time taken for patients to receive appropriate treatment.
Dr Ansa also notes that working as a unit improved the reach of training for regional and national healthcare programmes as it was easier for them to manage logistics and disseminate training and information. With healthcare workers based in the same unit, this also improved data capture and reporting to support the monitoring and evaluation of the national programmes, particularly the TB and HIV programmes.
Improving services for patients
Prior to the unit, patients would receive treatment and services for one diagnosis from different units. Due to the availability of clinics and doctors, this would often make it harder for patients to consistently access the services they needed. To address this, Dr Ansa and the team implemented an appointment system to help patients and healthcare workers manage their time and services. This system was particularly impactful in improving occupational health referrals for new university employees and external clients, reducing waiting times, and ensuring they were not in close contact with contagious patients also visiting the unit.
The appointment system also improved data capture on patients and service uptake, highlighting the potential for the unit to become a study site to support national and university research in areas such as TB, HIV and COVID-19.
Using her skills in academic and clinical research, Dr Ansa introduced systems to enable university academics and students to access the clinic and the hospital to collect data and support their research. Through this work, the unit has strengthened research capacity within the hospital. It was subsequently identified as a study site for several research projects in HIV, hepatitis, COVID-19, and vaccine research.
Training in the fight against serious disease
Under Dr Ansa’s direction, training became a significant part of the unit’s work to improve healthcare worker skills and knowledge, and service provision. Training was focused on infection prevention and control which became critical in 2014 and 2020 when Ghana faced Ebola and COVID-19 outbreaks.
During health emergencies, the unit is responsible for providing timely information and implementing healthcare programmes based on reviewed national and international guidelines to ensure staff, student and public safety.
During the Ebola outbreak, the unit received information from the national technical team and from the World Health Organization (WHO) which was used to contextualise the risk of exposure and infections within the university community and its environs. Whilst no infections were reported in Ghana, the unit was tasked with providing technical guidance and public health information on the disease and developing a screening tool to prevent infections and identify and manage infections.
This included screening staff, students and the local public, as well as visiting foreign students. Dr Ansa and her team developed a self-assessment form for students to complete in advance of admission registration with the university, which would then be assessed and approved by her team. Dr Ansa also established linkages with the Noguchi Memorial Institute for Medical Research in the university to fast-track analysis of samples taken from potentially infected patients to improve diagnosis time and implement treatment.
The COVID-19 pandemic provided an entirely new challenge for the unit due to the lack of, and changing, information about the infection, however the preparedness and prevention strategy developed for Ebola was a useful experience.
“When it came to COVID, we were able to build on all those [Ebola] processes. Of course, the difficulty with COVID was that the information and the knowledge about COVID itself was limited. So, we kept on evolving.”
Dr Ansa was appointed Lead for the COVID-19 Response Team in the UGHS. As the leader of the Public Health Unit, responsible for developing the emergency healthcare response and maintaining healthcare worker and university staff and student safety, this was a challenging and difficult time.
She notes that alongside the changing information about the infection and public health guidance from international and national organisations, the lack of logistics and access to equipment made it difficult to implement healthcare.
“The biggest challenge we had was getting the logistics when we needed them. We started working in February and the WHO declared it as a pandemic in March. But the things that we requested for, in terms of face masks and proper personal protective equipment, were late in coming. We got our first major supply in April or May.
“So, that was really scary. We were asking people to deal with suspected cases of COVID, or even diagnosed cases, without the full complement of the logistics. That was scary and intense. It was very difficult getting people to do that.”
Without adequate personal protective equipment (PPE), no known treatment and global mortality figures rising daily, Dr Ansa and the team, with the support of the Director of Health Services and the University Senior Management, turned to recruiting health workers as volunteers to deliver frontline emergency healthcare. This included developing a training programme to ensure they were prepared for the task.
Dr Ansa is proud of those who volunteered to not only support the unit, but also risk their lives to save others.
“They were willing to step up and be on the frontline when nobody else was.”
As information about COVID-19 and prevention and treatment strategies were released, the Public Health team managed the dissemination of this across the university and in the local area and managed ongoing healthcare worker training. Through the unit, they implemented screening processes and worked again with the local laboratory and the district health authority to test samples and disseminate results.
Due to the team’s preparedness and responsiveness during the COVID-19 pandemic, by November 2020, 4,893 suspected cases had been screened, with 863 testing positive and receiving care. A major achievement was that there were no health staff or student deaths from COVID-19.
Reflecting on her personal experience during this time, as both a leader and with a heightened risk of infection due to her work and contact with patients, Dr Ansa shares that her leadership style was an important part of this. Throughout the crisis, Dr Ansa ensured she was visible to healthcare workers and other stakeholders involved in making decisions about and implementing emergency processes.
“I have always led from the front. I wasn’t the type of person who would say, go and do this, go and do that. I was there on the ground with them, being part of everything.”
Solving complex healthcare problems
Dr Gloria Ansa delivering a presentation at Evidence Live in 2017.
Dr Ansa has always been passionate about managing health services, which was a key motivation to completing her PhD. Whilst she acknowledges the academic exposure, knowledge and research skills gained through this experience, she also highlights the personal development and growth.
“The PhD experience teaches you an approach to solving problems. How to define a problem and look at how you can resolve them: it really opened my eyes to know how to get things done. Because I was working in a setting where there are a lot of resource limitations, the PhD gave me the opportunity to have that confidence to push for things to be done.”
During her studies at the University of Leeds, Dr Ansa also had the opportunity to participate in professional development programmes and visit different places in the UK. Dr Ansa was able to bring her family to the UK during her studies and she notes that these extra-curricular activities were important for her personal development.
“Because I went with family, sometimes, if you’re not careful, you become so occupied with school and family that you forget to enjoy the environment that you are in.”
Following her role at UGHS, Gloria is now Deputy Medical Director at the Bank Hospital, a publicly owned and privately-managed hospital. She works in collaboration with the Medical Director and the hospital’s management team to develop and implement a strategic plan for the growth and expansion of clinical and non-clinical aspects of the hospital’s operations and standards.
The hospital has recently been selected as one of three study sites in Ghana (Africa) in a global clinical trial on kidney disease. She is now supporting the successful implementation of this work as a sub-investigator. Alongside this, Dr Ansa has been working to get the facility accredited for postgraduate training in medicine and for newly qualified doctors, following successful accreditation for paediatrics.
Her current role enables Dr Ansa to continue to work in public health management and drive forward clinical services and pursue teaching and research. She lectures part time at universities and supervises PhD students. She also works to instil the value of research in clinicians.
Dr Ansa credits her Commonwealth Scholarship and PhD experience for enabling her to pursue these professional goals.
“This scholarship and the PhD opened so many doors for me because I could do so many things. As a clinician, I really didn’t like the idea of just sitting in the clinic and seeing one patient after another: I found that a bit monotonous… It’s given me a lot of opportunities that make me feel that I am able to do much more. And I have benefited a lot from that. And it has really changed my life, in terms of making me feel very fulfilled as a health professional.”
Dr Gloria Ansa is a 2006 Commonwealth Scholar from Ghana. She completed a PhD in Public Health at the University of Leeds.
