Established in 2009 as a private sector cancer treatment centre of excellence in Ghana, Sweden Ghana Medical Centre (SGMC) had strong ties to Sweden. It was the idea of the Swedish Government and a group of investors to provide cancer care to people living in West Africa and beyond who seek European standard cancer-care. GMI-AB, an investment and project development company for Sweden’s development finance institution, Swedfund, partnered with Elekta, a leading innovator of equipment and software used to improve, prolong and save the lives of people with cancer and brain disorders. A state-of-the-art facility was born and christened SGMC.’ (Source, SGMC management Team). ‘In 2015 the destiny of the centre moved to another level.

Ownership shifted from the initial investors to The Ghana National Association of Teachers (GNAT). This was concluded in the fall of 2020. Today the dream and aspiration of the forbearers, which was not achieved, are being pursued diligently by its new owners all in the quest to make the centre a one-stop-shop in taking away the burden of cancer. During my practicum I observed that the SGMC is a high efficiency, zero waste facility; still pursuing continuous development through marketing and scientific research; as well as adoption of current high-end technology, competent oncologists and managerial and supporting staff to achieve competitive advantage. They also have a unique organizational culture, akin to Ensign Global College’s. At the outset of the practicum, I had the opportunity to meet my preceptor, Dr Emmanuel Amankwaa-Frempong, to discuss the needs on the ground he wanted me to tackle. In his words, he wanted me to help them set up a local IRB for the SGMC Research Department, which he heads as well.

We also agreed on a flyer, and some videos for health education; and one or two research proposals. After that, I was introduced to the Chief Executive Officer of the hospital, Dr Clement Edusa, who tutored me, briefly, on how he runs the day to day clinical governance for the facility. I later on had a detailed set of daily discussions with the General Manager of the Facility, Mr. Edward Banson, on how he carries out his managerial leadership activities that has made SGMC, profitable and growing. This happened for close to half of the day for the first 3 days of my practicum experience there.

I was also introduced to the Human Resource Manager, and other staff who were encouraged to provide me the needed support for activities during my stay there. Lunch was provided daily by SGMC. I had support from all the staff, particularly, Mr. Julius Tetteh of SGMC’s IT department who had the patience and helped design my flyer and information handy-brochure for cervical
cancer health promotional activities (and secondary data extraction on prostate cancer from their MIS). I also had support from Miss. Ewoenam A. Puplampu who was my go-to person for everything administrative or secretarial.

The rest of the period in between starting date and completion was used on researching on, and putting together the practicum products, discussing them with all preceptors and stakeholders and faculty, gaining their inputs and incorporating those inputs into the final product. I also obtained administrative and a documented ethical permission for secondary data collection for the second research proposal. My general experience at SGMC was fulfilling, and the learning was good; and I am grateful to the management, staff and leadership of the facility for the opportunity and the receptiveness; and I thank ensign global college for the opportunity.

FRANK OBENG (ENSIGN GLOBAL COLLEGE MPH STUDENT, APRIL 2023).

The quantitative analysis process exposed me to data cleaning and transforming data into meaningful outputs. The regression capability of STATA allowed me to model relationships between “visits to the dermatologist” and “age, gender, level of education, religion, marital status, occupation, relative to albinism, and enrolment in the National Health Insurance”. This aided in the development of visualization skills and tools for effective communication. For example, on page 8 of the manuscript report, awareness of skin cancer and other dermatological
conditions was presented in a bar chart to effectively illustrate patterns. The analysis also helped me gain a better understanding of the impact of education on People Living with Albinism in accessing health care. The findings underscore the disparities faced by People with Albinism in different geographic backgrounds in Africa compared to Ghana. The research indicates that people living with albinism have a good understanding of skin cancer, but face social and financial barriers that prevent them from accessing appropriate healthcare services.

A large majority of the participants had never visited a dermatologist because of financial constraints and limited coverage by the NHIS. Lack of access to dermatological care is a common problem in Africa and has been reported in other studies. The study also found a higher prevalence of premalignant and malignant skin lesions among participants, leading to SCC and BCC. This highlights the need for clinicians to provide appropriate screening and care to prevent the development of skin lesions in people with albinism. Policymakers must recognize the need for equitable financial support to ensure access to specialized dermatological care.

Public education is also needed to increase awareness of albinism and its associated dermatological risks. Addressing social and financial barriers to access healthcare for people with albinism in Ghana requires concerted efforts from all stakeholders to improve their quality of life. During the research process, I gained an understanding of the following entrepreneurial approaches to help people living with albinism improve their condition by seeking dermatological services. These include the need to conduct a needs assessment to identify income-generating opportunities suitable for persons living with albinism. Handcrafting, small-scale agriculture, and beauty services are very good options. Once income-generating opportunities have been identified, training and support should be provided to enable people living with albinism to develop the necessary skills and knowledge to participate in these activities.

Training and equipping them in business management, financial literacy, and marketing will be helpful. Another approach is to establish a social enterprise that supports the income-generating activities of people living with albinism. Social enterprises can provide them with access to financing, marketing, support, and other resources that can help them succeed in their activities. Establishing a healthcare fund backed by a portion of the profits generated by social enterprises can be very helpful. This fund can be used to provide people with albinism access to healthcare for their dermatological conditions. Most importantly, monitoring and evaluating the social enterprise to ensure that it is generating sufficient profits to support the healthcare fund and that the income-generating activities are sustainable and can provide a viable source of income for persons living with albinism is essential

The Applied Practicum Experience Journey took place from Monday, February 27, 2023, to Friday, March 17, 2023. The total duration of the experience was 80 hours and 30 minutes.Throughout this period, I participated in three key activities: the district’s annual performance review, NHIS accreditation, and a visit to the zipline at Anum. As part of the NHIS accreditation
process, I was tasked with providing protocols for the maternity ward. During the annual peer review, two main issues were identified: nonadherence to TB treatment and low uptake of the COVID-19 vaccine. To address these problems, we planned two interventions. First, a stakeholder engagement was organized to increase vaccine uptake, and second, a reminder system was developed for TB clients to adhere to their treatment. The reminder system took the form of a voice campaign delivered in the local language. The voice campaign was designed to play at 6 am each day for three weeks, as most TB medication is taken early in the morning on an empty stomach. It targeted a group of 14 individuals, including 13 clients and the TB Institutional Coordinator of Peki Government Hospital. After the three-week period, the campaign's effectiveness was evaluated by placing mobile phone calls to the participants. Out of the 14 individuals, 8 responded and expressed high appreciation for the campaign, requesting its continuation.

Participants provided some recommendations for improvement:
• Two participants suggested running the campaign twice daily, in the morning and evening, to accommodate those who take their medication in the evening. The TB Coordinator explained that medication timing depends on the clients' ability to remember and use prompts/cues in their environment, such as school bells, drums, or the Muslim adhan.

• A two-way campaign was also recommended, as one client expressed a desire to call and show appreciation but was unable to do so.

• The institutional TB coordinator suggested including information on good nutrition or healthy dietary practices for the clients.

The outcome of the evaluation was shared with my preceptor, Mr. Norvor. He expressed satisfaction with the results and assured me that he would share them with the health directorate.
He also promised to discuss the way forward after sharing the evaluation findings. The outcome of the evaluation was shared with my preceptor, Mr. Norvor. He expressed satisfaction with the results and assured me that he would share them with the health directorate. He also promised to discuss the way forward after sharing the evaluation findings.

Competencies Attained: I achieved three foundational competencies and two concentration competencies, which are as follows:

1. Assessing population needs, assets, and capacities that affect communities' health:

• Conducted a needs assessment of the population of TB clients receiving treatment
in the South Dayi district.

• Identified the need for reminding clients to take their medications.

• Discovered that clients possess mobile phones, which can be utilized as an asset
and medium for intervention.

• Noted that clients could easily respond to a form call.

2. Selecting communication strategies for different audiences and sectors:

• Developed protocols and displayed them on the walls of the maternity ward.

• Engaged with community heads to ensure stakeholder involvement.

• Sent invitation letters to stakeholders for a meeting.

3. Communicating audience-appropriate public health content (non-academic, non-peer
audience):

• Delivered the message in the local language of the clients, ensuring effective communication with the target audience.

4. Applying health promotion skills specific to low-resource settings to improve community
well-being:

• Implemented a voice campaign that involved answering a phone call.

• Delivered the message in less than half a minute, considering the limitations of low-resource settings.

• Addressed the public health issue of non-adherence to treatment, which can potentially spread drug-resistant strains of TB to the entire community.

5. Applying tools and concepts beyond the traditional public health scope to solve health challenges at the district level:

• Introduced an innovative voice campaign as a solution to the problem of non-adherence to treatment at the district level.

Attached is a sketch of the graphical representation of how the voice campaign works, the voice message, and a sample of the protocol.