Improving Accountability for Quality and Safe Healthcare: Lessons from Ghana

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The text presents the regulatory framework of Ghana’s healthcare system and proposes six areas for improvement aimed at ensuring accountability within the system. However, these areas are generic and lack contextualization, particularly the latter ones in relation to Ghana’s specific perspective. As a result, they do not provide a clear Ghanaian viewpoint on the implementation of the regulations and instead suggest approaches that could also apply to other countries facing similar issues. Therefore, the title and conclusions are overstated compared to what is actually discussed, beyond the presentation of the regulatory framework.

Authors' discussion does not provide information on the specific issue of granting healthcare service accountability in Ghana through the legal compliance. If some complexities and limitations are mentioned in the introduction and briefly addressed in the discussion, the text does not provide the perspective of Ghana on the topic, nor future directions or practical proposals for improvement are mentioned. Discussion part need more critical and contextualized deepening with proper updated referencing.

Many thanks

sincerely

Author Response

Thank you very much for the feedback. Kindly find attached responses. The manuscript has also been revised accordingly. 

 

 

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The article emphasizes that accountability, legal frameworks, and governance processes must be clearly defined and implemented for health systems to function effectively. As in the Ghana example, although these elements are present, a lack of implementation leads to negative outcomes such as human rights violations and waste of resources. The article identifies six basic elements to strengthen accountability and emphasizes that effective implementation of these elements will ensure more equal, high-quality, and safe health services. The article addresses an interesting topic. However, in order for the article to gain the dimension of a scientific study, the following issues need to be addressed by the authors.

1. The paragraphs in the introduction section of the study are disconnected. The meaning and flow between the paragraphs need to be reviewed.
2. In the last sentence of the second paragraph of the introduction section of the study, it is emphasized that accountability and health service quality are proportional. This statement puts both health systems and health workers under suspicion. Therefore, this statement should be changed.
3. According to the statement in the last sentence of the first paragraph of the second part of the study, considering the legal framework and policy documents at the same level creates conceptual confusion. The national health policy is not a binding law; therefore, it is important to restructure the sentence and emphasize the difference between legal frameworks and policy documents in terms of academic accuracy.
4. Providing more specific examples of the roles of stakeholders in the middle of the first paragraph of the third section of the study will solidify this view. At this point, a short case example should be provided on which types of health institutions undertake what roles.
5. Although the article is generally strong in terms of meaning, there are occasional irregularities in terms of grammar.

There is unnecessary use of apostrophes in places such as “Patient’s”.

There are character errors in a few places, such as “Be er” and “a ention”.

Finally, the topic is up-to-date and includes clear recommendations for policymakers. The literature and legal framework are well synthesized. The connection of lessons learned in Ghana to the global context provides a strong narrative. However, there is a lack of depth in the theoretical framework in some places. The distinctions between concepts (law, policy, rule) are not clarified. Some sections remain at the level of wishes or suggestions; empirical support is limited. Authors should review the work, taking into account the above criticisms.

Author Response

Thank you very much for this feedback. The manuscript has been revised accordingly.

 

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

The topic you address is timely and highly complex.

I thank you for your work, which will undoubtedly be very useful for the governance of healthcare systems in many countries, including your own.

However, I would like to offer you a few suggestions:

 

1. Introduction

1.1 Use more technical vocabulary that is consistent with scientific literature;

1.2 Introduction to the term wicked problem with contextual explanation

1.3 Report data, especially when, for the Ghanaian situation, we talk about "variability in health care quality, safety, outcomes, and equity across the population."

 

2. What legal frameworks exists in Ghana?

2.1 "In Ghana there is a comprehensive set of legal frameworks..." → better: "Ghana has a comprehensive set of legal frameworks..."

2.2 Avoid repetitions and overly long sentences (e.g., "Together, with the revised National Health Policy...").

 

3. How to implement health system accountability?

3.1 The section is well structured into the six key elements, but I would suggest dividing it more visibly into subsections with clear headings for each element.

3.2 The focus on governance and stakeholder roles is good, but it could be strengthened with practical local examples, further exploring the arguments through a comparison with the literature.

3.3 I suggerimenti politici sono apprezzati, ma proverei a citare modelli di altri Paesi e a spiegare come potrebbero essere applicati alla vostra situazione.

3.4 It would be useful to hypothesize desired results based on the data present in the literature.

3.5 Strengthen strategic suggestions with data, case studies, or examples from practice or other countries found in the literature.

 

Conclusion

Reformulate the conclusions to summarize the main findings and offer practical or operational perspectives for the future.

Comments on the Quality of English Language

See comments for authors

Author Response

Thank you very much for your feedback. The manuscript has been revised accordingly.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

A bit more balanced and informative. 

A sentence in introduction is not so clear " Like many other countries, Ghana lacks a common legislative, regulatory and institutional framework that harmonizes the functions of all the 12 existing regulatory bodies leading to duplication of efforts and inefficiency in regulatory function [13]." as it diverges from previous statements. Please revise.

Author Response

Thank you very much for this comment. However, I respectfully disagree because what we have sought to do is to describe some additional gaps and challenges that exist with respect to inequities and regulatory structure and functions. The current place of the indicated sentence in our respectful view is just OK and accurately connects with both the previous and the next sentence. Thank you

Reviewer 3 Report

Comments and Suggestions for Authors

I thank the editors for the opportunity for a constructive discussion.
In the author's opinion, the article deserves publication.

Author Response

Thank you very much for your commendation. Extremely grateful. Thank you.