'Health systems need to be strengthened so you get the best for your people': IPPHL Fellow Dr.Justice Thomas Sevugu

Dr. Justice Thomas Sevugu, the municipal health director for the Atwima Nwabiagya Municipal District in Ghana, remembers when he realized, as a young graduate, that he would focus his career on community health. "To make a real impact on the health of a population, you have to focus on communities, where families reside," he said.

Since then, Dr. Sevugu has become one of Ghana's leading advocates for strengthening health systems. "Human resources, leadership, and equipment may all change, but the health system remains; it must be resilient to continually serve our population’s needs," he said.

Exemplars News spoke with Dr. Sevugu, who was also an International Program in Public Health Leadership (IPPHL) Fellow, a program created by the University of Washington Evans School of Public Policy and Governance, about his journey and what he hopes to achieve in Ghana in the coming years.

Could you tell us about your personal journey? How did you become interested in primary health care and health systems strengthening?

Dr. Sevugu: My journey in public health started with a deep-rooted commitment to community health, which I built upon through my studies and experiences. After earning a diploma in community health at the basic level, I began realizing that health care delivery happens primarily at the community level, where households – the primary producers of health – are located. To make a real impact on the health of a population, you have to focus on communities, where families reside.

My interest grew as I pursued a PhD in public health, which showed me the profound impact of accessible primary health care on underserved communities. When you look at Ghana's primary health care system, organized at national, regional, and district levels, you see that policy and guidelines are set nationally, while the region focuses on coordination and monitoring. But the district level is where primary health care operates and policies translate into action – where planning and implementation create a resilient system that serves the population’s needs.

Over the years, as I took on more responsibilities, including serving as a municipal director, I recognized that a strong health care system is crucial to achieving equitable health outcomes. This understanding led me to focus on strengthening health systems. For primary health care to deliver valuable outcomes, the system must be strong.

It’s a dual challenge: we aim to provide access to every population, especially the vulnerable, but we need a robust vehicle to achieve this access. This realization drove me to advocate for system strengthening. Human resources, leadership, and equipment may all change, but the health system remains; it must be resilient to continually serve our population’s needs.

This realization led me to focus more on strengthening health systems, because the output of a system is as good as its strength and what it can do. So, it's a double-pronged situation where you want to ensure health access for every population, particularly the vulnerable, but in your effort to seek that access, the vehicle must be strong enough to deliver that. Because human beings can change. Leaders can change, health workers can change, even equipment can wear out and be replaced, but the system remains the system and it always needs to be strengthened to ensure you get the best for your people.

Could you tell us about your work as municipal health director for the Atwima Nwabiagya Municipal District? What are your current priorities within the primary health system? What unique problems are you addressing in your district compared to the rest of the country?

Dr. Sevugu: As the municipal director in a district that includes urban, peri-urban, and rural areas, my role involves ensuring high-quality health service delivery, managing teams to achieve this, and setting health priorities to meet the diverse needs of these different populations. I’ve focused on improving maternal and child health services, increasing immunization coverage, and enhancing the accessibility of health services, particularly for mobile populations.

In rural areas, people often move frequently for work, while in urban areas, busy career women may be closer to children than their male counterparts but can be out of reach of health care services. We’ve designed programs that track and follow up with these mobile populations to ensure they receive necessary services. For example, we target career women's children by implementing school health programs in early childhood centers. We deliver services directly to these children in schools, crèches, and nurseries, rather than waiting for them to come to health centers. This unique approach contrasts with other regions, where we must actively reach people wherever they are to ensure access.

Addressing these unique challenges requires targeted outreach, community partnerships, and engaging the health seekers themselves in planning how to meet their health care needs. This responsibility lies with the municipal team.

Exemplars in Global Health research shows that Ghana is a positive outlier in primary health care. Could you talk more broadly about your experience with the country’s health system? What is unique – and what do you think other countries would find valuable in building their own strong health systems?

Dr. Sevugu: Ghana’s health care system is unique because of its community-based Health Planning and Services (CHPS) initiative, the foundation of our primary health care system at the community level. Recently, this approach has been enhanced with a network of practice model, where all health care providers within a sub-district – public, private, and faith- based – form a network.

The leading public health center serves as the hub, while other facilities act as spokes, leveraging resources such as personnel, equipment, and expertise to serve the community. If a facility lacks a particular resource, the network mobilizes to fill that gap, either by transporting the patient to another facility or delivering the resource to them.

This network model not only improves access but also enhances the quality of care, supporting universal health coverage by ensuring equitable care. This resilience, built through community involvement and integration, makes our system adaptable in times of crisis. Mobilizing resources, engaging private sector partnerships, and investing in preventive health care are part of our approach. We encourage other countries to observe and adapt our model to strengthen their own health care systems.

Could you tell us about your experience with the International Program in Public Health Leadership program?

Dr. Sevugu: The IPPHL program has been very informative, enhancing my leadership skills, strategic thinking, and collaborative approach. In health care, collaboration is essential, and this program reinforced the importance of leveraging resources and expertise across sectors. It provided exposure to global health practices and a platform to exchange insights with other leaders in Africa and beyond, strengthening my commitment to adaptive leadership and data-driven decision making. IPPHL has equipped me with tools to create more effective and efficient health systems for our population.

What specific learnings from the program would you share with other global health professionals in Africa looking to create new strategies to support strong health systems?

Dr. Sevugu: I would emphasize adaptive leadership, data-driven decision making, and the Direction, Alignment, and Commitment (DAC) framework. Often, we set directions but lack alignment and commitment, affecting program and project quality. DAC ensures all organizational goals are aligned and met effectively. Additionally, learning from positive examples from countries with similar contexts, as well as community engagement, are vital. By focusing on equity and maximizing local resources, we can overcome constraints and advance universal health coverage in Africa.

How do you think your participation in the IPPHL program will impact your future work in Ghana?

Dr. Sevugu: After IPPHL, I have focused on expanding immunization coverage to prevent diseases, addressing structural challenges such as school access for health services. I’m pleased that we've established an MOU between Ghana’s ministries of health and education to facilitate school health programs. This ensures that even children in private schools, through the National Council for Private Schools, have access to health services. I am currently assisting in drafting the National Immunization Strategic Plan with WHO, applying these lessons to impact health policy at the regional and national levels, and mentoring future leaders to continue this work.

What are you hoping to accomplish in the future?

Dr. Sevugu: Looking forward, I want to advance universal health coverage, particularly at the national and African Unionlevels. System strengthening is crucial for African countries, and my goal is to support the development of resilient health systems across the continent. My focus will be on roles that allow me to contribute to robust health outcomes in Africa.