Abstract
Abstract
The persistent separation of hospital-based clinical care from public health functions constrains health system performance across low- and middle-income countries; a challenge worsened by the rising double burden of communicable and non-communicable diseases. In response, the Ghana Health Service introduced institutional Public Health Units (PHUs) through a national policy directive, embedding disease surveillance, prevention, health promotion, and occupational health within hospital governance structures. This review examines the design, documented implementation, and system requirements of the PHU model. We conducted a narrative review drawing on three complementary evidence streams: national policy documents and implementation guidelines; peer-reviewed literature on clinical–public-health integration in sub-Saharan Africa, synthesized thematically; and a further conducted a documentary mapping of hospitals with facility-specific evidence of a PHU or equivalent public health department. We analysed findings against the World Health Organization Health Systems Building Blocks framework. Our narrative review showed that integration in sub-Saharan Africa has been predominantly disease-specific, externally financed, and structurally parallel to routine services, with reported gains frequently undermined by workforce shortages, fragmented governance, weak health information systems, and absent dedicated financing. Against this pattern, Ghana’s PHU model is unique by its institutional anchoring within existing hospital governance and established health cadres rather than parallel programming. To understand how widely the model has been implemented, our review of publicly available information identified 40 hospitals across Ghana with a named PHU or equivalent public health department. Sustainable integration will require clarified accountability across system levels, dedicated financing for non-revenue-generating public health functions, competency-based workforce development, stronger facility-level data use, and reliable operational resources. The PHU model offers a replicable, institutionally grounded pathway for low- and middle-income countries seeking to embed public health within routine clinical settings.