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Health Service Marketing
Management in Africa
Health Service Marketing
Management in Africa
Edited by
Robert Ebo Hinson, Kofi Osei-Frimpong,
Ogechi Adeola, and Lydia Aziato
First edition published in 2020
by Routledge/Productivity Press
52 Vanderbilt Avenue, 11th Floor New York, NY 10017
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN, UK
© 2020 by Taylor & Francis Group, LLC
Routledge/Productivity Press is an imprint of Taylor & Francis Group, an Informa business
No claim to original U.S. Government works
Printed on acid-free paper
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Library of Congress Cataloging-in-Publication Data

Names: Hinson, Robert (Robert Ebo), editor, author. | Aziato, Lydia, editor, author. | Adeola, Ogechi, editor, author. |
Osei-Frimpong, Kofi, editor, author.
Title: Health service marketing management in Africa / editors: Robert Hinson, Lydia Aziato, Ogechi Adeola,
and Kofi Osei-Frimpong.
Description: New York : Routledge, 2020. | Includes bibliographical references and index.
Identifiers: LCCN 2019035257 (print) | LCCN 2019035258 (ebook) | ISBN 9780367001933 (hardback) | ISBN
9780429400858 (ebook)
Subjects: LCSH: Medical care–Africa–Marketing. | Health services administration–Africa.
Classification: LCC RA410.55.A35 H437 2020 (print) | LCC RA410.55.A35
(ebook) | DDC 338.473621096–dc23 LC record available at https://lccn.loc.gov/2019035257
LC ebook record available at https://lccn.loc.gov/2019035258
Visit the Taylor & Francis Web site at

www.taylorandfrancis.com
Contents
About the Editors and Contributors.............................................................................................vii
Acknowledgments...........................................................................................................................xv
Chapter 1 Introduction to Healthcare Service Marketing Management: Building

Customer-Driven Health Organisations....................................................................... 1
Robert Ebo Hinson, Kofi Osei-Frimpong, Ogechi Adeola, Lydia Aziato
Chapter 2 The Societal and Healthcare Context...........................................................................7

Lydia Aziato, Lillian Akorfa Ohene, Charles Ampong Adjei
Chapter 3 Strategic Planning and Healthcare Services............................................................... 21

Ogechi Adeola and Isaiah Adisa
Chapter 4 Marketing in Healthcare Management....................................................................... 31

Thomas Anning-Dorson, Nii Norkwei Tackie, Michael Boadi Nyamekye
Chapter 5 Segmentation, Targeting, and Positioning in Healthcare........................................... 45

Ogechi Adeola, David Ehira, Adaeze Nworie
Chapter 6 Consumers and Consumer Behaviour........................................................................ 57

Gideon L. Puplampu, Ama Pokuaa Fenny, Gwendolyn Mensah
Chapter 7 Managing the Healthcare Product.............................................................................. 71

John Muriithi, Abel Kinoti Meru, Emmanuel Okunga Wandera,
Mary Wanjiru Kinoti
Chapter 8 Utilisation and Pricing of Healthcare Services........................................................... 81

George Acheampong and Solomon Yaw Agyeman-Boaten
Chapter 9 Distribution in Healthcare Markets............................................................................ 95

Mahmoud Abdulai Mahmoud
Chapter 10 Integrated Marketing Communications in the Healthcare Sector:

Insights from sub-Saharan Africa............................................................................ 107
Golda Anambane and Robert Ebo Hinson
Chapter 11 Branding the Healthcare Experience........................................................................ 121

Oluwayemisi Olomo and Olutayo Otubanjo
Chapter 12 Branding for Small and Medium Sized Healthcare Institutions.............................. 135
Raphael Odoom and Douglas Opoku Agyeman
v
vi Contents
Chapter 13 Managing Healthcare Employees............................................................................. 149

Andrews Agya Yalley
Chapter 14 Physical Evidence and Healthcare Service Quality Management............................ 167

Robert Ebo Hinson and Michael Nkrumah
Chapter 15 Developing Customer Loyalty in Healthcare........................................................... 179

Kofi Osei-Frimpong, Kumiwaa Asante, Michael Nkrumah,
Nana Owusu-Frimpong
Chapter 16 Financing Healthcare and Health Insurance............................................................. 199

Anita Asiwome Adzo Baku
Chapter 17 Managing Healthcare Logistics................................................................................ 211

Obinna S. Muogboh and Jimoh G. Fatoki
Chapter 18 Managing Policies and Procedures in Healthcare Management.............................. 227

Philip Afeti Korto
Chapter 19 Technology and Health Services Marketing in Africa............................................. 243

Kenneth Appiah, Ibelema Sam-Epelle, Ellis L.C. Osabutey
Chapter 20 Application of Technology in Healthcare Delivery in Africa.................................. 255

Ernest Yaw Tweneboah-Koduah and Deli Dotse Gli
Chapter 21 Technology and Social Media in Healthcare Delivery............................................. 267

Raphael Odoom and Douglas Opoku Agyeman
Index �� 281

About the Editors and Contributors
George Acheampong holds a PhD from the University of Ghana after completing coursework
at the University of Copenhagen. His research interests focus on how businesses can influence
African development through market led approaches. These specifically focus on entrepreneur-
ship and internationalization issues. Some of his contributions have appeared in the International
Marketing Review and Journal of Small Business and Enterprise Development. He is a member/
fellow of the Academy of Management, Development Economics Research Group (Copenhagen)
and Academy of African Business and Development. He is currently a lecturer at the University of
Ghana Business School.
Ogechi Adeola is an Associate Professor of Marketing at the Lagos Business School (LBS), Pan-
Atlantic University, Nigeria. She is also the Academic Director, LBS Sales & Marketing Academy.
Her research interests include tourism and hospitality marketing, strategic marketing, healthcare
services, and digital marketing strategies in sub-Saharan Africa. She has published academic papers
in top-ranking scholarly journals. Her co-authored papers won Best Paper Awards at conferences in
2016, 2017, and 2018. She holds a Doctorate in Business Administration (DBA) from Manchester
Business School, United Kingdom.
Isaiah Adisa is a private researcher working with a faculty member at the Lagos Business School,
Pan-Atlantic University, Lagos, Nigeria. He studied Industrial Relations and Human Resources
Management at the Olabisi Onabanjo University (formerly Ogun State University), Ago-Iwoye,
Ogun State, Nigeria. He graduated with second class honours (upper division) and distinction,
respectively, from undergraduate and postgraduate studies at the same university. He is an astute
researcher whose interests focus on, but are not limited to, industrial relations and human resources
management, organisations strategy, marketing, and gender-related studies.
Charles Ampong Adjei is an Assistant Lecturer in the Department of Community Health

Nursing, School of Nursing and Midwifery, University of Ghana. He holds a Master of Public
Health and Master of Philosophy in Nursing from the University of Vrije/KIT in the Netherlands
and the University of Ghana respectively. He is currently a final PhD candidate at Maastricht
University, the Netherlands. Charles is an experienced teacher and a researcher. His research
focuses primarily on communicable diseases, sexual and reproductive health, and preceptor-
ship in nursing. He is a consultant to several firms including PPAG, Nurses-CPD Consult, and
Hepatitis Alliance of Ghana.
Douglas Opoku Agyeman holds an MPhil in Marketing and is a teaching assistant in the Department
of Marketing and Entrepreneurship at the University of Ghana Business School. He currently directs
a community-based human trafficking prevention project and a youth leadership project in Ghana
through the Cheerful Hearts Foundation and Patriots Ghana respectively. His research interests
are in the areas of SME growth, social entrepreneurship, and sustainable socio-economic develop-
ments in sub-Saharan African countries. He has published in the Journal of Entrepreneurship and
Innovation in Emerging Economies.
Solomon Yaw Agyeman-Boaten holds an MPhil in Economics from the University of Ghana. His
research spans the interface of development economics and institutional environments of business
and their implications for the welfare of Ghanaian households. He is currently a research assistant
at the University of Ghana Business School.
vii
viii About the Editors and Contributors
Golda Anambane is a lecturer in the Department of Marketing, Wisconsin International University

College, Ghana. She holds a Master of Philosophy Degree in Marketing from the University of
Ghana and has taught a number of undergraduate courses since becoming an academic. Aside her
experience in teaching, Golda has a profound interest in research and has had papers published
in recognized peer-reviewed journals. She emerged as the Valedictorian of her Master’s degree
graduating class (College of Humanities, University of Ghana – July 2018). She was also the proud
recipient of the Best Marketing Student award during her graduation for a Bachelor’s degree (All
Nations University College, Ghana – November 2012).
Thomas Anning-Dorson is a Senior Lecturer at the Wits Business School of the University of
Witwatersrand, Johannesburg, South Africa. He holds a PhD in Marketing from the University of
Ghana Business School. His research interest spans innovation, service management, strategy, and
emerging markets.
Kenneth Appiah is a Lecturer in Marketing, Entrepreneurship, Small Business Management, and

International Business at Cumbria Business School, University of Cumbria. He holds a PhD in
Marketing/International Business from the University of Bedfordshire, UK. His research focuses
on market entry strategies, internationalisation and competitiveness of SMEs, particularly emerg-
ing SMEs, and technology transfer; innovation, technology, and development; and influences on
marketing and SMEs. Kenneth has published articles in a number of journals such as the Journal
of Critical Perspective in International Business, Journal of Business and Retail Management and
several other outlets.
Kumiwaa Asante is a graduate assistant at the Ghana Institute of Management and Public
Administration (GIMPA) Business School. She holds an MSc in Business Administration
(Marketing option) and is working towards her PhD in Marketing at the University of Stellenbosch.
Her research interests include marketing, consumer behavior, social marketing, marijuana research,
mental health, and health marketing.
Lydia Aziato is an Associate Professor and the Dean of the School of Nursing and Midwifery,
University of Ghana. She has been a nurse since 1997. She had her Bachelor’s degree in Nursing
and Psychology and an MPhil in Nursing from the University of Ghana. She had her specialty train-
ing in Oncology Nursing from the Cross Cancer Institute in Edmonton, Canada in 2006 and a PhD
in Nursing from the University of the Western Cape, in 2013. She has published over 50 papers in
credible peer-reviewed journals. Her research interests are pain, cancer, women’s health, and surgi-
cal nursing. She has advanced skills in qualitative research.
Anita Asiwome Adzo Baku is a lecturer in the Department of Public Administration and Health
Services Management of the University of Ghana Business School. She has a PhD in Management
from the Putra Business School, Universiti Putra Malaysia. She lectures on courses in insurance
and health services management at the University of Ghana Business School. Her research inter-
ests cover healthcare financing and health insurance, occupational safety and health management,
health policy, and management. She has produced various publications and is a reviewer for jour-
nals such as the International Journal of Sociology and Social Policy and the International Journal
of Workplace Health Management.
David Ehira is a graduate student of Interactive Media at the University of Westminster. He has
been involved in transdisciplinary research efforts in cognitive technologies, marketing, and the
use of artificial intelligence (AI) expert systems. Known for his creativity and meticulousness in
putting ideas into motion, he is interested in the application of emerging technologies to creating
About the Editors and Contributors ix
user-centred innovations for optimising business processes and enhancing service delivery systems.
His current research interest lies in the use of artificial intelligence systems for promoting sound
mental health among employees in the UK.
Jimoh G. Fatoki is a Research Assistant in the Department of Operations Management at Lagos

Business School, Nigeria. He graduated from the Department of Agricultural and Environmental
Engineering, University of Ibadan, Nigeria with first-class honours; and he won the Association of
African Universities (AAU) graduate internship award in 2015 after bagging a Master’s degree with
distinction from the same university. Mr Fatoki has co-authored five peer-reviewed research articles
in academic journals and he is currently embarking on a PhD study in the Department of Business
Administration and Management at New Mexico State University in the United States.
Ama Pokuaa Fenny is a Research Fellow with the Institute of Statistical, Social and Economics
Research (ISSER) at the University of Ghana. Since 2005, she has researched and published in
the area of developmental issues in health financing, health service delivery, and social protec-
tion. Her current research areas include finding synergies to integrate governmental policies into
service delivery systems in Ghana. She has a PhD in Health Economics from the Department of
Public Health, Aarhus University, Denmark and an MSc in Health, Population and Society from the
London School of Economics and Political Science (UK).
Deli Dotse Gli is a Teaching Assistant in the Department of Marketing and Entrepreneurship at the
University of Ghana Business School. Deli Dotse Gli obtained his Master of Philosophy (MPhil)
degree from University of Ghana Business School. Deli Dotse Gli is passionate about research and
teaching, with research interests in corporate marketing, health marketing, sustainable marketing,
and consumer engagement.
Robert Ebo Hinson is an Extraordinary Professor at the North West University Business School
in South Africa and Head of Department of Marketing and Entrepreneurship at the University of
Ghana Business School. He has also served as Rector of the Perez University College in Ghana and
holds two doctorate degrees; one in International Business from the Aalborg University in Denmark
and the other in Marketing from the University of Ghana.
Abel Kinoti Meru is a Professor and Dean, Riara University School of Business, Kenya, and the
founding Chair of the Academy of International Business – Africa Chapter. He is a seasoned inno-
vation and business incubation consultant. He holds a Doctorate Degree in Commerce from Nelson
Mandela Metropolitan University, South Africa, an MBA (Marketing) and a Bachelor of Commerce
(Accounting) degree. He also holds a Post Graduate Certificate in Academic Practice from York
St. John University (UK) and an International Faculty Programme Certificate from IESE Business
School, University of Navarra-Barcelona (Spain). He also has extensive training in case writing and
the use of case teaching methods from Lagos Business School, Pan-Atlantic University, Nigeria and
Gordon Institute of Business Science, University of Pretoria, South Africa. He is a renowned author.
Mary Wanjiru Kinoti is a Professor and a certified behavioral scientist and axiologist from the
United States of America, and is Associate Dean at the School of Business, University of Nairobi,
Kenya. She holds a PhD Degree in Business Administration from the University of Nairobi, Kenya,
and an MBA-Marketing and BCom Finance and Economics from India. She has co-authored other
book chapters, among them “Women Empowerment through Government Loaned Entrepreneurship
Teams in Kenya” in Research Handbook on Entrepreneurial Teams: Theory and Practice, Edward
Elgar Publishing, and The Business Case for Climate Change: The Impact of Environmental forces
on Kenya’s Public Listed Companies, Emerald Group Publishing Limited.
x About the Editors and Contributors
Philip Afeti Korto is a seasoned Ghanaian Health Service Administrator who has been working
in the Ghana Health Service for over a decade. He holds a BSc Administration (Health Service
Administration option) from University of Ghana Business School (UGBS). He also holds a Master
of Public Administration from the Ghana Institute of Management and Public Administration
(GIMPA). He has worked as the Head of Administration and Support Services at three different hos-
pitals and he currently works in the same capacity at Achimota Hospital. He once worked at Ridge
Hospital as a junior Administrator. He has some publications to his credit and is currently writing a
text book on Hospital Administration in Ghana. He occasionally gives practical lectures at UGBS.
He is an active member of the Association of Health Service Administrators, Ghana (AHSAG).
Mahmoud Abdulai Mahmoud is a Senior Lecturer in the Department of Marketing and

Entrepreneurship, University of Ghana Business School. He is also a Senior Research Fellow in the
Department of Marketing Management, University of Johannesburg, South Africa. Mahmoud holds
a Doctorate Degree from the University of Ghana. He has a number of peer review journal publica-
tions to his credit. He has consulted and trained several institutions in the areas of marketing, sales,
and customer service.
Gwendolyn Mensah is a Lecturer in the Adult Health Department, School of Nursing and Midwifery,
College of Health Sciences, University of Ghana. She took her PhD at the then Nelson Mandela
Metropolitan University, now Nelson Mandela University, from 2014 to 2017. She enrolled onto
the MPhil program in 2010, completing it in 2012, and the BA Nursing with Psychology in 2004,
completing in 2007, all at the University of Ghana. She was trained as a State Registered Nurse and
a Registered Midwife in 1992 and 1996 respectively. She has been a nurse/midwife for 27 years and
a Deputy Director of Nursing Services.
Obinna S. Muogboh is Faculty Member and Head of the Operations Management Department,
Lagos Business School (LBS), Pan-Atlantic University, Lagos. He was Director of the Doctorate
program and served as Managing Editor of LBS Management Review. Dr Muogboh also served
as the Chief Executive Officer of Jess-NP limited, a Nigeria-based manufacturing firm. He also
worked as Researcher at the Automation and Robotics Laboratory, and the Center for e-Design and
Realization, University of Pittsburgh, USA. He was an International Fellow at INSEAD, France,
and in the Open University, UK. He has consulted for various organisations, including multilateral
agencies such as UNIDO. His research is in the area of manufacturing management, logistics, and
operations strategy. His work has been published in many international journals. He received his
MSc and PhD in Industrial Engineering from the University of Pittsburgh, USA. He received his
BEng in Electronic Engineering from the University of Nigeria, Nsukka.
John Muriithi is currently Deputy Vice Chancellor at Riara University, Nairobi, Kenya. Dr. Muriithi
is a proven leader in the corporate world and also has impressive teaching and management cre-
dentials at various universities. John was CEO of the Mater Hospital, Nairobi, Kenya (2008–2015).
Between 2001 and 2004, John served as Chief Executive of SC Johnson East Africa as well as on
the management board of SC Johnson sub-Saharan Africa. John has taught marketing and strategic
change management in executive education and MBA programs at Strathmore Business School
since 2009. Dr. Muriithi holds a Doctorate in Business Administration from the California School
of Business and Organizational Studies, an MBA from USIU, Nairobi, and a BEd (Chemistry) from
the University of Nairobi.
Michael Nkrumah holds an MSc Marketing and a Postgraduate Certificate in Business

Administration from Ghana Institute of Management and Public Administration. He is an adjunct
lecturer in marketing with the same institute. He manages a startup called SnooCODE, a fit-for-
purpose addressing system for individuals and businesses across the developing world. Michael
About the Editors and Contributors xi
Nkrumah also has experience in the advertising field, planning media campaigns for consumer
brands such as McVities, Beiersdoff (Nivea), GlaxoSmithKline (Lucozade, Panadol, Sensodyne,
Colart), and Merck SevenSeas. Michael’s research interests include both qualitative and quantita-
tive approaches in exploring positioning strategies for service brands and B2B firms, issues pertain-
ing to religious influence on customer orientation and perceptions of value, conceptualizing brand
love for service brands, and the relationship between corporate reputation and brand crisis. Michael
has published in international peer-reviewed journals.
Adaeze Nworie is a Registered Nurse with over 20 years of experience in Healthcare. She also has
an MBA in Marketing and Supply Chain from Penn State University, USA. Based in the United
States, she started Protem Homecare, a Medicare-certified homecare agency, in 2006, Protem
Hospice in 2014 and, more recently, Alliant Treatment Center in 2017. She is currently enrolled in
a Doctor of Nursing Practice (DNP) program at the Ohio University in Athens, Ohio.
Michael Boadi Nyamekye (PhD) is a Lecturer at the University of Professional Studies, Accra,
Ghana. The focus of his research is in the area of innovation, nonprofit marketing, service market-
ing, and strategy.
Raphael Odoom (PhD) is a research associate in the Department of Marketing Management,

University of Johannesburg, and is currently with the Department of Marketing and Entrepreneurship
at the University of Ghana Business School. His research interests are in the areas of branding, digi-
tal marketing, and small business management. He has published in the International Journal of
Contemporary Hospitality Management, Journal of Enterprise Information Management, Journal
of Product and Brand Management, Qualitative Market Research: An International Journal and
Marketing Intelligence and Planning, among others.
Lillian Akorfa Ohene is a registered nurse with several years of teaching experience in basic and
advanced nursing. As a lecturer in the Department of Community Health Nursing, University of
Ghana, Lilian holds a Bachelor of Science, Master of Philosophy and a PhD, all in Nursing. She spe-
cialized in the field of paediatric nursing and was a beneficiary of a Queen Elizabeth II Scholarship.
Dr Ohene is the Faculty Counsellor, Sigma Theta Tau, Chi Omicron Chapter at the University of
Ghana, a Foundation Fellow, Ghana College of Nurses and Midwives, and a member of the West
African College of Nurses and Midwives.
Emmanuel Okunga Wandera is a medical doctor with a specialization in Applied Epidemiology. He

currently serves in the Division of Disease Surveillance and Epidemic Response as Head of Epidemic
Preparedness and Response and also Public Health Emergency Operations Centre Manager in Kenya.
Oluwayemisi Olomo is a doctoral candidate in Marketing at Lagos Business School, Nigeria and an
Adjunct Lecturer at Pan-Atlantic University, Nigeria, where she teaches marketing to undergraduate
students. Her research interests include health branding, corporate branding, corporate communica-
tions, and social media marketing.
Ellis L.C. Osabutey is a Reader in International Business, Strategy and Technology Transfer at
Roehampton Business School, University of Roehampton. His research interests include Foreign Direct
Investment and Technology Transfer; Innovation, Technology, and Development; and Institutional
Influences on International HRM/D and Marketing. His current research aims to produce critical and
unique research outputs that can, distinctly, bring out nuanced African and non-African contexts to pro-
mote evidence-based policy-making in developing countries and Africa. Ellis has published articles in
journals such as the Journal of World Business, Journal of Business Research, International Journal of
Contemporary Hospitality Management, Technological Forecasting and Social Change, etc.
xii About the Editors and Contributors
Kofi Osei-Frimpong is a Senior Lecturer in Marketing at the Ghana Institute of Management and
Public Administration (GIMPA) Business School, Accra, Ghana. He received his PhD from the
University of Strathclyde, Glasgow, UK. Kofi is also a Research Fellow at the Vlerick Business
School, Belgium. His research interests include value co-creation in healthcare service delivery,
customer engagement practices, social media use, online live chat, and artificial intelligence. He
is published in high impact journals such as Computers in Human Behavior, Journal of Business
Research, Technological Forecasting and Social Change, the International Journal of Retail &
Distribution Management, Journal of Marketing Theory and Practice, Journal of Service Theory
and Practice, and Journal of Nonprofit and Public Sector Marketing, and he has also presented
papers at international service research conferences.
Olutayo Otubanjo is a Senior Lecturer at The Lagos Business School, where he teaches full time
and presents executive MBA modules in marketing management. He was a Visiting Research
Fellow at The Warwick Business School, University of Warwick (UK) and was in a similar capacity
at The Spears School of Business, Oklahoma State University, USA. He holds a PhD in Marketing
with an emphasis on corporate identity. Otubanjo attended the University of Hull (UK) and Brunel
University, London. He has published in the Academy of Marketing Science Review; Tourist Studies;
Management Decisions; Marketing Review; Journal of Product and Brand Management; Corporate
Reputation Review; Corporate Communications: An International Journal etc. His research inter-
ests sit at the interface between social constructionism, on the one hand, and the elements of corpo-
rate marketing including corporate branding, corporate identity, corporate reputation, corporate
communications cum corporate PR, on the other. He was at one time in his practitioner career,
Director of Strategy and Account Planning at FCB Nigeria.
Nana Owusu-Frimpong is a Professor of Marketing at the Ghana Institute of Management and

Public Administration (GIMPA) Business School, Accra, Ghana. He received his PhD in Marketing
from Durham University, UK. He has published extensively in leading academic journals such as
the Journal of Business Research, International Business Review, Technological Forecasting and
Social Change, Journal of Services Marketing, the Services Industry Journal, Journal of Retailing
and Consumer Services, and Thunderbird International Business Review. He has published in the
areas of financial/services marketing, consumer behavior, international marketing, foreign direct
investment in emerging markets, and customer relations management.
Gideon L. Puplampu holds a PhD in Nursing Education and Research from the University of
Alberta, Canada. His interest in global health trends and healthcare consumerism makes him an
interesting author on the subject. Gideon received a lifetime international award in 2013 from
Golden Key International as an outstanding scholar. Gideon is currently a lecturer at the School of
Nursing and Midwifery, University of Ghana, Legon. His specialty area is in mental health nursing
with a focus on HIV, hope, and healthcare consumers’ behaviors. Gideon has authored several peer
review articles.
Ibelema Sam-Epelle is currently a Doctorate of Business Administration (DBA) candidate at the

University of Gloucestershire. His current research interest involves the behavioral aspects of indi-
vidualised information systems. In fulfilment of an MSc in International Business, he independently
developed a social media marketing strategy for a carpooling startup in the United Kingdom and has
since co-authored a book chapter on smartphones. Over the years, Ibelema has also contributed at
Mobility Arena, one of West Africa’s revered technology-oriented online resources.
Nii Norkwei Tackie is Research Assistant at the Marketing and Entrepreneurship Department of
the University of Ghana Business School. His research interests include consumer behavior, social
media, marketing analytics, and big data.
About the Editors and Contributors xiii
Ernest Yaw Tweneboah-Koduah is a senior lecturer at the University of Ghana Business School.
He obtained his Doctor of Philosophy (PhD) degree from London Metropolitan University, UK.
His teaching and research interests include social marketing, health marketing, services market-
ing and political marketing. He has published in peer-reviewed international journals including the
Journal of Social Marketing; African Journal of Economics and Management Studies; Journal of
Hospitality Marketing and Management; Journal of Small Business and Enterprise Development;
Journal of African Business; Journal of Nonprofit and Public Sector Marketing; and Health
Marketing Quarterly.
Andrews Agya Yalley is a marketing lecturer at the University of Cape Coast, Ghana. He received
his PhD in Marketing from the University of Coventry, United Kingdom. His research focuses on
service marketing, co-production, political and religious marketing, and sustainability marketing.
His research has been published in refereed journals and other international marketing conference
proceedings.
Acknowledgments
The authors acknowledge the support of all the reviewers who gave constructive feedback to the
chapter authors. The authors also acknowledge the Development Policy Poverty Monitoring and
Evaluation Centre of Research Excellence at the University of Ghana and the Skills Development
Fund as well.
xv
1 Introduction to Healthcare
Service Marketing
Management
Building Customer-Driven
Health Organisations
Robert Ebo Hinson, Kofi Osei-Frimpong,
Ogechi Adeola, Lydia Aziato
INTRODUCTION
Healthcare services are considered the backbone of society and human wellness. The recent insti-
tutional transformations in the healthcare services have enormous potential for research and the
sector is fast becoming an exciting field of inquiry for marketing and management scholars. Given
that marketers are concerned about the creation of value for customers, one of the latest trends in
the healthcare sector in Africa is the application of tested and established principles of value crea-
tion in mainstream marketing to the healthcare sector. However, this remains a grey area which
requires a comprehensive understanding and application of mainstream marketing and manage-
ment principles. As a result, this book presents contemporary and thoughtful insights to address
marketing and management related principles in healthcare delivery within the African context.
Healthcare services are considered the backbone of society and human wellness. In recent times,
these services have undergone extensive institutional transformation (Danaher and Gallan, 2016).
Within the context of this transformation, marketing, service quality and value creation enhance
the service experience of healthcare customers (Osei-Frimpong, 2016). For example, Sahoo and
Ghosh (2016) identified service delivery, amongst others, as a significant contributor to enhancing
customer satisfaction in private healthcare delivery. It is notable that the healthcare industry has
enormous potential and is fast becoming an exciting field of endeavour for marketing practition-
ers. Given that marketers are concerned about the creation of value for customers, one of the latest
trends in the healthcare sector is the application of tested and established principles of value crea-
tion in mainstream marketing to the healthcare sector.
Stremersch (2008) notes that the application of marketing to healthcare is a fascinating field
that will likely have more impact on society than any field of marketing. He further states that an
intrinsically unstable environment characterises this very relevant emerging field, hence raising
new questions. Changing regulations, discoveries and new health treatments continuously appear
and give rise to these questions. Furthermore, advancements in technology not only improve the
healthcare delivery systems but also provide avenues for customers to seek information regard-
ing their health conditions and influence their participatory behaviours or changing roles in the
service delivery (Osei-Frimpong, Wilson and Lemke, 2018). Increasingly, there is a shift from the
doctor-led approach to a more patient-centred approach. About a decade ago, Kay (2007) argued
that healthcare organisations need to utilise marketing tools more effectively for customer infor-
mation and assistance in their healthcare decisions. This effort can only be achieved by healthcare
1
2 Health Service Marketing Management in Africa
organisations that promote increased accessibility of care and improved quality of service. Kay
(2007) argued these points from the perspective of the US-based healthcare system described as
“market-based”.
In Africa, the importance of marketing-d riven practices in improving the delivery of healthcare
services cannot be overemphasised. The issue of healthcare delivery and management is significant
for policymakers, private sector players and consumers of health-related services in developing
economy contexts. Scholars have strongly argued in favour of marketing and value creation in
healthcare service delivery in Africa (i.e. Wanjau, Muiruri and Ayodo, 2012; Mahmoud, 2016;
Osei-Frimpong 2016). For instance, in Ghana, Osei-Frimpong (2016) advocated for healthcare ser-
vice providers to understand patient needs or goals and adopt a holistic engagement approach that
would result in positive experiences. Customer experience affects the perception of service qual-
ity and acceptability of healthcare services. In South Africa, Hasumi and Jacobsen (2014) found
that long waiting times, unavailable medications and staff who are perceived as being unfriendly
affected the acceptability of healthcare services. In Egypt, Shafei, Walburg and Taher (2015) iden-
tified areas of shortfall in service quality as including physician reliability, physician assurance,
nursing reliability and nursing assurance. In the Nigerian context, Adepoju, Opafunso and Ajayi
(2018) found that patients were not satisfied with the quality of service in most of the dimensions
assessed (i.e. assurance, reliability, tangibles, empathy and responsiveness). In a study on factors
affecting service quality in the public health sector in Kenya, Wanjau, Muiruri and Ayodo (2012)
found that low employee capacity, low technology adoption, ineffective communication channels
and insufficient funding affect service quality delivery to patients, thus influencing healthcare
service quality perceptions, patient satisfaction and loyalty. These examples of healthcare service
marketing research, in the present contexts, highlight the need to utilise marketing and value crea-
tion tools in the delivery of healthcare services. Furthermore, there is a need for the integration of
service marketing and management principles to enhance the delivery of quality healthcare across
Africa and other developing economies. Therein lies the critical importance of this book.
Drawing on the above discussions, this new book on Health Service Marketing Management
responds to calls for quality healthcare service management practices or processes from develop-
ing economy perspectives. Focusing primarily on Africa, this book covers seven thematic areas,
namely: Strategy in Healthcare; Marketing Imperatives in Healthcare Management; Product and
Pricing Management in Healthcare; Distribution, Marketing Communications and Branding in
Healthcare; People, Physical Evidence and Service Quality Management in Healthcare; Process
Management in Healthcare; and Technology in Healthcare.
BOOK THEMATIC AREAS

This book takes a holistic view of the healthcare service delivery by integrating key concepts that
could enhance the performance of the sector from the perspective of the healthcare organisation,
professionals and customers. In particular, the book advocates for a need for healthcare organisa-
tions and professionals to reorient to understand the changing customer better. This also suggests
a need for healthcare organisations to improve on their engagement with customers to ensure a
holistic experience. In contributing to the growth and development of the healthcare industry in
Africa, this book offers a comprehensive understanding of how the healthcare service sector could
be managed to ensure sustainability, competitiveness and overall value creation.
The book is divided into seven parts as summarised in the following sections:
Strategy in Healthcare
The first part of this book discusses two important topics, namely, the societal and healthcare
context, and strategic planning and healthcare services. In Chapter 2, Aziato, Ohene and Adjei
discuss the societal and healthcare context. This chapter sheds light on the integrated literature of
Introduction to Healthcare Marketing Management 3
healthcare and positions healthcare in the context of changing societal factors such as globalisation,
economic factors, technological factors, cultural revolution, the consumerist customer and some
key healthcare developments. The authors argue that despite the milieu of challenges in African
healthcare, healthcare professionals should improve their orientation toward the changing societal
context, in particular the cultural diversity within the continent, and promote services that will
enhance customer satisfaction. Chapter 3, by Adeola and Adisa, addresses the issue of strategic
planning and healthcare services. This chapter examines the nature of the market and how a stra-
tegic planning process can be used to solve the challenges associated with marketing healthcare
delivery in Africa. The authors affirm the importance of strategic plans in improving healthcare
delivery and call for a need for healthcare organisations to develop strategic plans that respond to
the changing dynamics of the environment in order to create a healthcare sector that understands
the needs of the people. The chapter further sheds light on the relevance of integrating intensive
research in assessing the internal/external environments of the healthcare organisation to guide the
development of strategic plans and their effective implementation.
Marketing Imperatives in Healthcare Management

The second part of the book addresses some key marketing concepts as applied in healthcare man-
agement. Anning-Dorson, Tackie and Nyamekye explore marketing in healthcare management in
Chapter 4. They explain the critical role of marketing in healthcare management and offer some
considerations of the strategic value of marketing to healthcare and how it could be adopted by
entities operating in the healthcare space. The chapter argues that while the marketing concept
was not a priority of healthcare organisations in the past, the changing market conditions and
growing competition have made the adoption of marketing principles and philosophies relevant in
today’s healthcare environment. Chapter 5, by Adeola, Ehira and Nworie, discusses segmentation,
targeting and positioning (STP) in the healthcare sector by clearly explaining the approaches to the
market segmentation process for healthcare services and the factors to be considered in selecting
a healthcare target market. The chapter contends that STP informs the identification of needed
healthcare niches and as a result contributes to the proper management of expectations, increased
patient satisfaction and proper allocation of limited resources. The final section of this chapter dis-
cusses consumers and consumer behaviour in healthcare services management. Hence, Chapter 6,
by Puplampu, Fenny and Mensah, describes the major features of consumers and consumer behav-
iour in healthcare delivery and the factors and models associated with consumers and consumer
behaviour. They argue that while consumers’ behaviour is influenced by a number of factors, the
decision to purchase healthcare services or equipment is becoming a complex phenomenon due to
the changing nature of healthcare consumers as they become more knowledgeable and enlightened
and have increased expectations. In light of this, the chapter offers some recommendations to guide
healthcare professionals in the discharge of their duties.
Product and Pricing Management in Healthcare

The third part of the book discusses healthcare products and pricing management. Muriithi,
Kinoti, Okunga and Kinoti discuss healthcare product management in Chapter 7. The chapter
explicates the complex nature of the healthcare product and evaluates related marketing issues.
The chapter addresses two broad categories of the healthcare product: (1) pharmaceutical prod-
ucts as well as medical technology devices; (2) marketing of healthcare services by hospitals
and healthcare providers. In Chapter 8, Acheampong and Agyeman-Boaten provide an in-depth
discussion on the utilisation and pricing of healthcare services. This chapter deliberates on
the demand for healthcare services, its prediction and factors that influence this demand, and
explores the various pricing strategies being used in healthcare services. The authors acknowl-
edge the significant improvements in healthcare demand and supply in recent years in developing
countries, but stress that more work needs to be done to improve upon all aspects of healthcare
in developing countries.
Distribution, Marketing Communications and Branding in Healthcare

This part of the book also focuses on the distribution of healthcare products, marketing com-
munications strategies in healthcare services and branding strategies in healthcare management.
Chapter 9, by Mahmoud, presents an extensive literature review on distribution in healthcare
markets. The chapter reveals multiple healthcare distribution systems in the healthcare markets.
Among the different distribution systems are centralised and decentralised systems, supply chain
arrangements, public and private participation arrangements, producers, purchasers and providers.
The chapter also highlights a number of recommendations to improve the efficient and effective
distribution of healthcare markets in Africa. Application of integrated marketing communications
in the healthcare sector, with insights from sub-Saharan Africa (SSA), is the focus of Anambane
and Hinson’s contribution in Chapter 10. The chapter explores how healthcare providers, particu-
larly hospitals in SSA, use the various marketing communication mixes of advertising, public
relations, sales promotion, direct/digital marketing and personal selling. The chapter argues that
while marketing communication tools like public relations, direct/digital marketing and advertis-
ing have been fairly well used by hospitals in the context under consideration, sales promotion and
personal selling are yet to be widely embraced in the sector. The authors provide insights into the
application of the marketing communication mix elements as a strategic tool in healthcare man-
agement. The effectiveness of the communication of healthcare institutions is likely to contribute
to the branding of healthcare organisations. Following this, Chapter 11 by Olomo and Otubanjo
sheds light on the concept of healthcare branding, which is increasingly becoming important in
the light of competing health choices for consumers and emerging socio-economic trends across
the African continent. The chapter adopts the theoretical perspective of social constructionism and
provides detailed insights into how co-creation of knowledge occurs between various parties in
the health brand promise. Effectively, the authors explicate the brand-building process, the benefits
of branding and its relevance to sub-Saharan Africa healthcare. Further, Chapter 12 examines the
importance of branding in small and medium-sized healthcare institutions. In this chapter, Odoom
and Agyeman contend that branding is not an exclusive preserve of large healthcare institutions
only, but also a crucial function for small healthcare service providers, especially in sub-Saharan
Africa, to build their brand and boost their market performance. The authors focus on Gelb’s brand
trust model and present four brand-building strategies for small healthcare organisations to include
consistent experience, competitive differences, customer value and familiarity.
People, Physical Evidence and Service Quality Management in Healthcare

The fifth part of the book discusses in detail both the healthcare employee and management of
the physical evidence and service quality in healthcare to create a unique customer experience.
Chapter 13, by Yalley, discusses a need to consider managing healthcare employees as a strategic
tool for healthcare organisations in building customer-d riven service. The chapter highlights
managing healthcare employees as a key challenge for African healthcare organisations. A num-
ber of human resource management (HRM) challenges facing African healthcare organisations,
as well as some strategic interventions, are discussed in detail. Further, Hinson and Nkrumah
discuss the physical evidence and healthcare service quality management in Chapter 14. The
chapter brings to the fore the importance of service quality in healthcare through the lenses of
healthcare customers by drawing on its effect in improving overall service quality for custom-
ers and success for healthcare organisations. This chapter also elaborates on the need to give
attention to customer perception variables as well as leverage their rich insights to create mod-
els of continuous improvement in quality healthcare delivery. Chapter 15, by Osei-Frimpong,
Introduction to Healthcare Marketing Management 5
Asante, Nkrumah and Owusu-Frimpong, discusses how healthcare organisations could develop
customer loyalty in the healthcare sector. The chapter seeks to deepen our understanding of
customer relationship management techniques and practices in healthcare, with particular inter-
est in outlining strategies to be adopted by healthcare providers to enhance customer participa-
tion and improve customer satisfaction, experience and loyalty. The authors bring to light the
changing roles of the healthcare customer and discuss how care should be delivered to promote
customer loyalty. The chapter also advocates for cooperation between the healthcare professional
and the customer in co-creating healthcare, and for a holistic service delivery that could result
in overall positive experiences.
Process Management in Healthcare

The sixth part of the book discusses issues relating to healthcare financing and insurance, health-
care logistics management and policies and procedures in healthcare management. In Chapter 16,
Baku discusses financing healthcare and health insurance. This chapter sheds light on the tools
and skills needed to effectively manage the finances of a healthcare organisation and understand
the operations of health insurance schemes. Given the increasing cost of financing healthcare,
it becomes imperative to understand the strategic and sustainable management of the financial
resources in healthcare organisations. The author argues that the method of financing healthcare
has implications for the marketing of the service as well as the satisfaction healthcare customers
derive from the service. Further, Muogboh and Fatoki shed light on managing healthcare logistics
in Chapter 17. This chapter provides details of how healthcare service providers in sub-Saharan
Africa utilise and integrate human resources, facilities and equipment in the best possible way to
meet their need to achieve the physical, mental, emotional and social wellbeing of their custom-
ers. It explicates the critical importance of logistics management activities in sub-Saharan African
healthcare industries as well as the organisation and maintenance of healthcare facilities and equip-
ment. The authors argue that improving the efficiency and effectiveness of the healthcare industry
requires the harnessing of resources to ensure fragmented activities are efficiently linked in a pro-
active and dynamic manner through the use of innovative logistics practices to address the peculiar
challenges of healthcare delivery in sub-Saharan Africa. The final chapter of this section, Chapter
18, authored by Korto, deepens healthcare management scholars’ and practitioners’ understanding
of health policy procedures with regard to their day-to-day operations and will serve as reference
material for them. The chapter asserts with a significant margin of certainty that regardless of how
comprehensive, well-articulated, sound or good an adopted public policy may appear on paper, it
is of no use unless the policy is effectively implemented by street-level bureaucrats to solve the
societal problem(s) identified. Emphasis is placed on important topics such as policy articulation
and healthcare delivery; characteristics of effective policy; ways of stating policy; and compiling
and communicating policy.
Technology in Healthcare
Advancements in technology not only improve the healthcare delivery systems but also provide
avenues for customers to seek information regarding their health conditions and influence their
participatory behaviours or changing roles in service delivery. As a result, this part of the book
is dedicated to addressing technological issues and related applications in healthcare delivery.
Chapter 19, by Appiah, Sam-Epelle and Osabutey, discusses technology and health services mar-
keting in Africa. In this chapter, the authors explore how technology is impacting developments
in the African healthcare sector – with a keen focus on health service quality. The chapter also
highlights some current challenges facing the healthcare sector in Africa, and how entrepreneurs in
some of these countries are innovatively overcoming some of these obstacles, mainly with low-cost
solutions and strategies. Relatedly, Chapter 20 discusses the application of technology in healthcare
delivery in Africa. Tweneboah-Koduah and Gli present an overview of the role of technology in the
delivery of healthcare in sub-Saharan Africa. The chapter clearly highlights opportunities which
information technology presents for improving quality of life on a continent that is geographi-
cally dispersed and coupled with high rate of poverty. Furthermore, the chapter captures some
top technological trends advancing efficient healthcare delivery in Africa such as telemedicine,
virtual reality, mobile financial services, and cloud technology, internet of things, drone technol-
ogy, counterfeit detectors, artificial intelligence (AI) and digital communication tools. Chapter 21,
the final chapter of the book, by Odoom and Agyeman, touches on technology and social media in
healthcare delivery. This chapter discusses the role or opportunities that social media and health-
care technology can offer to the healthcare system, innovation and improvement. It highlights some
types of healthcare technologies that will guide research and development, along with some current
examples. Some action steps are also suggested to influence the adoption of technology into routine
health practices in sub-Saharan Africa.
CONCLUSION
This book presents significant insights into healthcare service delivery by applying key marketing
and management principles to enhance performance, sustenance and wellbeing. The book show-
cases a number of illustrations of best practices and also highlights some challenges within the
African healthcare sector. One unique aspect of this book lies in the discussion of forward-looking
recommendations and strategies that seek to transform the healthcare service sector. Overall, this
contemporary book seeks to serve as a reference resource to practitioners of a sector that has been
largely neglected within the developing country contexts.
REFERENCES
Adepoju, O. O., Opafunso, Z., and Ajayi, M. (2018). Primary health care in South West Nigeria: evaluat-
ing service quality and patients’ satisfaction. African Journal of Science, Technology, Innovation and
Development, 10(1), 13–19.
Danaher, T. S., and Gallan, A. S. (2016). Service research in health care: positively impacting lives. Journal of
Service Research, 19(4), 433–437.
Hasumi, T., and Jacobsen, K. H. (2014). Healthcare service problems reported in a national survey of South
Africans. International Journal for Quality in Health Care, 26(4), 482–489.
Kay, M. J. (2007). Healthcare marketing: what is salient? International Journal of Pharmaceutical and
Healthcare Marketing, 1(3), 247–263.
Mahmoud, A. M. (2016). Consumer trust and physician prescription of branded medicines: an exploratory
study. International Journal of Pharmaceutical and Healthcare Marketing, 10(3), 285–301.
Osei-Frimpong, K. (2016). Examining the effects of patient characteristics and prior value needs on the patient-
doctor encounter process in healthcare service delivery. International Journal of Pharmaceutical and
Healthcare Marketing, 10(2), 192–213.
Osei-Frimpong, K., Wilson, A., and Lemke, F. (2018). Patient co-creation activities in healthcare service deliv-
ery at the micro level: the influence of online access to healthcare information. Technological Forecasting
& Social Change, 126(January), 14–27.
Sahoo, D., and Ghosh, T. (2016). Healthscape role towards customer satisfaction in private healthcare.
International Journal of Health Care Quality Assurance, 29(6), 600–613.
Shafei, I., Walburg, J. A., and Taher, A. F. (2015). Healthcare service quality: what really matters to the female
patient? International Journal of Pharmaceutical and Healthcare Marketing, 9(4), 369–391.
Stremersch, S. (2008). Health and marketing: the emergence of a new field of research. International Journal
of Research in Marketing, 25(4), 229–233.
Wanjau, K. N., Muiruri, B. W., and Ayodo, E. (2012). Factors affecting provision of service quality in the pub-
lic health sector: a case of Kenyatta national hospital. International Journal of Humanities and Social
Science, 2(13): 114–125.
2 The Societal and
Healthcare Context
Lydia Aziato, Lillian Akorfa Ohene, Charles Ampong Adjei
2.1 INTRODUCTION
Healthcare has a globally understood definition of being aimed at achieving optimal health for
all individuals across the life span. There are cultural variations across each society that influ-
ence the healthcare choices and practices used in that specific area. The cultural variations in the
African context have led to a lot of disparities in healthcare services. For example, religiosity and
use of unsafe traditional medicine have negatively impacted access to healthcare services in many
African communities. Healthcare is dynamic and modern technology has led to many innova-
tions and advanced techniques in health. This requires that healthcare institutions in Africa should
improve and develop their infrastructure and equipment to meet global standards as well as pro-
vide high-level training of healthcare professionals. The explosion of information made available
by medical research and the worldwide web has created highly informed clients even within the
African context. Thus, the dynamics and competition in healthcare demand a closer discourse and
understanding of the societal factors that influence healthcare.
2.2 THE EMERGENCE OF HEALTHCARE AS AN INSTITUTION

Over the decades, healthcare institutions evolved from charitable guesthouses to hospitals, some
of which are now huge scientific centres of excellence. The changes in health institutions were
influenced by factors such as the evolving meaning of diseases, economic and geographic related
factors, religion and race, living conditions of individuals, technological growth, and the per-
ceived needs of societies (Risse, 1999). In the eighteenth century, medical and surgical interven-
tions expanded in such a way that hospitals took over the physical spaces of churches (Andrews,
2011). By the nineteenth century, hospitals became so widely known and commonly frequented
by patients that they began to be constructed with industrial proportions, able to have thousand-
bed capacities. France, for example, in the early 1800s was noted for the large bed capacity of its
hospitals, which housed wounded soldiers from the frequently occurring European wars fought
in and around French territory. It was reported that such hospitals were the first teaching institu-
tions of medical science for the training of physicians. The Florence Nightingale model School of
Nursing which influenced the training of nurses globally was established within King’s College,
London, England in 1860 (Karimi & Masoudi Alavi, 2015). Nursing is one of the oldest professions
in healthcare and has its values and practice linked to Christianity, in which care and help for the
vulnerable is a practice of the faith (Bullough, 1994). In the early years, communities began estab-
lishing health institutions to manage communicable diseases such as leprosy. The formal training
of health professionals arose during the medieval and early renaissance eras (Weakland, 1992),
replacing the initially dominant extremely superstitious practices of the Roman Catholic Church.
Historically, it was believed that highly skilled Muslim doctors from the Middle East drove the
7
training and education of contemporary health professionals, which increased the hope of recovery
for the sick (Weakland, 1992).
For the greater part of the nineteenth century, it was common practice for physicians to attend to
middle-to-upper-income patients in their homes, rendering institutional care mostly for the socially
marginalised and the poor (Wall, 2013). However, during the latter part of the century, societies
became increasingly more industrialised and mobile. Medical practice also continued to evolve in
a more sophisticated and complex manner (Sather, 1992; Stone, 1984). The introduction of indus-
trial medical equipment and intricate procedures thus gave rise to the wider patronage of hospitals
across classes, as complex care could not be given in the home. This resulted in the gradual shift
towards professionalism of healthcare services and then a competitive care environment which
contributed to the development of modernised hospitals (Bullough, 1994; Risse, 1999).
Fast forwarding to the early twentieth century, the power of science has impacted heavily on
decisions and practices of hospitals (D’Antonio, Connolly, Wall, Whelan, & Fairman, 2010). In
the contemporary twenty-first century, economic factors continue to dominate and direct the
establishment and operations of healthcare institutions (Swain, 2016). The economic variations
between regions have reinforced disparities in the establishment and practices of health institu-
tions. Therefore there is the need to look at globalisation as a key player in healthcare delivery.
2.3 GLOBALISATION
In recent times, healthcare industries have been increasingly challenged by globalisation. The
demand for good health for all populations and the progressive interconnectedness of countries
around the globe (Huynen, Martens, & Hilderink, 2005) appear to account for some of these
changing global trends. Given the effect of globalisation on every aspect of society (Mittleman &
Hanaway, 2012; Segouin, Hodges, & Brechat, 2005; Walpole et al., 2016), this section describes
the implications of globalisation, particularly for the healthcare industries, and how healthcare
organisations could derive maximum benefits from this global transformation occurring at an
unprecedented rate over the past decades. Various scholars have tried to delineate the concept of
globalisation which has informed the development of several frameworks (Huynen et al., 2005;
Woodward, Drager, Beaglehole, & Lipson, 2001). Some of the scholars tried to explain the linkages
between globalisation and health (Woodward et al., 2001) and others sought to identify the features
of globalisation (Huynen et al., 2005). Nevertheless, globalisation remains a complex phenomenon
which has attracted different opinions in the past century, particularly as to how it happens, its
main drivers, and its actual timeframe (Lee, 2004).
The most critical discussion in the academic and policy circles centres on whether globali-
sation is good or bad for human health (Lee, 2004). From the perspective of the World Health
Organisation (WHO, 2019a), globalisation presents both positive and negative effects on health. In
fact, the frequently changing trend of disease occurrence places much emphasis on the global uni-
fication, integration, and cooperation which are key benefits of globalisation (Ergin & Akin, 2017).
In the healthcare environment, globalisation has led to improved medical care in many countries
(Murphy, 2007). For example, the development of new medicines, advancements in medical inves-
tigations, and adoption of equipment which influences the care of patients have all occurred due to
globalisation. Now, medical inventions such as the computerised tomography (CT) scan and less
invasive surgical interventions are becoming common in most locales including Africa. Although
the CT scan was invented in 1972 by engineer Godfrey Hounfield in England and a physicist Allan
Cormack in the United States, due to globalisation it has spread worldwide (Castillo, 2012).
Globalisation can also have negative effects on economies and societies, especially those of
low-income countries (Aluttis, Bishaw, & Frank, 2014; Kalipeni, Semu, & Mbilizi, 2012; Kasper
& Bajunirwe, 2012). A typical negative consequence of globalisation is the migration of healthcare
providers from low-income countries with poorer economic conditions to high-income countries
(Kalipeni et al., 2012; Kasper & Bajunirwe, 2012; WHO, 2019a). In many countries, the migration
The Societal and Healthcare Context 9
phenomenon deprived these poorly resourced countries of their critical health staff, which to date
appears to have had adverse effects on their health systems. It is estimated that 56 per cent of
Ghanaian trained doctors and 24 per cent of nurses are working in high-income countries within
Europe and North America (International Organisation for Migration, 2009). These and other fac-
tors might be accounting for the reduced competitive advantage of African countries in the inter-
national market within the healthcare industry. It is therefore crucial that these countries explore
more proactive interventions to build customer-d riven health organisations paying particular atten-
tion to the societal and the healthcare context.
Establishing attractive markets in today’s healthcare industry requires the provision of top-
notch services that meet the needs and demands of consumers irrespective of their geographical
location. This opinion has previously been expressed by Segouin et al. (2005) who believed that the
provision of quality healthcare at a lower cost could be to the benefit of low- and middle-income
countries. Countries in Africa ought to commit more resources to research to validate the effec-
tiveness of the available indigenous medicinal plants by drawing lessons from China where herbal
medicines are integrated into the formal health system and remain attractive to the global commu-
nities. Lessons can also be drawn from countries such as Iran and India that are known to provide
affordable and quality medical services that attract diverse healthcare consumers from different
parts of the world. However, the realisation of these benefits can only happen when low-income
countries, particularly those in Africa, build a strong health delivery system.
2.4 THE INFLUENCE OF ECONOMIC FACTORS ON HEALTHCARE SERVICES

Healthcare utilisation and access has been explored by previous researchers (Andersen & Newman,
2005). Ostensibly, individuals in low-income countries tend to have limited access to health ser-
vices as compared to those in high-income countries (Peters et al., 2008). Cost of service delivery
remains an important contributor to the low and sub-optimal uptake of healthcare services, espe-
cially in deprived areas (Hangoma, Robberstad, & Aakvik, 2018; Lagarde & Palmer, 2008; Smith
et al., 2018). However, there is a paradigm shift of global attention toward universal health cover-
age with one of the key objectives focusing on protection of individuals from financial risk (WHO,
2019b). This initiative is very crucial given the significant role the economic environment plays on
the determinants of the population’s health (WHO, 2019c).
Economic inequality is more prevalent in the low-income countries than in high-income coun-
tries (Derviş & Qureshi, 2016). In fact, the expenditure on health in low-income countries was
estimated to be 5 to 15 per cent of gross domestic product (GDP) (Xu, Saksena, & Holly, 2011). It
can therefore be contended that the low expenditure on health in these areas has implications for
healthcare services since the amount of health resources available tends to influence health out-
comes (Dieleman et al., 2017). Some scholars have suggested the need to improve the efficiency and
equity of institutions in low-income countries. Areas highlighted include public sector manage-
ment, domestic resource mobilisation, and improved financial protection (World Bank, 2005).
There are very key economic factors that notably affect healthcare services. One such factor
is the low rate of acquisition of health insurance by individuals and families. According to the
World Health Organisation (WHO, 2019d), out-of-pocket payment for health can lead to a cata-
strophic expenditure by families, which in turn can render them impoverished. Although there
is a growing amount of health insurance coverage in low-i ncome countries including African
countries, some challenges exist in its efficiency and effectiveness in providing financial pro-
tection for the population. For example, a recent impact assessment of Ghana’s national health
insurance shows that the scheme is threatened financially and operationally by political interfer-
ence, inadequate monitoring mechanisms, and poor quality care in accredited health facilities
among other things (Alhassan, Nketiah-A mponsah, & Arhinful, 2016). There is therefore the
need for a reform of the health insurance funding model for Africa to one that takes into account
the dynamic needs of the populace.
Another important factor influencing healthcare services is socio-economic status (SES) of cli-
ents. Evidence shows that individuals with low SES are more often afflicted by diseases (Flaskerud
& DeLilly, 2012) and less likely to be able to afford the cost of care. It is therefore imperative that
people are empowered through education, employment, and enhanced income to improve their
lives. Furthermore, issues of quality of healthcare services cannot be underestimated in this regard,
particularly from the perspective of consumers (Abaerei, Ncayiyana, & Levin, 2017). Thus, the
quality of healthcare services hinges on the amount of funding that goes into the service provision.
Exploring innovative ways that can enhance resource mobilisation at the facility level would be
beneficial. In addition, reduction in wastage in the health system may also yield positive effects.
Such innovations can be linked to the influence of technology in healthcare.
2.5 THE INFLUENCE OF TECHNOLOGICAL

FACTORS ON HEALTHCARE SERVICES
Technological innovations in healthcare have evolved and are growing at a very rapid pace, influ-
encing almost all processes including patients registration, data gathering and monitoring, labora-
tory investigations, and self-care services (Laal, 2013). The smartphones and other devices which
have emerged should not substitute for the traditional approach to patient monitoring and infor-
mation management but, instead, could respond to challenges facing healthcare systems (Bardy,
2019). For example, smartphones can be used to increase access to health information. Health
records, one of the key segments of health practice, consist of clients’ personal information, which
is kept as confidential documents used for the purpose of healthcare delivery. Conventionally,
health professionals such as physicians, nurses, pharmacists, and laboratory personnel have all
had separate formats and files for entering such records. Through the advent of new technology,
electronic health records have created greater efficiency in patient care (Riano & Ortega, 2017).
The electronic health record is an integrated single platform system which is used for patient data
entry including a patient’s medical history. It is perceived that consolidated data driven decisions
will enable consistency in patient care that could improve patient outcome.
Telemedicine, although not entirely new, is another area considered as one of the fast growing
fields in healthcare. In telemedicine, health professionals utilise telecommunication technologies
to evaluate, diagnose and treat patients remotely (Bardy, 2019). The application of technology in
this sense is perceived as a great advantage for rural settings despite the limited resources. There
is evidence that telehealth services reduce hospitalisations (McLean et al., 2013). Mobile health
services deal with wireless and cordless devices to enable care professionals and patients to receive
instant updates on healthcare processes. The use of smartphones and tablets enables free exchange
of information between health providers and their clients at a faster rate. There are mobile tools
and applications which professionals use for the purpose of making care decisions, documenting
care, and acquiring information for client care. It is perceived that mobile health services are more
engaging and that with the use of portable technology, patients have become active actors in their
treatments (Ciani et al., 2016). Wireless communications with the use of walkie-talkies and instant
messaging are quite new in healthcare deliveries although these forms of communication are not
new. Wireless communication systems enhance intra-hospital information sharing among staff,
and thus improve security in hospitals (Anand, 1996).
Staffing problems are a major human resource challenge in the healthcare system globally.
However, the use of technology such as self-service kiosks has relieved staff burdens for many
organisations (Ciani et al., 2016). Self-service kiosks allow patients to carry out registration and
payment related tasks without having to wait to talk to service staff. This expedites the hospital
registration process and provides comfort for people which enhances service satisfaction. Globally,
millions of people have devices at home to monitor their health, which reduce cost and reduce
unnecessary visits to the hospital. For example, portable electronic blood pressure machines help
individuals to monitor their blood pressure at home. Evidence shows that home monitoring systems
The Societal and Healthcare Context 11
reduce readmission rates. With the advent of hospitals being charged penalties for readmissions,
remote monitoring tools available to patients at home may be a prudent way for hospitals to avoid
such charges. Also, the use of sensors and devices used on the body are additional aids to early
detection of abnormalities (Pramanik, Upadhyaya, Pal, & Pal, 2019). These devices are simple
machines which could send alerts to health professionals for timely interventions. Undoubtedly,
modern trends in health services require adoption of technology for effective and efficient care out-
comes. However, there are increased calls to investigate the role of technology in the cost of health-
care delivery (Anand, 1996). For the purpose of sustainability, much is desired from organisational
and community leaders in evaluating the spending on new technologies and their efficiencies.
2.6 THE INFLUENCE OF COMPETITIVE FACTORS ON HEALTHCARE SERVICES

In all industries, competition among businesses has long been encouraged as a mechanism to
increase value for patients. Competitive factors are features or benefits considered key or essential
to the promotion of a product or service to its intended market and should be used in the health sec-
tor to attract new clients. The World Health Organisation (WHO) recognises that responsiveness
to people’s expectations is an essential intermediary goal of a health system and poor responsive-
ness can negatively affect utilisation of services and the effectiveness of interventions (Moreira,
Gherman, & Sousa, 2017).
Traditional competition in healthcare involves one or more elements (e.g. price, quality, conveni-
ence, and superior products or services); however, competition can also be based on new technology
and innovation (Kurhekar & Ghoshal, 2010). A key role of competition in healthcare is the potential
to provide a mechanism for reducing healthcare costs. In the context of these competitive factors,
customers would opt for services or healthcare providers/institutions that meet their needs such
as cost. Within the African context, there are a lot of customers with low socio-economic status
so pricing of healthcare is paramount in attracting customers. The healthcare customer appraises
quality of healthcare in several dimensions including attitude of the health personnel (Bloom &
Kanjilal, 2012; Murti, Deshpande, & Srivastava, 2013). It is therefore critical that the healthcare
provider is committed to maintaining a positive attitude and providing individualised care that
will be noticed and appreciated by patients. With modern technology and the internet, customers
are more enlightened about their healthcare needs (Haskins, Phakathi, Grant, & Horwood, 2014).
Thus, healthcare providers should be abreast of current trends in healthcare services and upgrade
their knowledge and skills to meet the standards of the dynamic health system. Indeed, the health-
care facility with knowledgeable and skilful personnel will attract more customers within the com-
petitive market.
Location of healthcare facilities at the convenience of customers plays a role within the competi-
tive discourse. In low- and middle-income countries, access to healthcare facilities can be chal-
lenging especially in the less endowed areas. In this regard, building a well-resourced healthcare
facility where access is difficult and the clientele within the vicinity of the hospital is poor could
lead to major liquidity challenges for the institution. In the long run, such facilities will provide
poor services because they cannot pay their skilled staff and maintain the expensive equipment. In
a similar vein, healthcare facilities that are close to each other within a well-resourced environment
face a lot of competition. Such competition could lead to quality services in the bid to satisfy and
attract more customers. It is expected that healthcare facilities regularly assess their competitive
advantage and enhance their uniqueness and service advantage. There should be advertisement of
the specific service advantage to attract customers to the facility (O’Connor, 2017; Richins, 2015).
Customer surveys and effective feedback systems would also reinforce and review services that
provide competitive advantage (Al-Abri & Al-Balushi, 2014).
Healthcare competitiveness also hinges on conditions of service of staff. In the African context,
conditions of service are generally inadequate (Jaeger, Bechir, Harouna, Moto, & Utzinger, 2018)
and salary inequalities exist. For example, healthcare providers including doctors, nurses, and
midwives in private practice in Ethiopia, Ghana, Zambia, and Burkina Faso have better conditions
of service compared to their counterparts in the public sector (McCoy et al., 2008). It is imperative
for employers of health professionals to conduct market surveys and offer competitive salaries and
incentives so that they can maintain and attract expert service providers. Poor conditions of service
could result in loss of skilled employees to their competitors (Dash & Meredith, 2010). When the
staff are paid the right salary, they give of their best and the customers will also be satisfied and
continue to seek health services at the facility (Willis-Shattuck et al., 2008). Reducing waiting
time, creating effective interpersonal relationships and mutual respect, and adhering to ethical
standards would enhance customer satisfaction (Agung, 2018; Bakari Salehe, 2016).
2.7 THE CULTURAL REVOLUTION AND HEALTHCARE

Over the years, healthcare globally has been impacted to a large extent by advancement in many
facets of the culture, making ineffective care activities obsolete (Meskó, Drobni, Bényei, Gergely,
& Győrffy, 2017; Napier et al., 2014). Now in the twenty-first century, the world is in a time of major
transition, especially in the area of technology and innovativeness, and the healthcare system is
not an exception. In the past, patients viewed medicine as something beyond their understanding
and science was not developed to investigate various health problems. Healthcare customers gave a
certain amount of control to doctors and nurses and looked upon the practice of medicine as a kind
of magical art that only doctors were competent to perform (Bardhan & Thouin, 2013). Therefore,
doctors’ decisions were rarely challenged, and patients did not educate themselves on medical
matters, in part because medical knowledge was not widely available. However, currently, policy
makers aim to empower patients, to transform them into knowledgeable consumers with access to
a wide range of healthcare products (Elwyn, Edwards, & Thompson, 2016). Patients are getting
more engaged with their medical treatment through information available on the internet, medi-
cal chatrooms, and social media. Informed customers will demand quality care and ask questions
about their treatment options. The cultural revolution of the information explosion implies that
health professionals should be knowledgeable and also educate their clients about their health and
treatment options (Cipriano & Hamer, 2013). But although there is a knowledge explosion on the
internet and social media, it is not surprising to find customers who do not have adequate knowl-
edge on their disease as they may not be able to read and write (Palumbo, 2017).
The introduction of electronic health (E-Health) services and use of electronic devices to keep
health records is another area of cultural revolution in healthcare delivery. The upsurge of E-Health
has increased access to healthcare because innovative ways have been used with social media and
mobile phones to render healthcare services on the door steps of customers (Li, Talaei-K hoei,
Seale, Ray, & MacIntyre, 2013; Ossebaard & Van Gemert-Pijnen, 2016). Overall, electronic data
management speeds up services within the health facility. The availability of E-Health services
therefore means that contemporary healthcare providers should adjust or redesign their health ser-
vices to go beyond their hospital premises. However, in low- and middle-income countries, espe-
cially in Africa where internet and telephone reception may be a challenge, the use of E-Health
is inappropriate to meet the health needs of customers. Moreover, in cases where there is power
outage or network failure, the care system is disabled. This calls for back-up power supply and
internet connectivity to enhance work. Data management policies should be adhered to and strin-
gent measures should be adopted to protect the privacy of the customer (Tan & Payton, 2010).
Cultural diversity, migration, and cultural infusion have also impacted healthcare to a large
extent. Migration of healthcare professionals and customers from one part of the globe to the other
calls for health professionals who are culturally sensitive with skills to provide care that meet the
needs of their clients (Dell’Osso, 2016). It is expected that health institutions provide training and
the enabling environment to accommodate diversity among the staff and customers. Therefore,
healthcare institutions that employ professionals from different cultural backgrounds and provide
opportunities for diverse people to access services attract more customers (Young & Guo, 2016).
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"Yes," Kimmensen said, nodding slowly. "You're right—he's
dangerous." But Kimmensen was less ready to let his emotions carry
him away. The days of political killings were over—finished forever.
"But I think we can trust the society to pull his teeth."
Kimmensen hunched forward in thought. "We'll talk about it tomorrow,
at work. Our personal feelings are unimportant, compared to the
steps we have to take as League officers."
That closed the matter for tonight, as he'd hoped it would. He still
hoped that somehow tonight's purpose could be salvaged.
In that, he was disappointed. It was an awkward, forced meal, with

the three of them silent and pretending nothing had happened,
denying the existence of another human being. They were three
people attempting to live in a sharply restricted private universe, their
conversation limited to comments on the food. At the end of the
evening, all their nerves were screaming. Susanne's face was
pinched and drawn together, her temples white. When Kimmensen
blotted his lips, he found fresh blood on the napkin.
Jem stood up awkwardly. "Well ... thank you very much for inviting
me, Joe." He looked toward Susanne and hesitated. "It was a
delicious meal, Sue. Thank you."
"You're welcome."
"Well ... I'd better be getting home...."
Kimmensen nodded, terribly disappointed. He'd planned to let
Susanne fly Jem home.
"Take the plane, Jem," he said finally. "You can pick me up in the
morning."
"All right. Thank you.... Good night, Sue."
"Good night."
"Joe."
"Good night, Jem." He wanted to somehow restore Bendix's spirits.
"We'll have a long talk about that other business in the morning," he
reminded him.
"Yes, sir." It did seem to raise his chin a little.
After Jem had left, Kimmensen turned slowly toward Susanne. She
sat quietly, her eyes on her empty coffee cup.
Waiting, Kimmensen thought.
She knew, of course, that she'd hurt him badly again. She expected
his anger. Well, how could he help but be angry? Hadn't any of the
things he'd told her ever made any impression on her?
"Susanne."
She raised her head and he saw the stubborn, angry set to her
mouth. "Father, please don't lecture me again." Every word was low,
tight, and controlled.
Kimmensen clenched his hands. He'd never been able to understand
this kind of defiance. Where did she get that terribly misplaced
hardness in her fiber? What made her so unwilling to listen when
someone older and wiser tried to teach her?
If I didn't love her, he thought, this wouldn't matter to me. But in spite
of everything, I do love her. So I go on, every day, trying to make her
see.
"I can't understand you," he said. "What makes you act this way?
Where did it come from? You're nothing like your mother,"—though,
just perhaps, even if the thought twisted his heart, she was—"and
you're nothing like me."
"I am," she said in a low voice, looking down again. "I'm exactly like
you."
When she spoke nonsense like that, it annoyed him more than
anything else could have. And where anger could be kept in check,
annoyance could not.
"Listen to me," he said.
"Don't lecture me again."
"Susanne! You will keep quiet and listen. Do you realize what you're
doing, flirting with a man like Messerschmidt? Do you realize—has
anything I've told you ever made an impression on you?—do you
realize that except for an accident in time, that man could be one of
the butchers who killed your mother?"
"Father, I've heard you say these things before. We've all heard you
say them."
Now he'd begun, it was no longer any use not to go on. "Do you
realize they oppressed and murdered and shipped to labor camps all
the people I loved, all the people who were worthwhile in the world,
until we rose up and wiped them out?" His hands folded down whitely
on the arms of his chair. "Where are your grandparents buried? Do
you know? Do I? Where is my brother? Where are my sisters?"
"I don't know. I never knew them."
"Listen—I was born in a world too terrible for you to believe. I was
born to cower. I was born to die in a filthy cell under a police station.
Do you know what a police station is, eh? Have I described one often
enough? Your mother was born to work from dawn to night, hauling
stones to repair the roads the army tanks had ruined. And if she
made a mistake—if she raised her head, if she talked about the
wrong things, if she thought the wrong thoughts—then she was born
to go to a labor camp and strip tree bark for the army's medicines
while she stood up to her waist in freezing water.
"I was born in a world where half a billion human beings lived for a
generation in worship—in worship—of a man. I was born in a world
where that one twisted man could tell a lie and send gigantic armies
charging into death, screaming that lie. I was born to huddle, to be a
cipher in a crowd, to be spied on, to be regulated, to be hammered to
meet the standard so the standard lie would fit me. I was born to be
nothing."
Slowly, Kimmensen's fingers uncurled. "But now I have freedom.
Stepan Dubrovic managed to find freedom for all of us. I remember
how the word spread—how it whispered all over the world, almost in
one night, it seemed. Take a wire—twist it, so. Take a vacuum tube—
the army has radios, there are stores the civil servants use, there are
old radios, hidden—make the weapon ... and you are free. And we
rose up, each man like an angel with a sword of fire.
"But if we thought Paradise would come overnight, we were wrong.
The armies did not dissolve of themselves. The Systems did not
break down.
"You take a child from the age of five; you teach it to love the State, to
revere the Leader; you inform it that it is the wave of the future, much
cleverer than the decadent past but not quite intelligent enough to
rule itself. You teach it that there must be specialists in government—
Experts in Economy, Directors of Internal Resources, Ministers of
Labor Utilization. What can you do with a child like that, by the time it
is sixteen? By the time it is marching down the road with a pack on its
back, with the Leader's song on its lips? With the song written so its
phrases correspond to the ideal breathing cycle for the average
superman marching into the Future at one hundred centimeters to the
pace?"
"Stop it, Father."
"You burn him down. How else can you change him? You burn him
down where he marches, you burn his Leaders, you burn the System,
you root out—everything!"
Kimmensen sighed. "And then you begin to be free." He looked
urgently at Susanne. "Now do you understand what Messerschmidt
is? If you can't trust my advice, can you at least understand that
much? Has what I've always told you finally made some impression?"
Susanne pushed her chair back. "No. I understood it the first time and
I saw how important it was. I still understood it the tenth time. But now
I've heard it a thousand times. I don't care what the world was like—I
don't care what you went through. I never saw it. You. You sit in your
office and write the same letters day after day, and you play with your
weapon, and you preach your social theory as though it was a
religion and you were its high priest—special, dedicated, above us all,
above the flesh. You tell me how to live my life. You try to arrange it to
fit your ideas. You even try to cram Jem Bendix down my throat.
"But I won't have you treating me that way. When Anse talks to me,
it's about him and me, not about people I never met. I have things I
want. I want Anse. I'm telling you and you can tell Bendix. And if you
don't stop trying to order me around, I'll move out. That's all."
Clutching his chair, not quite able to believe what he'd heard, knowing
that in a moment pain and anger would crush him down, Kimmensen
listened to her quick footsteps going away into her room.
CHAPTER IV
He was waiting out on the patio, in the bright cold of the morning,
when Jem Bendix brought the plane down and picked him up. Bendix
was pale this morning, and puffy-eyed, as though he'd been a long
time getting to sleep and still had not shaken himself completely
awake.
"Good morning, Joe," he said heavily as Kimmensen climbed in
beside him.
"Good morning, Jem." Kimmensen, too, had stayed awake a long
time. This morning, he had washed and dressed and drunk his coffee
with Susanne's bedroom door closed and silent, and then he had
come out on the patio to wait for Jem, not listening for sounds in the
house. "I'm—I'm very sorry for the way things turned out last night."
He left it at that. There was no point in telling Jem about Susanne's
hysterical outburst.
Jem shook his head as he lifted the plane into the air. "No, Joe. It
wasn't your fault. You couldn't help that."
"She's my daughter. I'm responsible for her."
Jem shrugged. "She's headstrong. Messerschmidt paid her some
attention, and he became a symbol of rebellion to her. She sees him
as someone who isn't bound by your way of life. He's a glamorous
figure. But she'll get over it. I spent a long time last night thinking
about it. You were right, Joe. At the moment, he's something new and
exciting. But he'll wear off. The society'll see through him, and so will
Susanne. All we have to do is wait."
Kimmensen brooded over the valleys far below, pale under the early
morning mist. "I'm not sure, Jem," he answered slowly. He had spent
hours last night in his chair, hunched over, not so much thinking as
steeping his mind in all the things that had happened so suddenly.
Finally, he had gotten up and gone into his bedroom, where he lay on
his bed until a plan of action slowly formed in his mind and he could,
at last, go to sleep.
"It's not the matter of Messerschmidt and Susanne," he explained
quickly. "I hope you understand that I'm speaking now as someone
responsible to all the families in this area, rather than as the head of
any particular one. What concerns me now is that Messerschmidt is
bound to have some sort of following among the immature. He's
come at a bad time. He's in a good position to exploit this business in
the Northwest."
And I'm going to die. Kimmensen had to pause before he went on.
"Yes, in time his bubble will burst. But it's a question of how long that
might take. Meanwhile, he is a focus of unrest. If nothing happens to
check him now, some people might decide he was right."
Bendix chewed his lower lip. "I see what you mean, Joe. It'll get
worse before it gets better. He'll attract more followers. And the ones
he has now will believe in him more than ever."
"Yes," Kimmensen said slowly, "that could easily happen."
They flew in silence for a few moments, the plane jouncing in the
bumpy air, and then as Bendix slowed the vanes and they began to
settle down into the valley where the office building was, Jem asked,
"Do you have anything in mind?"
Kimmensen nodded. "Yes. It's got to be shown that he doesn't have
the population behind him. His followers will be shocked to discover
how few of them there are. And the people wavering toward him will
realize how little he represents. I'm going to call for an immediate
election."
"Do you think that's the answer? Will he run against you?"
"If he refuses to run in an election, that's proof enough he knows he
couldn't possibly win. If he runs, he'll lose. It's the best possible move.
And, Jem ... there's another reason." Kimmensen had thought it all
out. And it seemed to him that he could resolve all his convergent
problems with this one move. He would stop Messerschmidt, he
would pass his work on to Jem, and—perhaps this was a trifle more
on his mind than he'd been willing to admit—once Messerschmidt
had been deflated, Susanne would be bound to see her tragic error,
and the three of them could settle down, and he could finish his life
quietly.
"Jem, I'm getting old."
Bendix's face turned paler. He licked his lips. "Joe—"
"No, Jem, we've got to face it. Don't try to be polite about it. No matter
how much you protest, the fact is I'm almost worn out, and I know it.
I'm going to resign."
Bendix's hands jerked on the control wheel.
Kimmensen pretended not to see it. For all his maturity, Jem was still
a young man. It was only natural that the thought of stepping up so
soon would be a great thrill to him. "I'll nominate you as my
successor, and I'll campaign for you. By winning the election, you'll
have stopped Messerschmidt, and then everything can go on the way
we've always planned." Yes, he thought as the plane bumped down
on the weathered plaza. That'll solve everything.
As Kimmensen stepped into his office, he saw Salmaggi sitting

beside the desk, waiting for him. The man's broad back was toward
him, and Kimmensen could not quite restrain the flicker of distaste
that always came at the thought of talking to him. Of all mornings, this
was a particularly bad one on which to listen to the man pour out his
hysterias.
"Good morning, Tullio," he said as he crossed to his desk.
Salmaggi turned quickly in his chair. "Good morning, Josef." He
jumped to his feet and pumped Kimmensen's hand. "How are you?"
His bright eyes darted quickly over Kimmensen's face.
"Well, thank you. And you?"
Salmaggi dropped back into his chair. "Worried, Josef. I've been
trying to see you about something very important."
"Yes, I know. I'm sorry I've been so busy."
"Yes. So I thought if you weren't too busy this morning, you might be
able to spare ten minutes."
Kimmensen glanced at him sharply. But Salmaggi's moon of a face
was completely clear of sarcasm or any other insinuation. There were
only the worried wrinkles over the bridge of his nose and at the
corners of his eyes. Kimmensen could not help thinking that Salmaggi
looked like a baby confronted by the insuperable problem of deciding
whether or not it wanted to go to the bathroom. "I've got a number of
important things to attend to this morning, Tullio."
"Ten minutes, Josef."
Kimmensen sighed. "All right." He settled himself patiently in his
chair.
"I was up in the northwest part of the area again on this last trip."
"Um-hmm." Kimmensen, sacrificing the ten minutes, busied himself
with thinking about Jem's reaction to his decision. Bendix had
seemed totally overwhelmed, not saying another word as they walked
from the plane into the office building.
"There's been another family burned out."
"So I understand, Tullio." Kimmensen smiled faintly to himself,
understanding how Jem must feel today. It had been something of the
same with himself when, just before the end of the fighting years, the
realization had slowly come to him that it would be he who would
have to take the responsibility of stabilizing this area.
"That makes seven in all, Josef. Seven in the past eighteen months."
"It takes time, Tullio. The country toward the northwest is quite
rugged. No regime was ever able to send its police up there with any
great success. They're individualistic people. It's only natural they'd
have an unusual number of feuds." Kimmensen glanced at his clock.
It was a great responsibility, he was thinking to himself. I remember
how confused everything was. How surprised we were to discover,
after the old regime was smashed, that many of us had been fighting
for utterly different things.
That had been the most important thing he'd had to learn; that almost
everyone was willing to fight and die to end the old regime, but that
once the revolution was won, there were a score of new regimes that
had waited, buried in the hearts of suppressed men, to flower out and
fill the vacuum. That was when men who had been his friends were
suddenly his enemies, and when men whose lives he had saved now
tried to burn him down. In many ways, that had been the very worst
period of the fighting years.
"Josef, have you gone up there recently?"
Kimmensen shook his head. "I've been very occupied here." His
responsibility was to all the families in the area, not to just those in
one small section. He could never do his work while dashing from
one corner of the area to another.
"Josef, you're not listening!" Kimmensen looked up and was shocked
to see that there were actually glints of frustrated moisture in the
corners of Salmaggi's eyes.
"Of course I'm listening, Tullio," he said gently.
Salmaggi shook his head angrily, like a man trying to reach his
objective in the midst of a thick fog. "Josef, if you don't do something,
Messerschmidt's going to take an army up into the Northwesters'
area. And I'm not sure he isn't right. I don't like him—but I'm not sure
he isn't right."
Kimmensen smiled. "Tullio, if that's what's on your mind, you can rest
easy. I am going to do something. This afternoon, I'm going to make a
general broadcast. I'm going to call an election. I'm resigning, and
Jem Bendix will run against Messerschmidt. That will be the end of
him."
Salmaggi looked at him. "Of who?"
"Of Messerschmidt, of course," Kimmensen answered in annoyance.
"Now if you'll excuse me, Tullio, I have to draft my statement."
That night, when he came home, he found Susanne waiting for him in
the living room. She looked at him peculiarly as he closed the panel
behind him.
"Hello, Father."
"Hello, Susanne." He had been hoping that the passage of a day
would dull her emotional state, and at least let the two of them speak
to each other like civilized people. But, looking at her, he saw how
tense her face was and how red the nervous blotches were in the
pale skin at the base of her neck.
What happened between us? he thought sadly. Where did it start? I
raised you alone from the time you were six months old. I stayed up
with you at night when your teeth came. I changed your diapers and
put powder on your little bottom, and when you were sick I woke up
every hour all night for weeks to give you your medicine. I held you
and gave you your bottles, and you were warm and soft, and when I
tickled you under the chin you laughed up at me. Why can't you smile
with me now? Why do you do what you do to me?
"I heard your broadcast, of course," she said tightly.
"I thought you would."
"Just remember something, Father."
"What, Susanne?"
"There are a lot of us old enough to vote, this time."
CHAPTER V
Kimmensen shifted in his chair, blinking in the sunshine of the plaza.
Messerschmidt sat a few feet away, looking up over the heads of the
live audience at the mountains. The crowd was waiting patiently and
quietly. It was the quiet that unsettled him a little bit. He hadn't said
anything to Jem, but he'd half expected some kind of demonstration
against Messerschmidt.
Still, this was only a fraction of the League membership. There were
cameras flying at each corner of the platform, and the bulk of the
electorate were watching from their homes. There was no telling what
their reaction was, but Kimmensen, on thinking it over, decided that
the older, more settled proportion of the League—the people in the
comfort of their homes, enjoying the products of their own free labor
—would be as outraged at this man as he was.
He turned his head back over his shoulder and looked at Jem.
"We'll be starting in a moment. How do you feel?"
Jem's smile was a dry-lipped grimace. "A little nervous. How about
you, Joe?"
Kimmensen smiled back at him. "This is an old story to me, Jem.
Besides, I'm not running." He clasped his hands in his lap and faced
front again, forcing his fingers to keep still.
The surprisingly heavy crowd here in the plaza was all young people.
In a moment, the light flashed on above the microphone, and
Kimmensen stood up and crossed the platform. There was a good
amount of applause from the crowd, and Kimmensen smiled down at
them. Then he lifted his eyes to the camera that had flown into
position in front of and above him.
"Fellow citizens," he began, "as you know, I'm not running in this
election." There was silence from the crowd. He'd half expected some
sort of demonstration of disappointment—at least a perfunctory one.
There was none. Well, he'd about conceded this crowd of youngsters
to Messerschmidt. It was the people at home who mattered.
"I'm here to introduce the candidate I think should be our next League
President—Secretary Jem Bendix."
This time the crowd reacted. As Jem got up and bowed, and the other
cameras focussed on him, there was a stir in the plaza, and one
young voice broke in: "Why introduce him? Everybody knows him."
"Sure," somebody else replied. "He's a nice guy."
Messerschmidt sat quietly in his chair, his eyes still on the mountains.
He made a spare figure in his dark clothes, with his pale face under
the shock of black hair.
Kimmensen started to go on as Jem sat down. But then, timed
precisely for the second when he was firmly back in his chair, the
voice that had shouted the first time added: "But who wants him for
President?"
A chorus of laughter exploded out of the crowd. Kimmensen felt his
stomach turn icy. That had been pre-arranged. Messerschmidt had
the crowd packed. He'd have to make the greatest possible effort to
offset this. He began speaking again, ignoring the outburst.
"We're here today to decide whom we want for our next president.
But in a greater sense, we are here to decide whether we shall keep
our freedom or whether we shall fall back into a tyranny as odious as
any, as evil as any that crushed us to the ground for so long."
As he spoke, the crowd quieted. He made an impressive appearance
on a platform, he knew. This was an old story to him, and now he
made use of all the experience gathered through the years.
"We are here to decide our future. This is not just an ordinary
election. We are here to decide whether we are going to remain as
we are, of whether we are going to sink back into the bloody past."
As always, he felt the warmth of expressing himself—of re-affirming
the principles by which he lived. "We are here to choose between a
life of peace and harmony, a life in which no man is oppressed in any
way by any other, a life of fellowship, a life of peaceful trade, a life of
shared talents and ideals—or a life of rigid organization, of slavery to
a high-sounding phrase and a remorseless system of government
that fits its subjects to itself rather than pattern itself to meet their
greatest good."
He spoke to them of freedom—of what life had been like before they
were born, of how bitter the struggle had been, and of how Freemen
ought to live.
They followed every word attentively, and when he finished he sat
down to applause.
He sat back in his chair. Jem, behind him, whispered:
"Joe, that was wonderful! I've never heard it better said. Joe, I ... I've
got to admit that before I heard you today, I was scared—plain
scared. I didn't think I was ready. It—it seemed like such a big job, all
alone.... But now I know you're with me, forever...."
Messerschmidt got up. It seemed to Kimmensen as though the entire

crowd inhaled simultaneously.
"Fellow citizens." Messerschmidt delivered the opening flatly,
standing easily erect, and then stood waiting. The attention of the
crowd fastened on him, and the cameras dipped closer.
"First," Messerschmidt said, "I'd like to pay my respects to President
Kimmensen. I can truthfully say I've never heard him deliver that
speech more fluently." A ripple of laughter ran around the crowd.
"Then, I'd like to simply ask a few questions." Messerschmidt had
gone on without waiting for the laughter to die out. It stopped as
though cut by a knife. "I would have liked to hear Candidate Bendix
make his own speech, but I'm afraid he did." Messerschmidt turned
slightly toward Bendix's chair. In Kimmensen's judgment, he was not
using the best tone of voice for a rabble-rouser.
"Yes, Jem Bendix is a nice guy. No one has a bad word for him. Why
should they? What's he ever done on any impulse of his own—what's
he ever said except 'me, too'?"
Kimmensen's jaws clamped together in incredulous rage. He'd
expected Messerschmidt to hit low. But this was worse than low. This
was a deliberate, muddy-handed perversion of the campaign
speech's purpose.
"I wonder," Messerschmidt went on, "whether Jem Kimmensen—
excuse me; Jem Bendix—would be here on this platform today if
Josef Kimmensen hadn't realized it was time to put a shield between
himself and the citizens he calls his fellows. Let's look at the record."
Kimmensen's hands crushed his thighs, and he stared grimly at
Messerschmidt's back.
"Let's look at the record. You and I are citizens of the Freemen's
League. Which is a voluntary organization. Now—who founded the
League? Josef Kimmensen. Who's been the only League President
we've ever had? Who is the League, by the grace of considerable
spellbinding powers and an electorate which—by the very act of
belonging to the League—is kept so split up that it's rare when a man
gets a chance to talk things out with his neighbor?
"I know—we've all got communicators and we've all got planes. But
you don't get down to earth over a communicator, and you don't
realize the other fellow's got the same gripes you do while you're both
flapping around up in the air. When you don't meet your neighbor face
to face, and get friendly with him, and see that he's got your
problems, you never realize that maybe things aren't the way Josef
Kimmensen says they are. You never get together and decide that all
of Josef Kimmensen's fine words don't amount to anything.
"But the League's a voluntary organization. We're all in it, and, God
help me, I'm running for President of it. Why do we stick with it? Why
did we all join up?
"Well, most of us are in it because our fathers were in it. And it was a
good thing, then. It still can be. Lord knows, in those days they
needed something to hold things steady, and I guess the habit of
belonging grew into us. But why don't we pull out of this voluntary
organization now, if we're unhappy about it for some reason? I'll tell
you why—because if we do, our kids don't go to school and when
they're sick they can't get into the hospital. And do you think Joe
Kimmensen didn't think of that?"
The crowd broke into the most sullen roar Kimmensen had heard in
twenty-eight years. He blanched, and then rage crashed through him.
Messerschmidt was deliberately whipping them up. These youngsters
out here didn't have children to worry about. But Messerschmidt was
using the contagion of their hysteria to infect the watchers at home.
He saw that suddenly and plainly, and he cursed himself for ever
having put this opportunity in Messerschmidt's hands. But who would
have believed that Freemen would be fools enough—stupid enough
—to listen to this man?
Of course, perhaps those at home weren't listening.
"And what about the Northwesters' raids? Josef Kimmensen says
there aren't any raids. He says we're settling our unimportant little
feuds." This time, Messerschmidt waited for the baying laughter to
fade. "Well, maybe he believes it. Maybe. But suppose you were a
man who held this area in the palm of your hand? Suppose you had
the people split up into little families, where they couldn't organize to
get at you. And now, suppose somebody said, 'We need an army.'
What would you do about that? What would you think about having
an organized body of fighting men ready to step on you if you got too
big for people to stand? Would you say, if you were that man—would
you say, 'O.K., we'll have an army,' or would you say, 'It's all a hoax.
There aren't any raids. Stay home. Stay split up?' Would you say that,
while we were all getting killed?"
The savage roar exploded from the crowd, and in the middle of it
Messerschmidt walked quietly back to his chair and sat down.
Jem's fist was hammering down on the back of Kimmensen's chair.
"We should never have let him get on this platform! A man like that
can't be treated like a civilized human being! He has to be destroyed,
like an animal!"
Heartsick and enraged, Kimmensen stared across the platform at the
blade-nosed man.
"Not like an animal," he whispered to himself. "Not like an animal.
Like a disease."
Still shaken, still sick, Kimmensen sat in his office and stared down at
his hands. Twenty-eight years of selfless dedication had brought him
to this day.
He looked up at the knock on his open door, and felt himself turn
rigid.
"May I come in?" Messerschmidt asked quietly, unmoving, waiting for
Kimmensen's permission.
Kimmensen tightened his hands. "What do you want?"
"I'd like to apologize for my performance this afternoon." The voice
was still quiet, and still steady. The mouth, with its deep line etched at
one corner, was grave and a little bit sad.
"Come in," Kimmensen said, wondering what new tactic
Messerschmidt would use.
"Thank you." He crossed the office. "May I sit down?"
Kimmensen nodded toward the chair, and Messerschmidt took it. "Mr.
President, the way I slanted my speech this afternoon was unjust in
many respects. I did it that way knowingly, and I know it must have
upset you a great deal." His mouth hooked into its quirk, but his eyes
remained grave.
"Then why did you do it?" Kimmensen snapped. He watched
Messerschmidt's face carefully, waiting for the trap he knew the man
must be spinning.
"I did it because I want to be President. I only hope I did it well
enough to win. I didn't have time to lay the groundwork work for a
careful campaign. I would have used the same facts against you in
any case, but I would have preferred not to cloak them in hysterical
terms. But there wasn't time. There isn't time—I've got to destroy this
society you've created as soon as I can. After tonight's election, I
will."
"You egomaniac!" Kimmensen whispered incredulously. "You're so
convinced of your superiority that you'll even come here—to me—and
boast about your twisted plans. You've got the gall to come here and
tell me what you're going to do—given the chance."
"I came here to apologize, Mr. Kimmensen. And then I answered your
question."
Kimmensen heard his voice rising and didn't care. "We'll see who
wins the election! We'll see whether a man can ride roughshod over
other men because he believes he has a mission to perform!"
"Mr. President," Messerschmidt said in his steady voice, "I have no
idea of whether I am supplied with a mission to lead. I doubt it. I don't
particularly feel it. But when I speak my opinions, people agree with
me. It isn't a question of my wanting to or not wanting to. People
follow me."
"No Freeman in his right mind will follow you!"
"But they will. What it comes down to is that I speak for more of them
than you. There's no Utopia with room for men like you and me, and
yet we're here. We're constantly being born. So there's a choice—kill
us, burn us down, or smash your Utopia. And you can't kill more than
one generation of us."
Messerschmidt's eyes were brooding. His mouth twisted deeper into
sadness. "I don't like doing this to you, Mr. President, because I
understand you. I think you're wrong, but I understand you. So I came
here to apologize.
"I'm a leader. People follow me. If they follow me, I have to lead them.
It's a closed circle. What else can I do? Kill myself and leave them
leaderless? Someday, when I'm in your position and another man's in
mine, events may very well move in that direction. But until the man
who'll displace me is born and matures, I have to be what I am, just
as you do. I have to do something about the Northwesters. I have to
get these people back together again so they're a whole, instead of
an aggregate of isolated pockets. I have to give them places to live
together. Not all of us, Mr. President, were born to live in eagle rooks
on mountaintops. So I've got to hurt you, because that's what the
people need."
Kimmensen shook in reaction to the man's consummate arrogance.
He remembered Bausch, when they finally burst into his office, and
the way the great fat hulk of the man had protested: "Why are you
doing this? I was working for your good—for the good of this nation—
why are you doing this?"
"That's enough of you and your kind's hypocrisy, Messerschmidt!" he
choked out. "I've got nothing further I want to hear from you. You're
everything I despise and everything I fought to destroy. I've killed men
like you. After the election tonight, you'll see just how few followers
you have. I trust you'll understand it as a clear warning to get out of
this area before we kill one more."
Messerschmidt stood up quietly. "I doubt if you'll find the election
coming out in quite that way," he said, his voice still as calm as it had
been throughout. "It might have been different if you hadn't so long
persisted in fighting for the last generation's revolution."
Kimmensen sat stiffly in Jem Bendix's office.

"Where's he now?" Bendix demanded, seething.
"I don't know. He'll have left the building."
Bendix looked at Kimmensen worriedly. "Joe—can he win the
election?"
Kimmensen looked at Jem for a long time. All his rage was trickling
away like sand pouring through the bottom of a rotted sack. "I think
so." There was only a sick, chilling fear left in him.
Bendix slapped his desk with his hand. "But he can't! He just can't!
He's bulldozed the electorate, he hasn't promised one single thing
except an army, he doesn't have a constructive platform at all—no, by
God, he can't take that away from me, too!—Joe, what're we going to
do?"
He turned his pale and frightened face toward Kimmensen. "Joe—
tonight, when the returns come in—let's be here in this building. Let's
be right there in the room with the tabulating recorder. We've got to
make sure it's an honest count."
CHAPTER VI
There was only one bare overhead bulb in the tabulator room. Bendix
had brought in two plain chairs from the offices upstairs, and now
Kimmensen sat side by side with him, looking at the gray bulk of the
machine. The room was far down under the building. The walls and
floor were cement, and white rime bloomed dankly in the impressions
left by form panels that had been set there long ago.
The tabulating recorder was keyed into every League communicator,
and every key was cross-indexed into the census files. It would
accept one vote from each mature member of every League family. It
flashed running totals on the general broadcast wavelength.
"It seems odd," Bendix said in a husky voice. "An election without
Salmaggi running."
Kimmensen nodded. The flat walls distorted voices until they
sounded like the whispers of grave-robbers in a tomb.
"Did you ask him why he wasn't?" he asked because silence was
worse.
"He said he didn't know whose ticket to run on."
Kimmensen absorbed it as one more fact and let it go.
"The first votes ought to be coming in." Bendix was looking at his
watch. "It's time."
Kimmensen nodded.
"It's ironic," Bendix said. "We have a society that trusts itself enough
to leave this machine unguarded, and now the machine's recording
an election that's a meaningless farce. Give the electorate one more
day and it'd have time to think about Messerschmidt's hate-
mongering. As it is, half the people'll be voting for him with their
emotions instead of their intelligence."
"It'll be a close election," Kimmensen said. He was past pretending.
"It won't be an election!" Bendix burst out, slamming his hand on his
knee. "One vote for Bendix. Two votes for Mob Stupidity." He looked
down at the floor. "It couldn't be worse if Messerschmidt were down
here himself, tampering with the tabulator circuits."
Kimmensen asked in a dry voice: "Is it that easy?"
"Throwing the machine off? Yes, once you have access to it. Each
candidate has an assigned storage circuit where his votes
accumulate. A counter electrode switches back and forth from circuit
to circuit as the votes come in. With a piece of insulation to keep it
from making contact, and a jumper wire to throw the charge over into
the opposing memory cells, a vote for one candidate can be
registered for the other. A screwdriver'll give you access to the
assembly involved. I ... studied up on it—to make sure
Messerschmidt didn't try it."
"I see," Kimmensen said.
They sat in silence for a time. Then the machine began to click.
"Votes, coming in," Bendix said. He reached in his blouse pocket. "I
brought a communications receiver to listen on."
They sat without speaking again for almost a half hour, listening.
Then Kimmensen looked at Bendix. "Those'll be his immediate
followers, voting early," he said. "It'll even out, probably, when most of
the families finish supper." His voice sounded unreal to himself.

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Health Service Marketing Management

in Africa 1st Edition Robert Hinson

Customer Service Management in Africa A Strategic and

Regulating Telecommunications in South Africa:

Higher Education Marketing in Africa: Explorations into

Marketing Channel Strategy International Edition Robert

Spatial Planning in Service Delivery: Towards

Service Quality for Facilities Management in Hospitals

Marketing health services Fourth Edition Richard K.

Public Administration Training in Africa Competencies

2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN, UK

© 2020 by Taylor & Francis Group, LLC

Routledge/Productivity Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Printed on acid-­free paper

International Standard Book Number-­13: 978-0-367-00193-3 (Hardback)

Library of Congress Cataloging-­in-Publication Data

Visit the Taylor & Francis Web site at

Chapter 1 Introduction to Healthcare Service Marketing Management: Building

Chapter 2 The Societal and Healthcare Context...........................................................................7

Chapter 3 Strategic Planning and Healthcare Services............................................................... 21

Chapter 4 Marketing in Healthcare Management....................................................................... 31

Chapter 5 Segmentation, Targeting, and Positioning in Healthcare........................................... 45

Chapter 6 Consumers and Consumer Behaviour........................................................................ 57

Chapter 7 Managing the Healthcare Product.............................................................................. 71

Chapter 8 Utilisation and Pricing of Healthcare Services........................................................... 81

Chapter 9 Distribution in Healthcare Markets............................................................................ 95

Chapter 10 Integrated Marketing Communications in the Healthcare Sector:

Chapter 11 Branding the Healthcare Experience........................................................................ 121

Chapter 13 Managing Healthcare Employees............................................................................. 149

Chapter 14 Physical Evidence and Healthcare Service Quality Management............................ 167

Chapter 15 Developing Customer Loyalty in Healthcare........................................................... 179

Chapter 16 Financing Healthcare and Health Insurance............................................................. 199

Chapter 17 Managing Healthcare Logistics................................................................................ 211

Chapter 18 Managing Policies and Procedures in Healthcare Management.............................. 227

Chapter 19 Technology and Health Services Marketing in Africa............................................. 243

Chapter 20 Application of Technology in Healthcare Delivery in Africa.................................. 255

Chapter 21 Technology and Social Media in Healthcare Delivery............................................. 267

Charles Ampong Adjei is an Assistant Lecturer in the Department of Community Health

Golda Anambane is a lecturer in the Department of Marketing, Wisconsin International University

Kenneth Appiah is a Lecturer in Marketing, Entrepreneurship, Small Business Management, and

Jimoh G. Fatoki is a Research Assistant in the Department of Operations Management at Lagos

Mahmoud Abdulai Mahmoud is a Senior Lecturer in the Department of Marketing and

Michael Nkrumah holds an MSc Marketing and a Postgraduate Certificate in Business

Raphael Odoom (PhD) is a research associate in the Department of Marketing Management,

Emmanuel Okunga Wandera is a medical doctor with a specialization in Applied Epidemiology. He

Nana Owusu-­Frimpong is a Professor of Marketing at the Ghana Institute of Management and

Ibelema Sam-­Epelle is currently a Doctorate of Business Administration (DBA) candidate at the

BOOK THEMATIC AREAS

Marketing Imperatives in Healthcare Management

Product and Pricing Management in Healthcare

Distribution, Marketing Communications and Branding in Healthcare

People, Physical Evidence and Service Quality Management in Healthcare

Process Management in Healthcare

2.2 THE EMERGENCE OF HEALTHCARE AS AN INSTITUTION

2.4 THE INFLUENCE OF ECONOMIC FACTORS ON HEALTHCARE SERVICES

2.5 THE INFLUENCE OF TECHNOLOGICAL

2.6 THE INFLUENCE OF COMPETITIVE FACTORS ON HEALTHCARE SERVICES

2.7 THE CULTURAL REVOLUTION AND HEALTHCARE

Printed on acid-free paper

International Standard Book Number-13: 978-0-367-00193-3 (Hardback)

Library of Congress Cataloging-in-Publication Data

Nana Owusu-Frimpong is a Professor of Marketing at the Ghana Institute of Management and

Ibelema Sam-Epelle is currently a Doctorate of Business Administration (DBA) candidate at the