HEALTH SECTOR DECENTRALIZATION IN GHANA: EXPLORING THE IMPLEMENTATION CHALLENGES AT THE HOSPITAL LEVEL

ABSTRACT This study explored the implementation challenges of decentralization at Dormaa Presbyterian Hospital and Sampa Government Hospital. Data were collected using qualitative research approach using interviews guide. Key informants who had in-depth knowledge and play role(s) in the implementation of decentralization at the district level were purposively selected. In all, 22 key informants were interviewed from the two districts (11 in each district).In addition, extensive analysis of key policy documents for the two hospitals was made. Findings from the study showed that there are challenges that militate against the implementation of decentralization reforms at the hospital level. These included: inadequate human resource and low capacity at both national and local and district level; lack of communication among key policy implementers at the district level; financial constrains; inadequate support from government; and non-involvement of community members in planning and management of health program. It was also revealed that implementation of decentralization policy at the hospital level was not the best as many of the important policy measures were never initiated or were only partially implemented. The challenges existed at both policy design and the implementation phases. To ensure successful implementation of decentralization at the hospital level, the following recommendations were made: There is the need to restructure local governance institutions which are mandated to carry out the implementation and monitoring of decentralization. There is also the need for broader participation during policy formulation process; the role of development partners, civil society and private sectors responsible for health decentralization must be specified. Furthermore, policy makers are to carry out capacity needs assessment for policy feedback and implementation at decentralized unit. Development of an appropriate human resource and management policy to address the needs of the decentralization policy is also prudent.