Implementing decentralised management in Ghana: The experience of the Sekyere West District health administration

The purpose of this paper is to examine the barriers to the implementation of management decentralisation of health services and programmes at district level in Ghana.

Data for the study were collected through a qualitative technique in the Sekyere West district.

The findings are: transfer of authority for management decision making and planning was rarely operational at district level; and control over financial and personnel decisions remained centralised. The paper identified lack of staff capacity, lack of commitment and inter‐organisational conflict between health managers and local government officials as factors obstructing the implementation of management decentralisation in the district.

The lesson from the study is that the implementation of health care management decentralisation at district level has stalled because of the combined effect of internal and external constraints. The paper suggests that given the enormity of the problem of paucity of capacity to undertake new service management responsibilities, the process of transferring responsibilities, resources and control to lower level health managements should be gradual and incremental; the sequencing of reform too should be such that district health officers and stakeholders are given adequate training prior to the inauguration of new management reform.