Emmanuel Kojo Sakyi

A retrospective content analysis of studies on factors constraining the implementation of health sector reform in Ghana.

Ghana has undertaken many public service management reforms in the past two decades. But the implementation of the reforms has been constrained by many factors. This paper undertakes a retrospective study of research works on the challenges to the implementation of reforms in the public health sector. It points out that most of the studies identified: (1) centralised, weak and fragmented management system; (2) poor implementation strategy; (3) lack of motivation; (4) weak institutional framework; (5) lack of financial and human resources and (6) staff attitude and behaviour as the major causes of ineffective reform implementation. The analysis further revealed that quite a number of crucial factors obstructing reform implementation which are particularly internal to the health system have either not been thoroughly studied or overlooked. The analysis identified lack of leadership; weak communication and consultation; lack of stakeholder participation, corruption and unethical professional behaviour as some of the missing variables in the literature. The study, therefore, indicated that there are gaps in the literature that needed to be filled through rigorous reform evaluation based on empirical research particularly at district, sub-district and community levels. It further suggested that future research should be concerned with the effects of both systems and structures and behavioural factors on reform implementation.

Managerial problems of hospitals under Ghana's National Health Insurance Scheme

Purpose – Hospital and health system managers are facing several problems following the introduction of Ghanas national health insurance policy. This study aims to investigate the opinions of health managers about the problems emanating from the national health insurance policy for hospital managers in regard to reimbursement, claims management, service delivery and waiting time.Design/methodology/approach – The study involved key informants from 12 National Health Insurance Scheme (NHIS) accredited district hospitals, which were purposively selected from five regions in Ghana. Data were collected using in‐depth personal interviews with managers of pharmacy, supply/procurement, accounts and insurance scheme units of the hospitals. Data analysis was guided by the major themes that emerged during the interviews. A framework approach to analysis was used, grouping and incorporating themes and sub‐themes that emerged from the interview data.Findings – The major findings identified by interviewees with regard...

Barriers to implementing health sector administrative decentralisation in Ghana: a study of the Nkwanta district health management team.

PURPOSE This paper aims to examine empirically the ways in which workforce knowledge and organisational factors of an implementing agency affected the implementation of health sector administration decentralisation in Ghana with insights from the Nkwanta district health administration. DESIGN/METHODOLOGY/APPROACH This is a qualitative study using data from individual and group interviews through purposive selection of health officials, who were directly involved in the work of actual implementation of the programme. Specifically, participants included senior management, middle management and junior workers, who had worked at least for the past three months in the district. FINDINGS The study found that most of the interviewees involved in the implementation process are knowledgeable of the objectives of the decentralisation process. Also, major factors that are militating against effective decentralisation in the district include inadequate funds, lack of qualified personnel, inadequate logistics and equipment, poor interpersonal relationships, lack of transparency and a good operational system, lack of incentives to motivate the staff, political interference, poor infrastructure and high rate of illiteracy. ORIGINALITY/VALUE The findings of this study will help improve the implementation of decentralisation within the health sector in Ghana. The paper provides recommendations, which, if considered for implementation, will help improve the decentralisation process.

Implementing decentralised management in Ghana

Purpose – 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.Design/methodology/approach – Data for the study were collected through a qualitative technique in the Sekyere West district.Findings – 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.Originality/value – 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 p...

Drivers of return migration of Ghanaian health professionals: perspectives from doctors and nurses in urban Ghana

Purpose – The purpose of this paper is to examine the trend of return migration of health professionals to Ghana and how it is impacting the delivery of health services in the country. It also highlights the challenges facing returnees to the country. Design/methodology/approach – A qualitative exploratory case study approach was employed in the study. Data gathered were analysed using the sequential model of qualitative content analysis. Findings – It was found that while push factors dominantly influence out-migration, pull factors rather dominated reasons for return migration. Other determinants of return migration include social and financial benefits to the home country, achieving goals for travelling, skills’ improvement and spousal consideration. The paper also highlights some of the challenges returnees usually encounter in the home country. Social implications – This paper makes reasonable recommendations regarding how return migration of Ghanaian health professionals might be smoother. Originali...