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Please use this identifier to cite or link to this item: http://hdl.handle.net/123456789/2623

Title: Financial decentralization and supply of Tracer non-drug consumables in Effiduase District Hospital
Authors: Appiahene, Joseph Kofi
Issue Date: 6-Feb-2000
Series/Report no.: 2771;
Abstract: The Ministry of Health (MoH) has decentralised some of its functions including planning / budgeting, financial management, and procurement procedures to the district, which is the focus of implementation to correct internal weaknesses and promote effective and sustainable health care operations Management of Non-Drug Consumables (NDC) has of late followed the financial decentralization concept where BMCs are given their own monies in the form of Financial Encumbrance (FE) against their plans and budgets, to procure NDC for use. In addition, a cost-recovery system is introduced to ensure availability and sustainability of these items. The study thus sets itself to assess the level of financial decentralization in relation to supply of TNDC in Effiduase District Hospital by looking at planning/budgeting, financing, and procurement practices to establish the level of autonomy given to the hospital for improvement in the supply of TNDC. The study was quantitative and qualitative, descriptive and cross-sectional, and focussed on planning/budgeting, receipts, generation and disbursement of funds, and examination of the procurement practices in the supply of TNDC. Data collection technique included the administration of both structured and unstructured questionnaire (open-ended and closed) to key informants, use of available information and some observations. The study revealed that, there were shortages of TNDC at the facility even though planning and budgeting were decentralised and the BMC did budget for TNDC. With respect to funding, the study revealed sources as IGF (56%), GoG (38.5%), and DPF (5%) in order of decreasing contribution to the supply of TNDC. Recovery of IGF was as low as about 31%, yet a high disbursement for other things like building a ward (which is noted to be a capital project) was found other than restocking NDC. Financial autonomy was realised at the hospital for both the collection and disbursement of IGF. Even though FE was decentralised and released quarterly, there were a lot of inflexibility including delays, substantial cuts, and sometimes embargoes from spending, and no virement was allowed between two major items except between sub-items under an item. Capitalisation at the RMS for the initialisation of the ‘cash & carry’ of NDC also sustained a cut of about 50%. All these were external administrative restrictions that affected the flow of cash to fund the supply of TNDC. Procurement, on the other hand, was on ad hoc basis and no reorder level was established to curtail shortages. Full autonomy was given to the hospital in procurement, yet the staff had little or no training in the procurement guidelines and policies of the MoH. Unavailability of Revenue Collectors at strategic points to collect TNDC funds could account partly for the low recovery level. In conclusion, even though planning/budgeting, financing, and procurement functions in relation to the supply of TNDC were transferred to Effiduase District Hospital from the centre, resources to undertake these functions were not adequately provided
Description: A Thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi, in partial fulfilment of the requirements for the Degree of Master of Science in Health Services Planning and Management, 2000
URI: http://hdl.handle.net/123456789/2623
Appears in Collections:College of Health Sciences

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