Mechanisms for financial management and sustainability: the case of St. Joseph’s Hospital Koforidua

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The policy context of health care has undergone rapid changes during the last few decades. Governments are now seeing their resources base for the health provision dwindle, and in many countries churches are seeing their health care efforts being shifted back to the private sphere. Thus health care is no longer seen as a public responsibility but rather considered a commodity in the market place. CHAG institutions which work in partnership with government are also seeing their resource base dwindle which may in the long run affect efficient provision of services. The principal objective of the study was to assess the mechanisms for financial management and sustainability at the St. Joseph’s Hospital. Proportions of income from the different sources (IGF, GOG, Donations) were computed to establish the importance of each component. Financial management practices involving their mode of disbursement, monthly income and expenditure patterns, cost recovery rates and documents covering these transactions were assessed. Important to all these are the mechanisms in place to ensure continuous provision of health services. Hospital’s history, the quantity and quality of staff, cash collection and control measures in place were studied. The case study employed qualitative and quantitative methods. The sampling was purposive and the technique for data collection included, review of records, interviews involving key informants and individuals. An observation was carried out at the two revenue collection points and the accounts office. Results obtained indicated that donor support is indeed dwindling, from 41% in 1999 to 33% in 2000. However, generation of IGF seems to make up for the reduction. There are controls on financial management transactions. Moreover, the staffs have requisite skills but they do not have enough staff to keep all the necessary books of accounting. Although the hospital seems to be doing well in its IGF generation to cover up for reduction in donor support, increment is not possible all the time. Consequently, it is recommended that other forms of sourcing for funds is necessary to ensure continuous provision of efficient services to those who need them.
A thesis submitted to the Department of Community Health, School of Medical Sciences, College of Health Sciences Kwame Nkrumah University of Science and Technology in partial fulfilment of the requirements for the award of in Health Services Planning and Management, 2002