Health services planning and management under a Decentralised Administration: case study of Tamale Metropolis

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Centralized planning in many African countries and particularly in Ghana was seen as being responsible for the under-development of these countries. People who were the beneficiaries of the programmes and projects were not involved in the decision- making, planning and management of the development processes. In 1982, the Provisional National Defence Council (PNDC) government initiated the democratization and devolution of power as well as the re-organization of the structures and roles of the bureaucracy. A decentralized planning system that integrates social, economic, political as well as spatial factors with bottom-up structures were put in place in order to address the problems of planning inherent in the centralized system. This was supported by the necessary legal provisions. Based on this all sector departments were also to restructure and decentralize their planning machinery. The Ministry of Health’s (MOH) initiative to decentralize and strengthen health service delivery have not resulted in improvements, particularly in the areas of integration of health services planning and inter-sectoral collaboration and coordination. This study therefore assessed the capacity of the Tamale Metropolitan Assembly (TAMA) to plan and produce plans that satisfy the health needs of the people and whether in doing so the people who are the direct beneficiaries are involved and participate in the planning and management processes. The assessment focused on the variable concepts of decentralized administration, planning and decision-making, involvement and participation and inter-sectoral collaboration. Apart from obtaining information on the variables through the administration of questionnaires and discussions, interviews were held with community opinion leaders and all stakeholders in the Metropolis. Findings and conclusions drawn from the study indicated among others, that decentralization and decentralized planning has not taken firm roots in the Metropolis due to the absence of the lower structures to support the planning process. Involvement and participation at both the Assembly level and the sectoral level is weak. A significant recommendation (based on the findings of the study) is that Tamale Metropolitan Assembly should take the necessary steps to put in place the necessary structures that promote participatory planning at the Metropolitan as well as at the Metropolitan Health Management Team (MHMT) level.
A thesis submitted to the College of Health Sciences in partial fulfilment of the requirements for the degree of Master of Science in Health Services Planning and Management, 2004