The role of the district health management team in co-ordinating primary health care for district development (case study of Keta district)

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For the Primary Health Care system currently being pursued in Ghana to be a success, the need for effective co-ordination between all health related departments is inevitable. This is one of the main reasons why District Health Management Teams of the Ministry of Health were established as a fulcrum to facilitate this process. Often, the inability of the health sector to effectively deliver primary health care services has been blamed on inadequate funds. However, it must also be acknowledged that the lack of co-ordination of activities between health related departments limits the effectiveness of the PHC. The study sets out to find the type and degree of effectiveness of co-ordination mechanisms employed by the DHMT in Keta District and the problems militating against effective co-ordination of PHC activities. The study further examines the effects of weak co-ordination which later serve as the basis for making recommendations on how to strengthen and sustain a high level of co-ordination among all departments whose activities contribute to the delivery of PHC in the district. Eight departments were chosen and studied through interviews and focus group discussions. Major findings of the study include limited planning skill of the DHMT, lack of time and personnel to effectively co-ordinate PHC activities. Coupled with these, is the difference in perception and understanding of co-ordination by different health related departments. Finally, even though the departments contribute immensely towards PHC delivery, they are not members of the DHMT and hence are excluded from planning PHC programmes in an integrated way. This situation relicts the duplication of projects and functions as well as waste of resources (time, skill, money etc.) in the implementation of PHC projects. One major key issue is the need to create a forum for regular discussions by all departments on the need for co-ordination as a basis for effective PHC delivery. To improve co-ordination of PHC activities, some of the recommendations made include: Upgrading the planning skill of the DNMT to stand the prescribed functions of coordination, introduction of composite budgeting of all PHC activities and the organisation of seminars every six months to discuss the meaning of collaboration, cooperation and co-ordination, expansion of the membership of the DHMT to include representative of other health related departments. This can only be facilitated by a renewed commitment on the part of all actors and especially the DHMT to recognise and give priority to PHC as a basis for improvement in health delivery, and the translation of this into a bye-law by the Assembly to help the DHMT to effectively co-ordinate PHC activities.
A thesis submitted to the Board of Postgraduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi, in partial fulfilment of the requirement for the award of the Degree of Master of Science in Development Planning and Management, 1996