Decentralization in the Health Care Delivery in Ghana. ‘A Case Study of Komfo Anokye Teaching Hospital-Kumasi’.

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Since the 1980’s both developing and developed countries have been embarking on public sector management reforms. One such Reform was decentralization. The level of implementation of Health Care Decentralization in an institution depends on a number of indicators such as; the right of Directorates to generate their own income, the authority of Directorates to allocate resources, the authority to set targets and see to achieving them, the number and type of decisions taken by the Directorates, the degree of independence of Directorate from the CEO as self managed Directorates, the number of hierarchical levels in the organogram, the degree of delegations etc. Komfo Anokye Teaching Hospital(KATH) implemented decentralization of Health Care Delivery in the form of directorates system along the pattern of age, sex, diseases etc. five (5) years ago. There has not being much research to establish the existence of these indicators above and the level of the implementation of decentralization of health care is still unknown. The general objective of the research was to identify how decentralization in the Health Care Delivery is implemented at KATH in relation to Human resource, Finance and Service Organization. It was a descriptive cross-sectional study with purposive sampling size of 60 subjects. SPSS were used to analyze the raw data collected. The major outcome of the research was that about 55% of respondents appreciate the level of Health Care Decentralization at KATH. The major benefit of Decentralization of Health care Delivery at KATH was quick decision making (88.3%) whiles the major limitation was the GH¢ 25 spending limit of Directorates. In nutshell, for the fact that there is decentralization does not mean Directorates activities should not be subjected to approval by hospital top management. At least there should be some degree of accountability of the Directorates to the top Management of KATH.
A Dissertation Submitted to the School of Graduate Studies Kwame Nkrumah University of Science and Technology, in partial fulfillment for the award of the Degree of Master of Science Health Services Planning and Management, 2008