The path dependence of district manager decision-space in Ghana

Health Policy and Planning
Aku KwamieIrene Akua Agyepong

Abstract

The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive literature review of democratic governance in Ghana, and key informant interviews with high-level health system officials integral to the development of the district health system. Through our analysis we identified four periods of district health system progression: (1) development of the district health system (1970-85); (2) Strengthening District Health Systems Initiative (1986-93); (3) health sector reform planning and creation of the Ghana Health Service (1994-96) and (4) health sector reform implementation (1997-2007). It was observed that district manager decision-space steadily widened during periods (1) and (2), due to increases in managerial profile, and concerted efforts at managerial capacity strengthening. Periods (3) and (4) saw initial augmentation of district health system financing, further widening managerial decision-sp...Continue Reading

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Citations

Nov 18, 2017·Health Policy and Planning·Alvaro Alonso-GarbayoTim Martineau
Jul 28, 2018·The International Journal of Health Planning and Management·Ramadhani Kigume, Stephen Maluka
Nov 5, 2019·BMJ Global Health·Prosper TumusiimeJuliet Nabyonga-Orem
Aug 16, 2017·International Journal of Health Policy and Management·Tamlyn Eslie RomanDiane McIntyre
Jul 4, 2019·Ciência & saúde coletiva·Leila Bernarda Donato GöttemsRoberto José Bittencourt
Aug 1, 2020·Frontiers in Public Health·Anne Christine Stender HeerdegenKaspar Wyss

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