The First National Conference on Health Leadership,

Management and Governance

The Devolution Experience in Ghana Dr. Elias Kavinah Sory

Former Director General, Ghana Health Service

29 January 2013

Presentation Outline

• Ghana Profile• Decentralization in Ghana• De-concentration in the Health Sector• Leadership Development in the Health Sector• Challenges• Effective Approaches• Obstacles• Lessons Learned• Recommendations

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Map of Ghana in relation to Africa

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•Area;238,533 sq km•Pop 24,791,073•10 administrative regions•275 Districts•Political System: multi party democracy•Communication: Line and cell phones, broadcast media, internet

Ghana Profile

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Decentralisation in Ghana

• Provided for under the 1992• Local Government Act, 1993, act 462• Ghana Health Service and Teaching

Hospitals 1996, Act 525• Local Government Act, 2003 At 656

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Decentralization in the Health Sector

• National• Regional• District• Subdistrict• CHPS

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Leadership Development in the Health Sector

• Strengthening District Health Systems (SDHS)• District Directors Group formation• Strategic Leadership and Management

Course for Senior Staff, Ghana Institute for Management and Public Administration (GIMPA)

• Knowledge Management for Leaders Training for Senior Staff, GIMPA

• Health Administration and Management Course for Senior Staff, GIMPA

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Leadership Development in the Health Sector (continued)

• District Health Systems Operation (DISHOP), Kintampo Rural Training School

• Leadership Development Programme (LDP), Ghana Health Service

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Challenges

• Direct Medical and Public Health Interventions may be regarded more important than LDP as it might be seen as having a support function.

• Frequent change of Ministers at MOH draws back the smooth implementation of programmes

• Perceived threat of losing turf generates resistance at higher level.

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Challenges (continued)

• Inadequate funding and donor fatigue threatens sustainability

• Certain political decisions directly affect the smooth implementation of the Programme.

• In the case of frequent creation of new districts, there was the challenge of recruiting and training new ones when numbers were already inadequate.

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Effective Approaches

• LDP placed in the Human Resource Development Division as part of GHS Structure.

• Decentralize training to the regional and district levels

• Public/Private Partnership of Facilitators and Sponsors.

• Health Partners support (Focus, Unicef, USAID, Global Fund etc.)

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Effective Approaches (continued)

• GHS as lead Implementing Agency of LDP in MOH.

• All levels of the Health Sector (National, Regional , District ,SubDistrict are involved)

• Clinical and Public Health Mix in LDP Training

• Get Commitment of Director HRDD, D-G & his Deputy, Chief Director MOH, National Coordinator, GHS & External Facilitators.

• Plan Workshops in consultation with local Managers, Facilitators and Sponsors.

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Obstacles

• Budget unavailability/ inadequacies from GHS for LDP activities

• Involvement but not Commitment of some GHS Divisional Heads

• Inadequate involvement of other Agencies of the MOH in LDP

• Inadequate involvement of other Stakeholders at the District Levels e.g. DISTRICT ASSEMBLIES, in LDP,

• Inadequate Manpower

• Module for Training13

Lessons Learned

• Health Partners alone cannot be depended upon to fund vital programmes. Government Contribution is essential

• Commitment by all (Ministry and its agencies and Health Partners) is essential for successful implementation of programmes.

• Teams for training should have mix of professionals to enhance team concept.

• Workshops should be held as near to points of implementation as possible to be effective

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Lessons Learned (continued)

• Changes that have occurred after teams have gone through have been phenomenal. Problems became challenges. More was done without additional funding.

• Strong M&E is needed. Should be a key department of one of the Divisions.

• Support by the Directors of the Ministry of Health and its Agencies assures acceptability

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Recommendations

• Be confident and positive that with LDP, decentralization will become easier

• There are always many competing programmes such as clinical care and public health interventions that take most of the budget. But investing in LDP will give greater returns in decentralization.

• Budget for LDP at all Levels should be assured. The MOH should reflect LDP PRIORITY on their Agenda into BUDGETARY ALLOCATION

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Recommendations (continued)

• Orientation of New Staff, particularly Directors, Heads of Units, Departments, and Institutions should include Leadership and Management

• The programme should involve all stakeholders including health partners and other departments to assure acceptability and sustainability

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Thank you.