Institutional constraints and capacity issues in decentralizing management in public services: the case of health in Ghana

Abstract

Public health organization in Ghana has been a focus of reform in recent years. This paper examines the application of decentralized management as part of these reforms. It conceptualizes decentralized management as a component of the new public management. It assesses progress made in implementation, highlighting the institutional constraints encountered. The capacity issues raised by management decentralization, especially the trend towards autonomous hospitals and executive agencies, are outlined. The main lessons drawn are that reforms need to be sensitive to operational context and capacity and implementation needs to be planned and managed. © 1998 John Wiley & Sons, Ltd.