Decentralization and Governance in the Ghana Health Sector

Couttolenc, Bernard F.

Washington, DC: World Bank

关键词: DECENTRALIZATION;    DEVOLUTION;    GOVERNANCE;    HEALTH;    REGULATORY FRAMEWORK;   

DOI  :  10.1596/978-0-8213-9589-9
RP-ID  :  70274

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

In recent years, many countries, bothdeveloped and developing, have engaged in a process ofdecentralization of health service delivery and/or otherfunctions of the health system. In most cases,decentralization has been adopted to improve accountabilityto local population, efficiency in service provision, equityin access and resource distribution, or to increase resourcemobilization. Ghana has a long history of local government,going back to pre-independence times of the nineteenthcentury. By 1859 Municipal Councils were established in themajor coastal towns of the then Gold Coast. NativeAuthorities, Councils and Courts were also established toadminister law and order under the indirect authority of thecolonial government; the limitations of this system wasrepeatedly put forward in the 1930s and 1940s, and reformswere introduced in 1951 by the Local Government Ordinance(Ahwoi 2010). The government has embarked in adecentralization policy since independence, which wasstrengthened and amplified by the local government act of1993 and other legislations. At the present the Governmentof Ghana (GOG) is committed to strengthen the implementationof decentralization and for that purpose revise andstrengthen the policy and regulatory framework governingdecentralization. In spite of this long history andsuccessive waves of decentralization reforms, effectivedecentralization in the country still faces considerablechallenges, especially in large social sectors involvinglarge structures. The public health sector is one that hasnot fully embraced the decentralization model adopted by theGOG, decentralization by devolution to the districts, for anumber of reasons that will be discussed in this report.Some functions and responsibilities have been decentralized,but others remain centralized or simply deconcentrated.