Abstract
Background: The implications of decentralisation on human resource for health management has not received adequate
research attention despite the presupposition that the concept of decentralisation leads to the transfer of management
authority and discretion for human resource management from national levels to subnational levels. This study aims at
investigating the extent to which decentralisation practice transfers management autonomy and discretion to subnational
units, and the effect of the level of decision space on human resource management in the health sector.
Methods: A mixed methods study design was adopted employing a cross-sectional survey and a document analysis.
The respondents included health managers from the regional, district and hospital administrations as well as facility
managers from the community-based health planning and services zones. A decision space framework was employed to
measure management autonomy and discretion at various management levels of the study region. For the quantitative
data, descriptive statistical analysis was used to analyse and report the data whilst the qualitative data was contentanalysed.
Results: The study reported that in practice, management authority for core human resource functions such as
recruitment, remuneration, personnel training and development are centralised rather than transferred to the subnational
units. It further reveals that authority diminishes along the management continuum from the national to the community
level. Decentralisation was however found to have led to greater autonomy in technical supervision and performance
appraisal. The study also reported the existence of discrepancy between the wide decision space for performance
assessment through technical supervision and performance appraisal exercised by managers at the subnational level and
a rather limited discretion for providing incentives or rewards to staff.
Conclusion: The practice of decentralisation in the Ghanaian health sector is more apparent than real. The limited
autonomy and discretion in the management of human resource at the subnational units have potential adverse
implications on effective recruitment, retention, development and distribution of health personnel. Therefore, further
decision space is required at the subnational level to enhance effective and efficient management of human resource to
attain the health sector objectives.???