Assessing The Performance Of An Executive Agency In Ghana: The Case Of The Korle Bu Teaching Hospital, 2008-2018

ABSTRACT

The weaknesses of the public sector in the delivery of effective and efficient services in developing countries is a policy problem that is well documented in the literature. The public sector is noted for being unresponsive to customer needs and also fraught with corruption and rigid regulations. Consequently, the new public management ideas including the executive agency concept were proposed as an antidote to the problems associated with quality in public service provision.

Against this backdrop, this thesis examines the Korle Bu Teaching Hospital (KBTH) as a semi-autonomous public health organization and executive agency. Although the executive agency concept is a model that has been applied in several public sector organizations, the health sector is one area whose impact has not been examined in detail. This study approaches the KBTH as an executive agency and examines its impact in the delivery of health service.

The study employed the qualitative design methodology of interviews and focus group discussions. The sampling technique used included the purposive sampling and the snowballing technique. The respondents for the study included former Board chairpersons and Board members, formers directors of the hospital, current directors and unit heads. Others included senior members of the College of Health Sciences, clients and patients of KBTH who constituted the focus group sessions.

The study found that the KBTH was structurally segregated from the mainstream civil service and the Ministry of Health. The KBTH therefore had a flexible management Board and the management team to determine operational matters such as budget, recruitment of personnel and development, administrative and management autonomy in its day-day activities. However, institutional, legal and regulatory weaknesses have undermined the capability of the hospital to

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fulfil in fullest its mandate as a health sector executive agency. Some of the recommendations to deal with the weaknesses include the enactment of the legislative instrument to operationalize the Ghana Health Service and Teaching Hospitals Act 525, 1996 and devolution of the sub-budget management centres such as the Department of Child Health, Department of Obstetrics and Gynaecology, Department of Surgery and the Department of Medicine and Therapeutics as separate hospitals to improve management and operational efficiency, control and quality of care in the KBTH. Also, the use of improved technological infrastructure is crucial to enhance effective and efficient healthcare.